The first ever Healthcare Experience Design Conference is currently underway in Boston, and thanks to some active conference participants those of us who can’t be there in person can still follow along from afar. Here are some resources for doing just that:

• #hxdconf hashtag on Twitter
• Thuc Huynh’s blog
• Matthew Grocki’s blog
• The conference’s CrowdVine page

From what I’ve seen so far through the resources mentioned above, it looks like the conference is off to a great start (above image is of @jasonrobb‘s sketchnotes of @bjfogg‘s opening keynote, as captured by @nhmackin).

Quick-Lube Shop Masters Electronic Record Keeping Six Years Before Medical Industry

KETTERING, OH–A comprehensive digital cataloging system that keeps track of its customers’ car maintenance history, oil-change needs, and past fuel-filter replacements puts Karl’s Lube & Go’s computerized record- keeping an estimated six years ahead of the medical industry’s, sources confirmed Friday…

Alas, it’s from The Onion.

I recently read the excellent Design Driven Innovation, Roberto Verganti’s fascinating take on how certain paradigm-shifting products and services are created. In it, he introduces the concept of “innovation in meaning,” which he contrasts throughout the book with “innovation in technology.” Here’s my high-level summary of the differences:

• Innovation in technology: new electronics, parts, components, etc. that are smaller, cheaper, and more effective at accomplishing existing tasks and which may allow for new things to be accomplished
• Innovation in meaning: new and different experiences that users have that redefine how, what, and why they do things

Innovations in meaning often result from inspirations drawn from situations where the context, if not the content, is similar to the area of concern. A great example that Verganti provides is of an Italian lamp manufacturer that worked with a renowned opera director to understand how light can influence human emotion and to in turn incorporate that understanding into the design of a new lamp.

Healthcare is filled with examples of innovation in technology but is relatively light on examples of innovation in meaning. Take diabetes management, for example. Technological innovations such as strips for testing blood sugar (first with urine and later with blood), single-use syringes, and portable glucose meters all made it easier for physicians to treat patients with diabetes. But these technological innovations alone were not enough to dramatically change the status quo in which diabetic patients were essentially at the mercy of the treatments given to them by their physicians.

That status quo was disrupted with the advent of diabetes self-management, something that was brought on by a radical innovation in meaning. In 1969, Richard K. Bernstein learned about a novel technology–the portable glucose meter. Bernstein, a diabetic and engineer at the time, became intrigued at the prospect of measuring and monitoring his own glucose. Leveraging his wife’s position as psychiatrist (sales of the monitors were restricted to medical personnel), Bernstein found a way around the status quo and obtained his own portable glucose monitor. Like any good engineer, Bernstein began frequently measuring his glucose levels and eventually became the first patient to self-adjust his diet and insulin dosage based on his blood glucose levels.

By applying the mentality of an engineer to the problem of diabetes, Richard Bernstein changed what it meant to be a patient living with diabetes. And while his innovation used a novel technology, the real breakthrough was in his taking ownership of his condition. Read more about Bernstein (who went on to become on influential physician) in this excellent article in the Journal of Participatory Medicine.

The healthcare industry–loaded with technology and filled with complexity and entrenched protocols–is ripe for the type of disruptive innovation in meaning exhibited by Richard Bernstein. Such innovation doesn’t require great technological breakthroughs–it simply requires a willingness to collaborate and to question the status quo. What does it really mean to be a patient, a healthcare practitioner, or a hospital administrator? What should “health insurance” actually cover? How should healthcare reimbursement work?

Of course, answering these questions and implementing the changes that the answers call for is often easier said than done.

This Fast Company article about the hot credit card-processing startup Square (their product is on the left side of the above image) got me thinking about health data, especially this snippet:

Rabois says Square was designed to be the “Google Analytics” of small- to medium-size businesses, and unlike traditional POS systems, the app’s simple dashboard design takes virtually no training to understand. All sales are tracked to the Nth degree, enabling merchants to easily compare, for example, their price of a cappuccino to a local competitor’s, to the neighborhood cafes’, or to the city’s coffee shops as a whole.

