How design can drive down health care costs

In Tuesday's post, How design can save the health care delivery system, David Webster of the consulting firm IDEO talked about the growing role of design in health care. Here's the rest of our recent discussion, which focused on health IT, health costs and more IDEO-designed health care projects.

How can carefully designed health IT change how people interact with the health care delivery system?

We refer to that as 'connected health.' It's a really exciting, vibrant area at the moment. Everybody understands electronic medical records are coming and they will be extremely beneficial in terms of connecting dots that aren't connected at the moment. There's an awful lot of design that needs to happen to have them evolve from pretty clunky systems into things that are delightful to use.

There is amazing opportunity around the idea of telemedicine and real-time communication. You swallow the pill and it speaks to the smart band-aid, which speaks to your phone, which speaks to your EMR and your physician and your social network around a condition. There are all sorts of amazing permutations within that system. You don't have to figure out the whole system to create a meaningful experience. We did a project called Health Buddy a few years back. It's a counter-top device that lives in your home and can monitor your adherence to prescriptions and how you're feeling. On a real-time daily basis it can gather data about somebody's condition that can then be fed to the physician. That enables a different and more effective interaction between the doctor and patient. You can't go and visit the doctor everyday, but you can have a meaningful exchange of information.

Our work with the National Campaign to Prevent Teen and Unplanned Pregnancy is about another very desirable aspect of health, which is prevention. [We worked with them on a project related to] birth control for American women ages 18 to 29. [Many] pregnancies in that demographic are unplanned. We've been trying to figure out how to have a meaningful and ongoing relationship with women around the idea of contraception. Berating them occasionally about the potential downsides doesn't really work. We generated a website and videos about methods people use to defend behavior they know is risky. [There were] ongoing tweets and texts to generate news and keep the topic fresh. [It changed] the flavor of the conversation from very transactional -- 'Let me tell you what to do' -- to more of a relationship with fresh dialogue that maintains the idea of contraception in the minds of these women. They'll get an email from Bedsider on Friday afternoons. In an entertaining tone, it talks about the topic of sex this weekend and gently reminds them to reengage with this idea of contraception. It's much more subtle and less patronizing and more dynamic. That's the kind of thing real-time communication can afford you.

Let's get back to the delivery system. Talk about IDEO's project with the Mayo Clinic.

The interesting thing about the Mayo work is that we didn't do it alone. Most of the innovation that happened there came from people within Mayo. That's a pretty powerful thing. Design thinking and the design mindset and attitude and process isn't just the reserve of professional designers. It's easy for anyone to engage with. We've done quite a few projects about helping organizations figure out how they can become more innovative. In Mayo, for example, we worked with them to design what's called the SPARC Innovation Program in one of their clinics. It's a prototyping area. It's Mayo in their language describing the design process. You go out there in a human centered way and get at what matters to people. For me, the interesting thing about the work we did with Mayo was more about the ingraining of that process in culture into their organization so they compulsively innovate. It was as least as much about that as it was about the specific outcomes around user experience improvement.

How can design drive down health care costs?

Health care isn't optimized around value. It doesn't care about getting to patient outcomes as efficiently as possible. It's fragmented in a way that encourages a bunch of different entities to try to game the system for their own benefit. There's a huge opportunity to optimize value in the system around patient outcomes per dollar spent. I think design can provide a mechanism for pursuit of that goal.

At a more specific level, there are a lot of opportunities around new ideas to keep people out of primary care by having more of the health experience outside the institution. I mentioned telemedicine and home monitoring earlier. That's an opportunity that's already happening and will continue to happen with the aging population. There's a lot of interesting opportunity for providing a bridge in the home to the clinical experience. It could temporarily enable a home to function more like a hospital ward. It's to get [the patient] out of the hospital ward sooner and stop them from racking up incredible costs. There's a huge opportunity to jump in front of the really expensive moments when conditions have reached crisis point by having better data in advance of that. That's where connected health comes in.

There's also opportunity around supporting individuals in their navigation of their own health choices. It's not really possible to be passive about your own health anymore. Responsibly attending to your health is a life skill. There's opportunity around helping people do that. People are now aware of the exponentially increasing cost of the downside and are inclined to engage with their health. But it's not that easy. Doctors provide too little information and the Internet provides too much. There's opportunity for providing navigators to help people get their head around appropriate solutions. It's analogous to financial responsibility in many ways. It's about individual empowerment and trying to change the equilibrium of the system, so it's got value in terms of patient outcomes at the center.

What else would you like to add?

I'm massively optimistic. Most of what you hear in the media about health right now maps out an untenable crisis. I don't think that's the case at all. In fact, from a designer's perspective, we're at this amazing moment. Via technology, we've got this palate of tools to effect change in a meaningful way quickly. That's exciting. There's opportunity to make a difference relatively easily and very soon. Looking at designers who we hire out of school, they're more motivated to make a meaningful difference in the world than ever before. We've got this crisis situation, a toolkit to do something about it and we've got incredibly talented people who are passionate about making something happen. That's a great situation.

Image, top: Health Buddy / IDEO

Image, bottom: Mayo Clinic rendering / IDEO

This post was originally published on Smartplanet.com