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Six lessons that guided 2016

1. In the 99% of healthcare that happens outside the doctor’s office, care planning is vital to reaching health goals
A team effort, led by Beth Herlin, developed content for a three part series unearthing the history of Care Plans, delving into the current state of care planning, and what all this means for their future development. This past Fall, Beth traveled to the Stanford Medicine X to give a keynote on Care Plans, and the concepts that the team developed continue to saturate our in-house and client based design.
Care Plans: A 3-part series of the landscape, design and future of personalized healthcare

2. Understanding that our health is determined by so much outside of medical care increases our responsibility for our own health
On the 25th of October, Social Determinants of Health visualization by Edwin Choi went live at determinantsofhealth.org. The giant printed posters made their way into Boston Children’s Hospital (Innovation Center), IoraHealth in Chicago, and MITRE, to name a few. They are a striking reminder of how our health is connected to more components than we realize and addressing health problems requires a holistic approach.

3. Bringing fun into care planning can help a new habit stick and open up otherwise difficult health conversations
The new 60-card care planning decks were finalized and shipped. Decks were given to attendees at the Partners Connected Health Symposium and the Partnering For Cures Conference. Care card stickers made it into the iOS Messaging App Store. Since then, the open source cards have popped up in a variety of talks and articles (e.g. Claudia Williams’ talk at Stanford Medicine X). At Health Refactored in Boston, Sugar Kills connected us with Susannah Fox (current HHS.gov CTO) and Alex Drane (co-founder of Engage with Grace and Seduce Health).
Susannah Fox and Alex Drane at Health Refactored, Boston

4. Pursuing radical transparency means promoting open source
Radical transparency has always been a core principle at Invo and has influenced everything from open standard Electronic Health Record design, to a visual primer on the Zika virus, and even our work on visualizing city budgets. We advocated for open source in healthcare through interviews (e.g. Juhan Sonin in the book Developing Citizen Designers by Elizabeth Resnick) and keynotes (e.g. Juhan at NE HIMSS).
Understanding Zika, a visual guide to the virus

5. Growth and development at Invo means cultivating a strong team and working on impactful projects…
2016 brought new faces and backgrounds into the studio, including interns Lilly Fan, from the Rhode Island School of Design, and Kelsey Kittelsen, from Dartmouth. Hrothgar, an Oxford mathematician and world traveling coder, and Sharon Lee, a biomedical engineer and artist from the University of Virginia, joined the team.
Sharon Lee, Biomedical Engineer and Designer from UVA
Hrothgar, Mathematician and Designer from Oxford

We designed the genetic carrier testing experience for clinicians and patients with WuXi NextCODE, future visioning for Walgreens, health IT tools for Imprivata, Electronic Health Record workflow design with eMDs, big data analytics with Crimson Hexagon, design strategy for clinical trial matching based on genomics for Cure Forward.

6. … but it also means learning how to brew hard cider and making new friends
Taking time to try something new refreshes and primes our minds for the work we care so much about. This past year, we partnered with Collective Next to pilot their Graphic Facilitation workshop, and Grove to learn about planting, growing, and farming vegetables in the kitchen. Internally, we held our own tech-talks featuring typography, by Hrothgar, cider brewing, by Sarah Kaiser, and DNA sequencing, by Edwin Choi.
Craig McGinley explaining his graphic thought process

Next up for ’17... 

Evolving care and transition planning (one collaboration is with our studio neighbor, Danny van Leeuwen) and an added focus on precision medicine for all, giving individuals full access, full ownership, and full participation in their health. 

Laurel wreath and medal photo: http://jenchoosesjoy.com/

This week marked the 119th Boston Marathon, the world’s oldest annual marathon. Over a million people gathered in chilly rain to watch 30,000 runners compete, starting at 10:00 a.m. on Monday, April 20. While the winner, Ethiopia’s Lelisa Desisa finished at 2:09:17, the last brave competitor crossed the finish line at around 4:30 on Tuesday morning—a 20-hour run—truly a remarkable feat for Venezuelan Maickel Melamed who has muscular dystrophy. And it wasn’t his first marathon, either!

