By Bryson Wong and Jon Follett
with Juhan Sonin and Edwin Choi

The great promise of electronic health records (EHR) is one of improved care through increased communication and care coordination between providers and patients. Yet, despite the legislative push for meaningful use in 2009 and accompanying financial incentives, nearly a decade later, EHR solutions remain immature and not fully realized. The good news is that over 85% of hospitals have implemented an electronic medical record system. However, a number of factors—including extensive data entry, incomplete records, and a lack of standards for communication between systems—have limited the impact and in some cases made aspects of care, like patient doctor interaction, even worse. So, how can we get closer to that elusive promise of improved care, access, and digital service? For the Office of National Coordination for Health Information Technology (ONC), standardization is one of the top priorities: This focus highlights the critical, yet neglected role that standardization plays in healthcare.

Standardization of the health IT backbone involves a series of processes following a shared set of norms—from content definition to transport definition to algorithmic definition—which can lead to better patient outcomes, improved safety, better access, and reduced cost, by repeatedly using the best available knowledge. For example, the aviation industry offers a model showing how a culture focused on safety, supported by standard communication terminology and technology, and extensive use of checklists, can result in low accident rates, with 2017 the safest year to fly on record. According to the Aviation Safety Network, there were no commercial passenger jet deaths in 2017 and a total of 10 fatal airliner accidents—including cargo planes and commercial passenger turbo prop aircraft—with 44 fatalities onboard and 35 people on the ground. The fatal accident rate of commercial aviation is one per 16 million flights. Imagine if we had similar stats for engaging with the healthcare system.   

Medical errors are the third leading cause of death in the US, with over 250,000 deaths per year, according to a recent study by John Hopkins, and our own open source "Killer Truths" researchOf course, unlike machines, the complexity and variability of humans requires personalized care. Here then, are a series of steps to build beyond current efforts for standard data and incrementally move towards standardized care.



Standardized Data


The first step in achieving standardized care is to create a common language for clinicians, patients, and healthcare systems. Miscommunication and errors can result when different healthcare providers, or different medical records, collect similar types of data with wildly different syntax. 


Most health IT schemas—like ICD and SNOMED—are not free and open, but rather, licensed commercially. This adds a wrinkle to the push for standardization, as patients will have difficulty owning their data if the vocabulary of description is not open and co-owned. 

Standardized Measurements


Standardized measurements establish a repeatable and consistent way of evaluating the quality of collected data and measuring outcomes. For example, a standard measurement of readmission rates for cancer patients specifies the timeframe, age, and type of facility, which should be captured in the same way from every clinic, every time. The combination of standard measurements and data facilitates the exchange of information between all parties.


Standardized Algorithms


Standard algorithms build upon standard data and measurements by providing consistent results when given certain inputs in order to recognize patterns and make predictions. The benefit of this is that clinicians and patients are guided to follow up-to-date best-practices to make decisions and have consistent results from decision support tools and tests.

Importantly, when considering standardized algorithms, we need to be able to audit the mechanisms that drive care. These include creator biases, system biases, and unintended engineered biases. 


  • Clinical Decision Support Connect
    AHRQ CDS is tricky. For example, if a cholesterol treatment CDS cites three separate studies from three separate universities, how do you distribute ownership? That IP issue needs to be sorted out and codified.

Standardized Services


Standardized services integrate a family of algorithms with clinical practice guidelines to drive care. For example, a lab test involves multiple steps, starting from chief complaint to evaluation to administration of the test, and followed by multiple types of analysis, and consultation about the results. Standardized services include not only guidelines for interpretation but also for clinical and patient experience.


Integrated Experience


The aggregate of a patient’s health record encompasses multiple encounters with multiple care teams. Orchestrating insights from a longitudinal health record requires coordination by a digital service driven by standardized management algorithms. This digital health care service or health data manager will actively manage health data and care in a timely, accurate, repeatable, and patient friendly manner.

The healthcare system is only at the beginning stages of undertaking standardization. Healthcare actively resists standardization because existing systems are too often tribalistic in nature. Doctors, understandably, want to use what they've invented and experienced versus what others have statistically proven. This is a very human trait. But healthcare can not afford locally grown, finger in the air outcome management. We need statistically proven, repeatable care modeling, so we can get closer to 99% diagnosis rates. This will require standardization, and doctors and machines working together. 

Interested in digital healthcare strategy and user experience design?Drop us a line at info [at] goinvo [dot]  com. Or use our contact form.  