What if we could apply the same powerful simplicity to healthcare data? Providers could compare not only prices but also any other healthcare metrics that can be tracked. Patients could also compare prices and maybe even service ratings.

About an hour after reading that Fast Company article, I saw a tweet linking to a Medgadget blog post about a new personal health card from LifeNexus (this is the product shown in the right side of the above image). The LifeNexus Personal Health Payment Card is an all-in-one solution that stores a patient’s health record on a chip that’s embedded in what is essentially a credit card that can be used to pay for healthcare services. Here’s a snippet from that post:

An individual’s personal health record is stored on the card’s embedded microcomputer, the iChip, which is encrypted and password-protected, providing a highly secure environment that the individual owns and controls…The multi-functionality of the LifeNexus Personal Health Payment Card(TM) provides an additional and exceptional benefit. If individuals choose to have the Personal Health Card on a payment card, they can make purchases, providing a convenient way to manage their health-related information and make general day-to-day purchases on the same card.

For the time being, Square-like analytics don’t seem to be in the strategic cards for LifeNexus, as they are marketing their solution as an alternative to storing data in “the cloud.” But an obvious source of potential revenue for the data collected by LifeNexus would be providing de-identified data to drug and device manufacturers , healthcare informatics companies, or payer-sponsored comparative effectiveness studies. Especially if they can create a user experience as simple and easy as Square.

Here’s a fun video montage from a recent episode of Grey’s Anatomy where tweet-happy residents collaborate with doctors from other facilities via Twitter to discover an alternative procedure during surgery. The first live-tweeted surgery (in real life) occurred over two years ago in January of 2009, when staff from the Henry Ford Hospital in Detroit used Twitter to document a robotic procedure to remove a cancer.

Via Dr. Lucien Engelen’s Twitter feed (@Zorg20).

A new healthcare startup called Massive Health has been getting a lot of buzz recently. They are still in–as they call it–“ninja mode,” so there aren’t a lot of details about the products and services they will be offering. But it’s clear that the company is going to be focusing on driving behavior change by tightening the feedback loop between the actions people undertake (eating, exercising, working, sitting, etc.) and the performance of their body systems. With Aza Raskin–an innovative interaction designer who last served as the creative lead for Mozilla Firefox, it’s all but guaranteed that whatever solutions Massive Health comes up with will feature user experiences that are intuitive and enjoyable. As Raskin put it in this Xconomy interview, those things are essential to behavior change:

We looked at the state of the world and realized that 90 percent of U.S. healthcare costs go to 15 percent of patients–people with diabetes, weight loss problems, hypertension, heart disease. We are trying to create fantastically user-centric products that tackle these really hard problems that are going to be the pandemics of our times. The reason we raised as much as we did, $2.25 million as a seed round, was to give us the leeway to make products that actually change users’ behavior. Why is it that you can have fantastically designed products when you want to make a phone call or listen to music, but when you’re sick you’re back to something that feels clinical and sterile? It’s no wonder people have trouble changing their behavior.

That quote highlights another intriguing aspect of Massive Health–they have been explicit about focusing on people that are already sick. As discussed on this blog, there are numerous wellness apps and accessories for mobile devices that do some pretty impressive things and will ultimately make for better interactions between patients and doctors. But a lot of people that seek out wellness apps are already pretty healthy. Massive Health hopes to take a different tack and target people that wouldn’t necessarily buy a FitBit or use Nike Plus. This will be a tricky (and fascinating) challenge, as a lot of the people in that 15 percent that Raskin refers to are seniors and are unlikely to be super tech savvy; many may have just gotten their first cell phone (perhaps as a gift from their children) in the last couple of years.

If Massive Health can find a way to break through the technological, cultural, and motivational barriers and engage even a portion of the 15 percent of Americans who incur 90% of healthcare costs, they will be successful.