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While Invo-ites might be more inclined to a Netflix marathon, we do take an interest in the technologies involved. Some aren’t new, for instance runners have had barcodes on their bibs since 2006. Using handheld scanners, race organizers use the barcode to identify runners who need assistance, as well as to locate runners who may have gone off course or at the end of the race. The bar codes provide only basic ID information, not medical data.

With approximately 1 in 10 runners needing some medical help during the marathon, the Boston Athletic Association implements a huge operation involving over a thousand volunteers, 10 hospitals, 20 i-STAT® portable blood analysis systems, 28 medical tents, and hundreds of beds, IVs, and pounds of ice. In addition, staff are are trained to use defibrillators in case of a cardiac arrest, pulse oximiters to measure oxygen levels and identify heat stroke. 

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Boston Marathon medical infographic: Abbot Laboratories.

Marathon sponsor Abbot Laboratories provided the i-STAT handheld devices to enable the Boston Marathon medical staff to peform a variety of lab tests in just minutes, including cardiac markers, lactate, coagulation, blood gases, chemistries and electrolytes, and hematology. From a small blood sample, medics are provided with information to check heart function or monitor physical exertion and administer needed care onsite.

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The i-STAT handheld blood analyzer.

The i-STAT device uses specialized cartridges to provide an array of tests found in complex lab testing systems. The test cartridge contains a silicon chip equipped with chemically sensitive biosensors that are configured to perform specific tests. A medic applies a few drops of blood to the cartridge and then inserts it into the i-STAT. The cartridge performs a series of preset quality control diagnostics such as monitoring the quality of the sample and validating the reagent. The i-STAT tests include diagnostic indicators for disease state and clinical practice guidelines.

Access to blood analysis data is critical in treating two common marathon conditions: dehydration and hyponatremia. The first is familiar to most of us who have played sports on a hot summer day and neglected to drink enough water, ending up with a terrible headache or dizziness. The second is caused when a person drinks more water than the body can handle, essentially diluting their blood. This causes a drop in the level of salt in the blood which can have serious consequences if left unchecked. Since the symptoms of both these hydration condtions can look similar, blood work is the best way to determine the most safe and effective course of treatment.

This year, the heavy rain and cold temperatures also caused many runners to experience hypothermia, a condition where the body temperature drops dangerously low, despite the runner’s continuous exertion. For some, warm liquids and reflective blankets provided relief, but others were treated with a 3M™ Bair Hugger™ therapeutic system that circulates forced warm air around the person’s body.

Marathon runners are all about speed and are often reluctant to stop for medical attention. If a runner is injured or otherwise impaired, he or she wants fast diagnosis and treatment in order to get back into the race. With the help of effective technologies, medical staff are able to quickly identify someone who simply needs an electrolyte drink and a brief rest, while also saving the life of the runner on the edge of a heart attack. And while that runner might not make a personal best, he or she will get to try again next year.

Intrigued by the latest in digital health diagnostics? Check out  The Digital Life: The Frontiers of Digital Health Diagnostics

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As an interdisciplinary design team dedicated to creating the future of healthcare, we are proud to be a returning sponsor of the Health Experience Refactored conference taking place next week in Boston.

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Visit the Involution Studios booth April 1st and 2nd to meet authors, get books signed, and receive a special offer—only for HxR attendees. 

Wednesday, April 1

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“Designing for Emerging Technologies: UX for Genomics, Robotics and the Internet of Things” —Meet author and editor Jonathan Follett.

Thursday, April 2

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“Inspired EHRs: Designing for Clinicians”—Meet authors Dr. Jeff Belden, Jennifer Patel, and Juhan Sonin.

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We’ll also be giving away 250 copies of the gorgeously illustrated healthcare posters— “Healthcare is a Human Right” and “Food is Medicine” —based on our our nationally recognized Care Cards.