This week on The Digital Life, our special guest is Christopher Janney, a pioneer in the field of sound art, merging architecture, sound, light, and interactive technology. For over 30 years, Janney has been blending music and light with the physical space in unexpected ways, including public art installations like Soundstair, which can be viewed at the Boston Museum of Science, and the playful Rainbow Cove at Logan Airport. Janney famously worked with Mikhail Baryshnikov on "Heartbeat:mb", which used a medical sensor to monitor Baryshnikov's heartbeat to provide the rhythmic music to his dancing. Janney is bringing his show, “Exploring the Hidden Music”, to the Boston University Dance Theater on Friday, June 8th at 8 pm. Join us as we discuss art at the intersection of music, architecture, and technology.


Subscribe to The Digital Life on iTunes and never miss an episode.

This week on The Digital Life, for our 250th episode, we discuss designing a creative culture with guest Juhan Sonin, director of our studio, GoInvo.
Many companies try to create a design-centered culture in order to drive innovation but fall flat. We talk about some of our studio tenets and approaches that have worked. In particular we dig into the concept of transparency: seeking to tell the truth to others, both within an without an organization, with the intention of doing the most possible good. We also explore the concept of continuous learning, as we are curious, open creators, who welcome new ideas and the input of others. Join us as we discuss!


Subscribe to The Digital Life on iTunes and never miss an episode.

This week on The Digital Life, we chat about net neutrality, the digital divide, and fast, cheap Internet for all with guest Brough Turner, Founder of netBlazr.
What is net neutrality and why is it important? And why should it matter to the average consumer? Often, access to the Internet is controlled by only a few providers in a given geographic area. Given this near monopoly in many regions of the country, the idea of net neutrality, or the idea that ISPs should enable access to all content regardless of source, without showing favor to or blocking particular sites, is rooted in an egalitarian view of online information and service distribution. Join us as we discuss.

The Digital Life 248 - Net Neutrality

Subscribe to The Digital Life on iTunes and never miss an episode.

This week on The Digital Life, we chat about design and creative professionals and what the future of work might look like for them. Our special guest on the show is Daniel Harvey, Head of Product Design and Brand at The Dots, a professional network for “no collar'” professionals.
Alongside with the immense power and flexibility that technology can bring, comes an evolution in, not only how we get creative work done, but also why we do it. Values and behaviors are changing among job seekers in creative industries. We see some of this, for example, in the growing emphasis on project work, rather than on continuous employment. Further, with such powerful emerging technologies as AI, will it be possible, eventually, to automate creativity? And if this is the case, will people be able to accept that technology driven output as creative? How will designers and other creative professionals survive and thrive in this environment? It's critical that we design roles and organizations that make the most of people, while leveraging technology. And, that we properly educate the next generation of designers so they can thrive and compete in the future. Join us as we discuss.
The Dots


Subscribe to The Digital Life on iTunes and never miss an episode.

This week on The Digital Life, we chat about international law and cyber war. According to a World Economic Forum article, over 30 governments have acknowledged that they have offensive cyber capabilities including: espionage and spying; sabotage including denial-of-service attacks and attacks on the power grid; and, perhaps the most talked about recently, propaganda. The difficulties of developing policy to regulate and respond to emerging technology like these cyber war capabilities highlights the problems of working within interlocking, complex systems of governmental and political process, meant for a previous era, that are now subject to rapid changes. And managing policy within the areas of fast moving emerging technologies—from software to genomics to robotics—will only get more difficult. What is the right way, or is there even a right way for governments and societies to respond to this need for laws and regs? Join us as we discuss.

Why we urgently need a Digital Geneva Convention


Subscribe to The Digital Life on iTunes and never miss an episode.

Just Google “messy desk.”

Forbes, Business Insider, The New York Times, and any number of blogs will assure you that out of desktop chaos can come the very best of innovation. University studies have even been devoted to the topic of the cluttered workspace and its benefits to creative thought.

I generally have a messy desk both at work and at home. I don’t like clutter, but since I’m a working parent I claim higher priorities than tidiness. Recently I looked more closely at the “empty desk, empty mind” topic and was struck by these comments from designer Eric Karjaluoto of smashLAB:

A number of myths around creativity are simply hardwired into our culture. In no particular order: The belief that designers are sensitive prima donnas whose needs must be catered to; The idea that “eureka” moments come only after great toil; The belief that you need to create a mess in order to pull out a gem; The perception that ideas occur as a result of random, chaotic action, and are only impeded by rational, clear-headed examination and planning.