(via ePatientDave)

You know how in science fiction movies the alien/human language barrier is overcome by some tiny electronic universal translator that instantaneously allows each party of a conversation to speak and listen in their native language? Google’s new voice-enabled Google Translate app (currently available for Android, iPhone likely coming soon) brings us one step closer to that reality. As the above video by emergency medicine resident Graham Walker shows, the app listens to a user’s words in one language and, once the user has verified the accuracy of the voice recognition, plays back the translated audio. While not quite instantaneous, it can greatly reduce the communication barrier that arises when patients and clinicians literally don’t speak the same language.

Taking a step up one level, I think this is where a lot of the promise of healthcare IT lies–in breaking down communication barriers. In fact, that’s the one thing that the other cool new technologies we’ve covered recently here–devices for tracking weight and blood pressure, social media for sharing blood glucose readings, iPhone cases for recording arrhythmias–all have in common. They all help facilitate communication between patients and clinicians, or patients and other patients, or patients and healthcare technology manufacturers.

What are some other great examples of healthcare technology breaking down communication barriers between patients, clinicians, administrators, insurance providers, etc.? More importantly, how is your healthcare technology application breaking down these barriers?

Want to keep up with the latest news that we at Perficient Healthcare IT blog are following? Then follow @Perficient_HC on Twitter! If you really want to get into the weeds, you can follow some of the contributors individually:

• Liza Sisler: @lizasisler
• Christel Kellogg: @Gr8Wolf
• Erin Eschen: @ErinE
• Christopher Monnier: @chrismonnier

We at the Perficient Healthcare IT blog are big proponents of social media. As Liza recently outlined, social media offers numerous ways to find information and develop and deepen relationships. Along those same lines, I think social media offers some great tools for cultivating empathy.

What do I mean by empathy? Dev Patnaik literally wrote the book on empathy in business (for an overview, see this video), and his main point is that employees imbued with an empathic understanding of their customers can gain an intuitive understanding for what customers want, and in turn create products that customers love. Such an intuition doesn’t come from reviewing surveys or analyzing spreadsheets; rather, it comes from engaging with customers and participating (to the extent possible) in the same experiences as them.

Social media makes this easier than ever. On Twitter, there are thousands (millions?) of Tweets from patients–the ultimate customers of healthcare–talking about how their lives have been impacted by health conditions and the technology they use to deal with those conditions. Perhaps the most popular example is the hashtag #bgnow, a hashtag used by diabetes patients to share their blood glucose levels and talk about their experience using blood glucose meters. The company Log for Life has even put together a data aggregation page (pictured above) that displays, in real time, a graph of blood glucose levels tweeted by patients from around the world. Even without a popular hashtag such as #bgnow (or #bgwed, for blood glucose readings on Wednesdays), with a quick Twitter search you can listen to what patients are saying. For example, searches for key phrases such as “pacemaker” or “my mri” yield dozens of recent Tweets. You’ll have to wade through some noise (for example, there’s a portable music player called the “Pacemaker”), but within a matter of minutes you’ll see real people voicing emotions ranging from concern and anxiousness to excitement and even a sense of relief.

To be sure, spending a few minutes on Twitter is no replacement for spending face time with patients, and there’s really no way to truly understand what patients are going through without actually experiencing the same ordeal. But social media tools like Twitter make it easier than ever to at least get a basic appreciation for how patients are affected by healthcare technology.

The above video is a sneak preview of AliveCor’s iPhonECG, and is brought to us by scrubd.in, a brand new site devoted to categorizing, describing, and organizing medical apps. The iPhonECG has gotten a lot of well-deserved press, with many commentators remarking that the device is “proof that we are living in the future.” Indeed, the iPhonECG has a lot of potential and is an example of a technology that can help patients participate in their own healthcare.

The brilliance of the iPhoneECG is that, since it’s coupled to the one device people tend to bring everywhere, it dramatically increases the odds that a person who may be experiencing some abnormal heart rhythms will actually capture a recording of it. Once the rhythm is recorded, patients are empowered with data that they can present to their physician and ask, “Please take a look at this rhythm–is there anything going on here?”