We hope to see you there!

Did you miss our two recent articles about healthcare design?

From Bathroom to Healthroom: How magical technology will revolutionize human health
Understanding Ebola: A Visual Guide

defining_patient_experience

This definition of patient experience comes from The Beryl Institute, a global community of practice and thought leader on improving the patient experience in healthcare.

In January, we offered a three-part series on the future of design for the patient experience, a topic on the minds of everyone involved in healthcare. Here, we revisit the themes of each article and invite you to read them—for the first time, or again—and consider the possilibities for emerging technologies and design.

Design for the Patient Experience

Patient experience is part of a larger ecosystem. If we desire better care, quality clinical experiences and good clinical outcomes for patients, we must contemplate designing for a complete patient experience—from process to system to built environment—that emphasizes usability, functionality, and even beauty.

The revolution in mHealth and sensor technology makes it possible to achieve greater patient engagement outside of the traditional confines of the doctor's office. The healthcare system must exploit technologies that make getting and using data more seamless with other tasks, like goal-setting, fitness-tracking, and calorie budgeting. In a similar fashion, increased transparency around cost enables better healthcare decision making.

Design for the Patient Experience: Health Axioms

Invo’s design philosophy for the patient experience is articulated in our Health Axioms, which speak to critical areas of patient engagement, adherence, and clinical design, and are meant to inspire and support a healthy lifestyle outside of the health system and doctor's office. When patients are involved in their own care, they manage conditions better and they need fewer visits to specialists and hospitals and fewer tests. Designers must strive to create simple, accessible ways for individuals to incrementally change behavior.

Design for the Patient Experience: Software in Action

New software applications address long-standing problems in American healthcare delivery from a patient perspective. These examples support building knowledge around personal health factors, pricing transparency, and clarification of the billing process.

PatientsLikeMe

A web application that enables members to share their data including condition, treatment, and symptom information, so that they can monitor their health over time and learn from each other.

hGraph

An open source software tool for visualizing a patient’s complete range of health metrics.

Change Healthcare

Platform comprising a suite of tools for educating patients around healthcare costs including prescriptions, medical procedures, and dental and vision services, with results that are based on an individual's plan, network, and location.

To learn more about Involution Studios in the healthcare world, visit our Healthcare pages.

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We are doing our best to not think about the upcoming blizzard. Heavy snow is pretty much old news around here, anyway.

If you, too, are holed up waiting for spring, here are a couple of fascinating reads to keep you occupied.

London Review of Books, Anti-Condescensionism: The fear of needles

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Susan Pedersen reviews Bodily Matters: The Anti-Vaccination Movement in England, 1853-1907 by Nadja Durbach. Wait till you find out how babies were vaccinated in the 1800s.

Medium: I’m Autistic, And Believe Me, It’s A Lot Better Than Measles

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This writer: Vaccines don’t cause autism. But even if they did, is being like me really a fate worse than death?

BBC News: Google Introduces Illness Tips

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Google announced an extension to its Knowledge Graph information tools. Will it be just another way for people to scare themselves before they see their doctors? After all, “One in 20 Google searches are for health-related information.” (Prem Ramaswami, Google Product Manager)

And from this week:

The Digital Life: Smart Cities and the IoT Dirk and Jon explore the long-term implications of designing Smart Cities, and the potential pitfalls of such wide-ranging projects, as the digital infrastructure of our urban environment grows.

Around the Studio: Getting Involved in Digital Arts Education When the Arlington Education Foundation(AEF) approached Involution Studios with an opportunity to help support digital arts in the high school, we were happy to step up.

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Self-care, care planning, and prevention are essential to staying healthy

so we always looking for the latest resources. Here are two that piqued our interest this week.

Self-care: Digital Therapeutics

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Omada Health offers a number of programs like Prevent, which provides online support  and health/careplan kits with the tools an individual needs to manage serious chronic health conditions such as heart disease and type II diabetes.