The problem with all of this is that a great deal of it isn’t accurate—particularly when it comes to design. Most designers I know are normal, sensible folks who like to solve problems. I think a lot of us start to find that our insights don’t come from within, but rather are the result of truly understanding a problem. Many appear to gravitate towards increasingly methodical ways of working, and documenting, their processes. And, with time, even their experiments become less random.

GoInvo designers, like most, approach this question in a variety of ways. 


Clutter is a distraction for me so I keep my desk pretty sparse. Only the bare essentials are within arms reach. It helps me focus. And any mess I do make is usually a series of sketches attempting to untangle some complex system I’m thinking about. — Eric Benoit


I like to think that a cluttered desk isn't necessarily a bad thing, but I don't believe that it's a requirement for creativity. Design is messy but it's drawn out of order just as much as out of mess and clutter, and in either case vision often needs to be tamed by order and practicality for successful design. Not just designers, but anyone will naturally organize their workspace to match their process and way of thinking. I really resent the idea that designers are sensitive and delicate creatures. Designers are made of harder stuff and can and need to take criticism, especially since critique is such a big part of the design process. We can be wrong. A lot of the time. Design takes research and experimentation and finding all the wrong answers before we arrive at the right answer. — Jen Patel


I have been writing my own music since I was eleven. I have found that there is no exact formula for me. Most musicians I've worked with are disheveled and messy, but that doesn’t necessarily make them a great song writer. On the other hand, you sometimes hear of amazingly talented artists are are neat freaks, perfectionists, and so on. Many great minds/artists have had routines—I believe I remember reading that Beethoven dumped a pot of water over himself every morning. I think it honestly just depends on the person. Music comes to me when I am absent minded or doing mundane tasks. A theme will be running in my head, sometimes for quite some time before I even realize it. This also happens when I am falling asleep. I also hear music in my dreams, and sometimes I will be able to remember it when I wake up and record the idea. The music comes when my brain is not actively seeking it, but instead when it is relaxed or on "auto-pilot" (which could be argued is a form of meditation). Even after writing music for 15 years, I cannot pick when I will write something good, or something I like. It happens when it happens, according to my emotions, my surroundings, and so on. I might argue that toiling away at something hour after hour, creating a “mess,” only produces a “gem” because your brain becomes so fatigued that the subconscious is allowed entry, to guide your pen or fingers. — Craig McGinley


Note the sketchbook, Copic markers, drawing space, and resin at the ready. Always. — Sarah Kaiser


Note the lack of a chair. There’s a treadmill, instead. Clear desk, tools at hand, surrounding prints in disarry, and movement. — Juhan Sonin


Koko seems to have a number of well-organized design projects ongoing. Good dog, Koko. — Koko Sleeper


This week on The Digital Life, we chat about all the new technology fun as CES 2018, the de facto emerging tech showcase, gets going in Las Vegas.

The smart home battleground is heating up as AI virtual assistants, like Google and Amazon Alexa, are being built into everyday household items and appliances. For instance, the bathroom is fast becoming a smartroom with Alexa incorporated into products like Kohler's new mirror, which can personalize light levels for different tasks, and Moen's digital shower technology, that enables users to set a specific water temperature. Connecting the digital to the physical is a big theme for CES this year, as AI is rolled out for a bevy of products and services. Join us as we discuss all this and more.


Subscribe to The Digital Life on iTunes and never miss an episode.

On this episode of The Digital Life, we chat about science, emerging technology and whiskey with Sammy Karachi from Relativity Whiskey.

American craft whiskey is having a big moment and, more and more, innovation in science and technology is changing how whiskey is being made. In particular, Relativity Whiskey, uses a special, data-driven, maturation technology to age the spirit more quickly, saving years of time in the process. How will software and algorithms shape the whiskey creation process in the future? Join us as we discuss.


Subscribe to The Digital Life on iTunes and never miss an episode.

On this episode of The Digital Life, we wrap up the year with some emerging tech predictions for 2018. We discuss the expansion of AI services in significant ways, automated trucks on the road, Target's online struggles, Amazon's difficulties in exploiting niche businesses, and the streaming services war as Disney prepares to take on Netflix among other topics.


Subscribe to The Digital Life on iTunes and never miss an episode.

Click here for more blog posts!