This is my trip report from “Healthcare Experience Design” conference held in Boston, MA on March 26, 2012 at the Westin hotel conference center.
The second annual Healthcare Experience Design (HxD) conference was primarily the endeavor of Mad*Pow, a user experience design consulting agency based in Providence RI boasting a strong healthcare client portfolio and strong industry leadership. Their Director of Design, Megan Grocki, was also Program Chair for Interaction12, the annual conference of the Interaction Design Association that I was thrilled recently to attend in Dublin, Ireland. Especially following the great buzz around the inaugural HxD conference in 2011, I knew I simply had to attend HxD after experiencing the inspiring variety of health-related talks she programmed for the Interaction conference. The HxD conference was held at the Westin Waterfront hotel, in a pretty generic conference setting; the Boston weather cooperated for us being stuck inside by presenting heavy rain and wind.
This topic-focused conference, incidentally known on the Twitterz by its hash tag #hxdconf, was mainly aimed at healthcare influencers occupying roles such as product managers and design consultants. Many talks were delivered by user experience design professionals imparting their techniques via real-world case studies to demonstrate the efficacy of their approaches. Data loomed large in many talks, as well, speaking to the often quantitatively-oriented nature of many healthcare professionals. The single-day conference format involved 5 keynote speakers when all attendees convened to listen en masse, and then three separate tracks where folks could choose their preferred topic. The following comprise my notes and observations from the sessions I attended.
Robyn O’Brien: Allergykids and the Unhealthy Truth (Keynote)
I was surprised but pleased that Ms O’Brien opened the conference. Hailed as “the Erin Brockovich of genetically modified foods”, I had watched the video of her TEDxAustin talk some months prior. A food industry executive and super-achieving MBA, Robyn then decided to have children and in typical Type-A fashion had given birth to four children in 5 years. One morning at breakfast, her youngest had a severe allergic reaction (to either the waffle, the milk or the eggs) that led the family to the ED. O’Brien learned to her shock that “allergy kids” were a common sight for the modern physician, and wondering why this phenomenon was so today led her to investigate facts and trends. She told us that as an analyst, she knows well that correlation is not causation but nevertheless she turned up a host of disturbing information and trends. Starting with the introduction of GMO (genetically modified organisms) crops and rGBH (synthetic growth hormone) around the mid-70s, we can see a precipitous rise in the incidence of food allergies–as well as heart-rending conditions such as autism, ADHD and cancer. Cancer is today the leading cause of death for kids younger than 15, an astonishing statistic that as a parent I would love to deny. Peanut allergies were twice as prevalent in 2002 as they were in 1997. Primarily, genetic modification of crops has involved introducing pesticide/insecticide resistance into the genome of the plant itself, which has led to a massive increase in the quantity of such toxins being applied to these crops. Where the rest of the developed nations have chosen to restrict the use of GM crops because they have not yet been proven safe, the US has taken the opposite approach of allowing them because they have not (yet) been proven dangerous. Although this approach may echo our admirable, case law based legal system that presumes people are innocent until proven guilty, this strategy is a questionable one when it comes to health and human welfare. The American reality is that capitalistic profit drivers motivating such business decisions on the part of companies such as Monsanto do not have to incorporate the “external” costs of possible side-effects as unhealthy populations that could be the by-product of heavily chemically-treated foods. Time will have to tell, but unfortunately the evidence is mounting against the safety of the now-conventional food supply in America.
Tod Moore, “Weathering the Perfect Storm: Design and Management Strategies for Hospital Technology Systems” (Talk)
Tod is a Principal at “IT Architecture Practice Leader” Sparling. I certainly appreciated his points that a technology system needs to be intuitive, accessible, and adaptive. The adaptive element is particularly important in the current landscape of hospital-based information technology, which is a challenging patchwork of different and largely disparate systems. He also made the point that one has to manage obsolescence, which is an often forgotten stage in the product lifecycle. Tod said that today’s hospital CEO & CFO are making decisions based on an interest in reducing cost and improving outcomes – and the bottom line is still ROI (Return on Investment). He cited the lean design movement, and cited the importance of having a design vision to ignite passion and drive efforts forward. An interesting question during Q&A provoked Tod to examine the drivers for such a focus on cost reduction today, which he assessed as due to the economic lull; new meaningful use requirements; the nature of payments in the U.S. healthcare system; and uncertainty about the future. He pointed out that the only two things a hospital can really impact is payments and operational costs; the ACO movement away from fee-for-services is tackling the payment structure question while technology is what can most affect operational costs.