Health Month

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This little app promises to help you improve your health habits in a “fun and sustainable way” using social games. You can try it for free. If you do, let us know what you think.

Healthcare as an "alternate economic universe"

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Give yourself an hour and listen to this podcast: Hacking Affordable Care on Radio Open Source. Christopher Lydon talks with Steve Brill about how we got to where we are right now and who really benefits from the Affordable Care Act legislation. It’s worth your time.

New this week:

Don’t miss The Digital Life: The Super Bowl, Emerging Tech, and Health! Jon and Dirk explore the training, techniques, and technology for professional football and how the advances the NFL is making toward a complete view of health metrics and performance in real time is inspired by the quantified self movement. 

Wednesday brought the final article in our series looking at design for the patient experience, Software in Action, which looks at current software solutions including PatientsLikeMe®, Involution’s hGraph, and the Change Healthcare™ platform.

And on Monday we shared a unique look into the design process for a new Health Axioms card in How a Health Axiom Card is Made. Perhaps you will be inspired to share your own ideas!

This is the third in a series of three articles looking at the future of design for the patient experience. The first article was "Design for the Patient Experience", and the second was "Design for the Patient Experience: Health Axioms"

This week in our final article in this series, we'll examine some real world examples of software improving the patient experience. Each of these applications helps to address long-standing problems in American healthcare delivery from a patient perspective — in particular, lack of knowledge around personal health factors, pricing opacity, and billing confusion.

PatientsLikeMe
The PatientsLikeMe Web application contains a comprehensive registry of patients and their diseases, and is focused on recording and sharing real-world outcomes. PatientsLikeMe enables members to share their data — including condition, treatment, and symptom information — so that they can monitor their health over time and learn from each other. It compliments, but exists outside of the confines of the existing health system and doctor’s office, achieving a significant level of engagement with users and expanding the ecosystem of care. 

As users of PatientsLikeMe begin to more deeply understand the health issues associated with particular disease states, they can see recurring patterns and take action. Additionally, the data collected from the patient community can help clinical researchers to better understand a disease, ultimately leading to more effective treatments. The platform has about 200,000 users, covers more than 1,500 diseases, and has published more than 40 peer-reviewed research studies.

PatientsLikeMe UI

PatientsLikeMe enables users to share data and view the collective experiences of those who share their disease state.

hGraph
hGraph, an open source software tool for visualizing a patient’s complete range of health metrics, aggregates health data both on a personal and community level. It provides clinicians with at-a-glance analytics of a patient’s overall health, allowing doctors to spot patterns and red flags. hGraph works by comparing a person’s health data against targeted health ranges based on factors like age and gender. Metrics that appear red are either lower or higher than the “good health” range. The hScore is an overall, aggregated score of health (1-100) that represents a person’s health status, or grade. In this deceptively simple fashion hGraph enables the compilation and display of a considerable amount of information within a limited space.

Like PatientsLikeMe, hGraph encourages patient involvement in their own care, enabling them to better manage conditions and ultimately reduce visits to specialists and hospitals. hGraph is in use at corporate clinics for two Fortune 500 tech companies, and is being prototyped for use by a major retail pharmacy chain and next generation patient portals. 

hGraph Main Screen

hGraph shows all of a patient's health metrics in one picture.

Change Healthcare
The Change Healthcare platform is made up of a suite of tools for educating patients around healthcare costs — including prescriptions, medical procedures, and dental and vision services — with results that are based on an individual's plan, network, and location. As national healthcare costs have risen, so too have the costs that employers, workers, and even the retired and unemployed must bear. Co-pays, deductibles, and out-of-pocket expenses are up. Transparency in pricing enables better decision making, as patients can not be informed consumers if the costs of healthcare services remain hidden.

Change Healthcare’s cost lookup tool features pricing matched for the user's location, insurance plan design, and network; a view of total cost, member cost, and plan cost; and quality ratings sourced from public and private data. According to the company, the cost transparency software tool supplies the expected costs for more than 81% of medical services and more than 75% of prescriptions used by its client population.

