A recent study by Mayo Clinic and the American Medical Association delivered a scathing “F” rating on the usability of electronic health record systems (EHR), blaming them for an epidemic of burnout that has taken a toll on nearly half of physicians across the country. Frustration with EHR system usability is not new. Exactly a year ago, in a piece entitled “Why doctors hate their computers,” physician and author Atul Gawande essentially made the same case, indicting EHR systems for poor design.
Paradoxically, an entire industry designed around meeting people’s healthcare needs is now the victim of poorly designed systems that get in the way of meeting those objectives. For their part, healthcare consumers are demanding more from the broken experience of a typical healthcare encounter. In response to the changing marketplace dynamics, healthcare is beginning to embrace a new discipline in developing software-driven healthcare experiences – namely, human-centered design.
I have written about digital front doors previously here. While non-traditional players such as Walgreens are trying to win new consumers through superior mobile apps, traditional health systems such as Providence Health are applying proven models in e-Commerce businesses to convert patients from offline to online relationships with advanced tools such as chatbots.
Design has become the focus of patient experience and patient engagement. Anthony Pannozzo of Frog Design, a firm that has been around for fifty years, says “Let’s start with acknowledging that when we say healthcare consumer, we don’t think of just the provider and the patient, but all of the people that are part of the health care relationship. So it’s the health care provider; it’s the front office staff; It’s the patient; It’s the patient’s family members.” Changing the lens through which we see patients and caregivers is the starting point for human-centered design, a way of thinking about software-driven experiences that address both the emotional and functional needs of all stakeholders in health care.
Healthcare enterprises are now recognizing that designing intuitive, engaging and seamless digital experiences is critical to not only engaging patients better in their health care, but also for improving convenience, not to mention dealing with the emerging competitive landscape. Unfortunately, healthcare as a sector has only lately been catching up to the importance of design in digital health experiences. The digital transformation of healthcare has now imposed a dual mandate on healthcare providers – how to not just improve the experience for consumers, but also for caregivers and other stakeholders in the healthcare experience.
What exactly is human-centered design, and why should anyone care?
Design is the primary tool for competitive advantage that’s being leveraged by the startup world. Think of all the giants of the tech world today that dominate our day to day life – Apple, Uber, Facebook, Google, Instagram – and the common thread that defines their success is design. In the context of healthcare, the major EHR vendors, whose most significant competitive advantage is the high switching costs for their customers, have given little or no importance to design, and not without reason. Firstly, the healthcare sector has never had to care about user experience design – be it for caregivers or patients. Secondly, the focus of the past decade has been almost exclusively on designing systems that would enable clinical transactions to be captured in EHR systems for claiming federal financial incentives.
Human-centered design stands this logic on its head; the first step of the process of designing and building any product or service now starts with the understanding of user needs that define the use cases, requirements and principles that drive all subsequent decisions from the architecture to the form factor, ergonomics and interface components, all seen through the lens of the people who are going to use it. Digital front doors are a recent and belated response to the dual mandate of improved experiences for caregivers and consumers.
So, design is about pretty interfaces – right?
A superior interface is only one part of the puzzle. Digital front doors, adequately wrapped around core EHR systems, can deliver significantly better user experiences, at least at the interface level. However, human-centered design in healthcare is a multi-disciplinary practice that includes agile software development, lean methodologies, data interoperability, privacy and security and a host of other factors. Combining design effectively with tech, organizations can increase engagement, improve outcomes and reduce costs – in other words, meet the triple aim of healthcare. A final piece in design is the integration of behavioral economics and choice architectures, such as penalties for bad behaviors or incentives for good behaviors, which seems to be the central theme of Weight Watchers , facebook’s preventive health tool, or even Google’s acquisition of Fitbit.
Startups and design firms looking to help health systems meet the emerging needs of human-centered design in their digital health tools often encounter resistance on a couple of fronts. Caregivers are mission-driven professionals who take great pride in a human-centered approach to their patients, which is what they have always done. Adapting their approach to care based on design thinking for digital health may cause dissonance, which could get in the way of reimagining the healthcare experience. Consumers, for their part, want to make informed decisions based on convenience, transparency and choice; however these goals don’t always square with the healthcare sector’s traditionally paternalistic approach (witness the industry’s resistance to the HHS’s proposed rules on price transparency, and also how emerging players like Walgreens are deliberately tapping into it by publishing prices on their healthcare app).
A new breed of healthcare providers – such as Livongo and Omada Health in diabetes management – is achieving success by designing care delivery models from first principles and working with their members to manage lifestyles and prevent healthcare events which in turn enable health insurers and employees to reduce costs of care. Design is, therefore, not just about simpler UI or experiences but also about recognizing that healthcare providers need to find ways to create a controlled ecosystem that can drive the desired outcomes. It goes to the heart of what healthcare is about today – a shift from sick care to prevention and wellness.
Human-centered design may be the secret sauce for competitiveness in healthcare’s digital future; however, it is unlikely to be at the expense of established and proven clinical care pathways. In that sense, it’s not a zero-sum game between patients, caregivers and emerging digital health companies. The challenge in front of healthcare is to not just to use human-centered design but to make it a win-win for everyone.