Read on for much more…
Alexandra Dunne, “Talk Health To Me, Baby” (Talk)
President and Co-Founder of Eliza Corporation, Alexandra was a fast-talking, energetic speaker whose presentation was filled with goodness. (Eliza Corporation is an interesting firm, new to me, that offers consumer research and communication services to promote better health.) She pointed out that often our data-obsessed healthcare environment can miss what really matters: the people. It’s also a sad and ironic fact that marketing budgets for selling cigarettes might net out to $80/user, whereas healthcare’s marketing budget for selling chronic disease management is often more like $0.30/patient. So Alexandra took it upon herself to introduce some key examples of Eliza’s market research and communications for the audience. She used an example of asking people point-blank, “Do you smoke?” to which 11% will admit “yes”; by contrast, saying to somebody, “It doesn’t matter if you smoke…or if somebody you know smokes…it’s really hard to quit!” will prompt 38% to admit that “yes”, they smoke. Language and empathy are crucial. She also raised the major point that it’s often the difficult issues of life itself that surround the context of healthiness. She cited the “unmentionable” issues that affect health as being: money issues; unhealthy sex lives; relationship problems; caregiver stress; and job stress. Any one of these issues are felt by up to 95% of people today according to their surveys; fully 40% of people will have 4-6 such difficult issues at play in their lives. Those who have these 4-6 “unmentionable” issues are 5 times more likely to have bad health. Encouragingly, people whom Eliza speak with indicate that they want help most with money issues and caregiving stress, and are prepared to get that help from their employer and/or their healthcare providers. Alexandra also introduced us to some of the “buffers” that protect the health of people beset with such issues, which include peer groups; spirituality; and exercise. Unfortunately, “magnifiers” such as sleep issues; depression; and substance abuse can also exacerbate those difficult underlying issues. She presented what she called a “vulnerability index” that shows people having a sharp tipping point from less vulnerable to more vulnerable states, and pointed out how we have to help people before they go over such a tipping point. Alexandra concluded by helping us open our minds around using humor to reach people, with a case study for mammogram reminders that phrased the request to people in the form of an opening statement: “Your mammography machine really misses you!”
(After Alexandra’s talk, I personally took advantage of some preventative health medicine by having a 10 minute chair massage that was nicely sponsored by the conference organizers. Ah, yes, take that, travel stress! Now, back to business….)
Gary Hirshberg, “You Can Help People Be Healthier While Making a Profit” (Keynote)
When Gary began his presentation by saying that in his view, good food IS preventative health, Robyn O’Brien’s opening talk suddenly made a lot more sense. Gary is CEO of Stonyfield Farm, an organic dairy that makes well-regarded smoothies and yogurt products and which is now almost a $400 million/year business. He pointed out that diabetes costs the US healthcare system $174 billion/year. Gary, like Robyn, presented a whole range of frightening statistics around pesticide levels in children, and the fact that it’s now presumed that 41% of Americans will develop a cancer in their lifetime, a number that’s climbed precipitously since President Reagan first started a study of the topic. He also discussed the rise of “super weeds” across the U.S. that are resistant to the pesticides dumped on typical farms, leading to escalating warfare on the part of the GMO architects and chemical manufacturers who are now peddling a pesticide that’s basically half the recipe of Agent Orange. By contrast, Gary shared an example of the sugar cane farm in Brazil which Stonyfield Farm uses that has gone organic, and seen greater yields and a much healthier ecosystem as a result. He also travels the world visiting organic farms and seeing the beautiful environment they provide for a whole web of nature. One of the key issues seems to be that humans consider themselves to be above nature, whereas we need to recognize that we’re really just one part of nature herself. Our actions have major, systemic consequences, and America’s 50 year experiment in industrial farming may just be a giant mistake. Overall, the U.S. has lost 50% of its topsoil through current practices. Unlike most other developed nations, America also doesn’t even provide labeling or oversight for foods containing GMO ingredients. At a minimum, it seems laws are needed to ensure that GMO and rGBH-infused foods are clearly labeled, as they are already mandated to be in other countries. This practice will allow consumers to make an informed choice and express its voice in the powerful marketplace that is capitalism. Gary shared the websites of organiccenter.org and thefullyield.org to help educate us how organic food practices also really can make business sense.