The New Frontier of Patient Experience
If PatientsLikeMe, hGraph, and the Change Healthcare platform provide prime examples of how software is playing a huge role the patient experience of healthcare, it’s worth remembering that these services are, to varying degrees, still in their earliest stages. The current American healthcare system, with its structural roots dating back to the early 20th century, is unwieldy and burdened at best.

If we are to re-balance that system with an equal weight to the patient experience, it will take continued evolution of healthcare policy, mass adoption of these types of software systems, and practical, forward-looking steps like interoperability and standardization of EHR data. It remains unclear how the US will find a way forward in the debate over healthcare, but we should expect the patient experience to play a crucial role.

Designing for Healthcare
Have a healthcare design project you'd like help with? We'd love to hear from you.

Interested in further exploring the topic of design and healthcare? Have a look at some of our case studies, publications, and podcasts:

Case Studies
3M / Coderyte
Mount Sinai Hospital Icahn Institute
Partners HealthCare Gene Insight
Numera Health

Publications
Health Axioms
Inspired EHRs

Podcasts

Health_Station

Despite the blizzard, we delivered more than the US Postal Service this week!

We launched a new site feature, From Bathroom to Healthroom: How magical technology will revolutionize human health.

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Beautifully illustrated with interactive graphics, Juhan Sonin's well-researched exploration of the intersection of emerging technologies and individualized health presents fascinating possibilities.

“Suppose your data are simply and automatically collected—all of your numbers surrounding your existence from the financial ... to travel ... to habits to eating to exercise to examining your daily biome. It’s captured. It just happens, in the background. And your captured data are visible: you can see the data points, see the trends, and even see the data of your close friends and family so you can help them make decisions and make change."

Also from this week:

On Monday we had more to tell about the Arlington Visual Budget, which met with enthusiasm at the Massachusetts Municipal Association’s Annual Meeting in Boston last weekend.

Design for the Patient Experience: Health Axioms describes our design philosophy for the patient experience by examining several of the Health Axioms in context as part of a patient experience ecosystem.

Episode 87 of The Digital Life, Microsoft HoloLens and the UX of Augmented Reality examines the renewed promise of augmented reality and discusses the promise and potential perils of the Microsoft HoloLens.

This is the second in a series of three articles looking at the future of design for the patient experience. The first article was "Design for the Patient Experience." 

In the first part of this series, we discussed the myriad problems with the patient experience — from long wait times at the doctor's office, to confusion over billing for patients, to lack of knowledge of personal health factors.

The entire American healthcare system needs to evolve to better serve patients — shifting to non-invasive personal diagnostics, highly specialized clinicians that work closely with patients and their families, and self-monitoring, self-empowered patients. Design for such an experience requires an approach that takes into account not just the clinical environment, but also the larger health and wellness ecosystem that encompasses people's day-to-day lives.

At Involution Studios, our design philosophy for the patient experience — honed over a decade working with clients like Mount Sinai Hospital, Partners HealthCare, and Walgreens — is articulated, at least in part, in our Health Axioms, which have been featured on NPR, Patient Safety and Quality Healthcare (PSQH), and Health Populi. These axioms speak to critical areas of patient engagement, adherence, and clinical design, and are meant to inspire and support a healthy lifestyle outside of the health system and doctor's office.

Consider the full ecosystem
When designing for the patient experience, it's easy to get trapped into thinking that a solution set needs to exist within the confines of the existing health system. But the revolution in mHealth and sensor technology is making it possible to achieve greater patient engagement outside of the traditional confines of the doctor's office. For instance, a wearable device can help patients understand health issues, see patterns, and take action. Smartphone apps can track data, vital signs, and health habits, like sleep or nutrition.