I think that the iPhonECG, like less-specialized connected health and wellness devices, could help drive the adoption of PHRs and EHRs. However, I think that there’s an even greater potential for specialized devices like the iPhonECG to directly demonstrate their clinical value. For example, the iPhonECG may allow a patient who is taking an active role in her own health to document an arrhythmia earlier and with less cost and hassle than relying solely on traditional means (a physician-prescribed Holter monitor or 12-lead ECG). This could in turn lead to earlier intervention and treatment and maybe even improved outcomes. In this respect, the iPhonECG is not so much a replacement for traditional means of arrhythmia detection but rather a supplement that gives the person that spends the most time with the patient–the patient herself–the tools to monitor her own heart rhythm and ultimately improve her own health.

With powerful yet easy-to-use specialized tools such as the iPhonECG, patients have yet another incentive to get involved in their own healthcare.

Today’s big news is that the iPhone will soon be available on the Verizon network, and Verizon was quick to reassure potential customers that its 3G network is ready for the onslaught of new iPhone users. The chart pictured above shows the impact of the iPhone 3G on the AT&T network (source), an impact that was not anticipated by AT&T (as anyone with an AT&T iPhone can surely attest).

The reason I bring this up is simply to point out that when a product like the iPhone comes along, a product which helps users do not only the things they need to do but also the things they hadn’t yet realized they wanted to do, the adoption rate (and usage rate) of that product can exceed even the wildest expectations of industry observers. People who didn’t even think they wanted a smartphone were enticed into buying (and then exhaustively using) an iPhone. Not convinced, but enticed–an important distinction. The iPhone didn’t rely on marketing gimmicks or slick salespeople–its compelling user experience sold itself. This is what I mean by the “iPhone effect.”

\0xFEFFContrast that with the state of healthcare IT, where policymakers–frustrated with the slow adoption of EHRs–have resorted to paying health care practices (via HITECH incentives) to use EHRs. While the adoption curve is certainly moving in the right direction, I believe the best way to increase the rate of EHR adoption is to leverage the iPhone effect. Make life easier and more enjoyable for clinicians through an EHR that is intuitive, useful, and engaging, and the EHR experience will sell itself.

One of the most intriguing movements in the healthcare industry today is participatory medicine. Participatory medicine holds a lot of promise and seems to be gaining momentum among both patients and healthcare professionals. Nevertheless, participatory medicine is far from the standard of care, and one of the biggest barriers is actually getting patients interested in their own health.

Personal Health Records (PHRs) seems to be the strategy that insurance companies and tech giants like Microsoft and Google, as well as their partners at hospitals, clinics, and pharmacies have pursued as a way to engage patients. The thinking seems to be, “If you build it, they will come.” And indeed, early adopters have. By April 2010, 7% of Americans were estimated to have used a PHR. This is a respectable number for a relatively new product line, but unfortunately the data on which this number is based doesn’t include details on how often PHRs are used, or how many of those that have used a PHR routinely do so. I suspect the number of routine users of PHRs is somewhat lower.

In retrospect, it seems that the “if you build it, they will come” mentality of PHRs was a little like putting the cart before the horse, especially given the ambiguous nature of the data made readily available to patients. It’s like patients were being asked to go straight from having an occasional curiosity about a medical condition to being completely immersed in every detail of their medical history.

Perhaps a more effective strategy to getting patients interested in their own health care is a bottom-up approach that starts small and then lets patients build from there. Specifically, I think that simple, easy-to-use wellness devices with network connectivity may be one way to get people more interested in their own health. There are some really cool wellness and fitness monitoring devices hitting the market, including FitBit, Basis, and Nike Plus. There are even some exciting devices such as weight scales and blood pressure monitors (the Withings blood pressure monitor is shown above) that combine beautiful design with network connectivity to offer users a vastly improved value proposition to monitor their health. To top it all off, these connected devices are beginning to integrate themselves with PHRs!

An increase in the amount of health and wellness data collected by patients has the dual benefits of (1) increasing the utility of PHRs for patients, as now patients have a reason to routinely login and use PHRs, and (2) increasing the utility of PHR-EHR connections, as now physicians can benefit from viewing the data collected (for free) by patients. In other words, the data gives the patient and physician something to talk about. The data and the patient’s activities in collecting the data provide a starting point for collaboration and shared decision making, two essential components of participatory medicine.