Todd Park, “Unleashing the Power of Open Data & Innovation to Improve Health” (Keynote)
I have a new hero, and his name is Todd Park, the newly-minted CTO of the US Department of Health and Human Services (HHS). The word “awesome” was uttered without irony (albeit with conscious humor) about 4,000 times during Todd’s talk, every one of them well-deserved. What Todd has done during the past couple years he’s worked as an innovation consultant with HHS (he only became CTO a few weeks ago!) is create the Health Data Initiative (HDI), a massive effort to open all the data streams of the HHS to the world. As Todd is also the co-founder of Athena Health and Castlight, he knows the power of the entrepreneur first-hand. By launching the HDI, he will “liberate data and catalyze innovation”—“viva la liberacion!” he cried out. Through such openness, he intends to improve public health by enabling helpfully-minded people to utilize publicly available data in novel ways. Mostly, Todd covered a dizzying array of HDI efforts already launched or soon to launch, including: provider directories that include quality assessments; the “Blue Button” that allows VA patients to download their personal health records; useful data for ACOs; consumer product information; vast stores of medical & scientific knowledge. He cited numerous websites such as healthcare.gov; medlineplusconnect; healthdata.gov; health2challenge.org; challenge.gov, and hdiforum.org as places where we can go to learn more and join the data-palooza party he’s started.
BJ Fogg, “The Health Solution” (Keynote)
Dr. BJ Fogg directs the Persuasive Tech Lab at Stanford University, where his personal passion is understanding how technology can motivate and influence people. In his understated, well-structured talk, BJ began by asking us to excise the phrase “motivate behavior change” from our vocabulary. Instead, he proposes we use the phrase “facilitate behavior change”, for he points out that only the individual truly can undertake his/her own behavior changes. Those of us external to that individual need to do our best to understand his/her level of motivation and deliver the right materials to take advantage of where s/he is at that moment. To frame this point, BJ Fogg proposed that each of us rides a “motivation wave”. We are all usually hovering in the “low” motivation realm, and only occasionally does our motivation wave crest to a place of “high” motivation. It’s these rare moments that have the potential to catalyze more significant behavior changes – to do the “hard stuff”. For example, in times of low motivation, we might be able to do something easy like buy a training sneaker, whereas in moments of high motivation, we might be willing to enlist a personal trainer. BJ contends that when it comes to creating desirable health behaviors in ourselves and others, we can: instill beneficial habits; enact positive changes in our environment; and undertake structured behaviors. The key to facilitating behavior change is fitting the action to the moment. So, in those precious moments of high motivation, we need to: 1) do hard things that structure our future behavior (such as, hiring that trainer so that two weeks from now the training session still happens); 2) do hard things that reduce barriers to healthy behaviors (such as, cutting up that big load of vegetables from the grocery store so that three days from now they’ll be easy to cook); and 3) do hard things that increase people’s capability (such as, learning a new, low-carb recipe so that two months from now it will be second nature to prepare).
Deb Gelman, “Ready or Not? How Design Can Inspire and Support Behavior Change” (Talk)
Happily, Deb didn’t have to adjust any of her talk after BJ’s keynote, as her experiences as the User Experience Director at Nutrisystem, Inc emphasize that proper understanding of a person’s level of motivation and goals will help products and services excel. Behavior change has to capitalize on the current state of the target consumer, on a spectrum of behavior change known as Stages of Change. The stages are: Precontemplation; Contemplation; Preparation; Action; Maintenance. Deb proposed the kind of behaviors and materials to deliver in each phase as follows. Provide education for Precontemplative people. They need information. Acknowledgement is needed for people in the Contemplation phase, which can go on for about six months in her case studies of people pursuing weight loss through dietary means. In the subsequent Preparation phase, the user has to be celebrated. They could be about to achieve their breakthrough into the action phase. Once in the Action phase, an activated user needs to be given tools and techniques to prolong their work and success in this phase. For Maintenance, then, reinforcement is needed. Here, behaviors start to become habits. Dangers in the maintenance phase include complacency, indicating a need for ongoing encouragement. Deb interestingly also added the Relapse stage of change, where encouragement is key to getting a user back into the active, healthy realm. I found this model very informative, and in the Q&A I asked about how we communicate with consumers when we can’t know yet how activated our user is? She said that one strategy is to consider what people have searched on at your website, seeking clues to their interests and responding with content accordingly. Also, she recommended to generally deliver messages in one of the earlier stages of the change model (such as acknowledgment around the difficulty of preparing to change), presumably to be more likely to capture the less-actived people who need help the most.