In the future, technology will further expand our patient experience ecosystem. We'll use personal technologies even more to monitor micro changes in the body and fine tune medication, diet, exercise, and doctor's visits. Scientists will use patient-generated data for population studies on disease and treatment. Sensors, cameras, and a built-in touch screen will put health data at our fingertips — for example, heart rate or medication instructions — helping the sick get better and the well stay healthy.

The Doctor Is In Your Pocket

mHealth and wearables make up a powerful extended ecosystem for the patient experience.

Increase transparency
A patient's health habits and decisions are partially based on the information they receive. When doctors, hospitals, and labs give patients easy access to health data, they can act more knowledgeably. It's not enough to open the file cabinet; the healthcare system must exploit technologies that make getting and using  data more seamless with other tasks, like goal-setting, fitness-tracking, and calorie budgeting.

In a similar fashion, revealing costs also enables better decision making around healthcare. As national healthcare costs have risen, so have the costs that employers, workers, and even the retired and unemployed must bear. Co-pays, deductibles, and out-of-pocket expenses are up. Patients can not be informed consumers, if the costs of healthcare remain hidden. 

Give Me My Data

Transparency in both health metrics and cost leads to better decision making around health.

Encourage patient engagement
When patients are involved in their own care, they manage conditions better, and they need fewer visits to specialists and hospitals and fewer tests. For instance, patients who search online for health and medical information tend to trust their doctors and be better prepared for the visit. Whenever possible, designers should provide mechanisms encouraging patient engagement through education, reminders and alerts, and even gamification.

Let Patients Help

Patient engagement is critical to improving long-term outcomes.

Incremental steps are key to behavior change
Health behaviors are interconnected. A combination of small steps can lead to big changes like improved nutrition, greater activity, and more motivation. For instance, a small change in one area, like cutting down on TV time, can trigger changes in other areas, like diet.

When designing for behavior change, the optimal approach involves two small changes at a time, jump-started over a few weeks. If the patient can stick with them for six weeks, the amount of time needed to form a habit, they can add two more.

Take Baby Steps

Small steps build into healthy habits.

Next week we'll examine some real world software and technology examples of ways to improve the patient experience. Join us!

Designing for Healthcare
If you're interested in further exploration of this topic, you might want to check out:
Health Reform 2.0: Envisioning a Patient Centered System
Health, Technology, and Design

Health_Station

If you tuned in to POTUS giving his State of the Union address

you know that President Obama will continue to hold his ground on the Affordable Care Act. Even those who have been playing close attention to these issues can find it all very confusing, so this week we are offering a few resources to help keep you current.

Last Year Was a Wild One For Health Law—What’s New on the Docket For 2015?

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The Petrie-Flom Center at Harvard Law School Health Law Policy, Biotechnology, and Bioethics aims to provide unbiased analysis of pressing questions facing health policy makers. If you are in the Boston area, next Friday, January 30, you may want to check out the Third Annual Health Law Year in P/Review at Harvard Law School in Cambridge, MA. 

Shots: Tax Preparers Get Ready...

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While we’re on the topic of the ACA, one of its impacts is a small checkbox on your tax form with which you will report your health-insurance-coverage status for 2014. Simple—if you’ve been covered all year. If you don’t yet have coverage, read NPR’s Shots blog to find out what you might need to know.

Biomedical Informatics: What’s That Mean?

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Harvard Medical School is establishing a Department of Biomedical Informatics. Don’t know quite what to say? The American Medical Informatics Association (AMIA) defines biomedical informatics as “the interdisciplinary field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving, and decision making, motivated by efforts to improve human health.”

This week’s highlights

The Digital Life: Episode 86 follows our new blog series with Challenges in Designing for the Patient Experience.

Wednesday brought Design for the Patient Experience, the first of a three-part blog series. We'll examine the complex problem set contributing to patient experience, design approaches for improving it, and some real world examples from a software and technology perspective of attempts to improve it. 

Around the Studio: Getting Things Done gave a peek at how some of us keep track of all we have to do.

Click here for more blog posts!