Scott Lind, ” Secret Life of EHRs” (Talk)
This talk was relatively disappointing because I personally foresee needing and wanting Providence’s new EPIC EHR system to do, well, epic things with the health data of our consumers for us to deliver well-designed, consumer-centric products & services. Scott, Director of User Experience at Siemens, has been out in the field doing usability testing of their EHR system in field activities. Contextual research such as in-clinic observation time is a necessity for their user experience design team, who discover usability issues and make adjustments to systems by seeing them in practice. They seek to design pleasurable products that rise above the functional – reliable – useful paradigm. However, his science-minded organization sometimes has challenges with the regulation of usability testing, as experience-oriented assessments tend to have non-repeatable, non-measurable outputs. I sympathize with his organizational challenges, but hoped for something more practical to my work as a product manager. When I asked him for his secret tips of designing features I wanted in an EHR, he replied that I should simply keep demanding it. Viva voice of the customer?
Trapper Markeltz, “3 Useful Schemas for Health Product Design” (Talk)
Trapper’s talk was full of insanely interesting concepts, and visually I enjoyed that he scripted his talk using Prezi, that new presentation software that zooms and pans for transitions. As Head of Product at Me You Health, he’s been working on the “engagement problem”. His product involves a daily challenge that becomes a longitudinal well-being tracker, that allows other people to come on the individual’s journey. The first schema is being Person-Centered. Adherance to a prescription is a different approach than engagement by a person, moving from a force-based model to a choice-based model. Being person-centered also includes being realistic, being convenient, being immediate, and being genuine. The second schema is Gamification. Game mechanics such as establishing fuzzy goals for good, long-term play are helpful in health models of engagement. Other userful game elements might also include appointments, accountability, and progress indicators. The third schema is Attention Dynamics, which acknowledges first that attention is our scarcest resource in a world filled with choices. I loved Trapper citing Herbert Simon as saying that “a wealth of information creates a poverty of attention”. The value of attention makes conversation so important, for conversations exchange attention. Consider the importance in product design that when a user answers a question, the system responds appropriately – in the same measure and level as the user. He also proposed that products be “opinionated”, which I find a beautiful thought in line with a personalizing the system problem I’ve grappled with for many years. Another interesting point Trapper made is that we might want to create an attention cost with our health products, where using something is easier than stopping. Facebook, for example, has created this attention cost in our minds by convincing us that if we quit Facebook, we would need to spend time keeping in touch with 300+ friends – a daunting challenge that simply seems like a loss.
John Yesko, “7 User Experience Principles for Online Self-Service” (Talk)
John is Director of User Experience at Walgreens. As a major online self-service provider of personal goods and health products, he presented a variety of examples from their work in delivering good customer service. I have to admit I only noted numbers on a couple points, but hopefully more insights would be provided in a reference he cited, “Defensive Design for the Web” by the good folks who make 37Signals. I appreciated his point that online services have to be better than the alternative. If it doesn’t save time, cost or add flexibility somehow, then it might better be dealt with in the physical or other realm. He also noted that trouble at any point in a multi-channel experience will reflect badly on the online experience. Basically, the website can become a kind of whipping post. For this as well as other reasons, he pointed out the importance of communicating proactively with users when something does go wrong. Being honest and always seeking to improve is a good strategy.
Jonathan Bush (Keynote)
I’m sorry to say that the closing keynote was a complete bust, in my opinion. The untitled nature of his keynote reflects its empty content. CEO and co-founder of cloud-based service provider Athena Health, Jonathan was interviewed by journalist Brian Dumaine of Fortune Magazine in a format that could have afforded them an opportunity to synthesize emergent conference themes and elevate attendees before we left to re-enter our daily routines. Doing the opposite of this, the speaker appeared to seize a chance for self-aggrandizement, muddled humor and not-so-subtle political digs at the healthcare reform act. I found their talk incoherent and off-point, and gained nothing but appreciation for the relevancy of earlier speakers, by contrast.
Other people raved about the presentation titled “What Does Art Have to Do with Medicine?” by Regina Holliday, who painted for the rest of the day in the lobby area, and the talk “Failure by Design” by Devorah Klein. In summary, the conference was filled with inspiration and edification in nearly equal measure. I’m grateful for the chance to have attended this event, and am more motivated than ever to design and deliver some health-promoting, easy-to-use, desirable products and services to my healthcare organization’s consumer.