Healthcare innovation and the digital madhouse gulag effect

I spent the day hanging out with healthcare innovators, entrepreneurs and investors at the Innov8forhealth Business Expo at the Northern KY University METS Center, a beautiful conference center across the river from Cincinnati. I really enjoy these events. It’s an occasion for me to improve my own work, and an opportunity to compete with other startup ventures for the attention of investors and healthcare system buyers.

As I have written before, healthcare is now a galaxy.  At the center is a black hole where everything that happens is mandatory and payment is by and large measured in bulk on a population-served basis. A little farther out is a ring of fee-for-service places, the Primary Care Zone. Out beyond that is the realm of health educators and “healthy support” people. Think of the nurse that calls from your health insurance company, or the educator that shows up at the senior center. Or folks like me, with books and programs.

The space between these layers is becoming filled in with health data transaction machines, satellites really, that people in the population hook their phones, gadgets and computers up to, so the information infrastructure of the galaxy can check in and measure what the population is doing.  Or they phone back to tell you how you are doing.

Some examples: Phone apps now connect older adults to caregivers. People can know when their elderly relative has forgotten to take her pills, because the app sends an alert to the caregiver’s phone when it’s time to call and complain. (Sorry, I mean “remind the person to do better.”)  Exercise bikes can email out gift cards when a person racks up enough miles. Smartphone sensors can work like always-on stress detectors, heart rate monitors, blood gas measuring devices. Phones can even wake people at just the right time to optimize their dreams.

Within these apps, the experience is being turned into a game. Healthcare is becoming “gamified.”  If I lose a couple pounds, my scale will report in and I will get a coupon for vegetables I probably won’t eat. The coupon will let my grocer know to report in if I bought them.

As all these trends come together, people in a position to access data profiles for employment, justice system, credit, insurance, political and other economic purposes will be able to view each of us as avatars, or data constructs. (We will all check the box on some form that says this is okay.) A job applicant’s “permanent record” might include what he buys at the grocery, the books he has downloaded, the restaurants and clubs where his face has been seen, the people he travels with, how well he sleeps and more.

Over the next few years, the gamified data incursions on personal privacy will be absolutely horrifying to people concerned about personal autonomy and freedom from intrusive monitoring.

I think this has significant implications for mental health. What algorithms will we develop to track personal growth? Will people be permitted a “fresh start” in a data-dominated ultra-competitive economy?  And what will the data profiles of people experiencing trouble of one kind or another look like?

The future madhouse will, I think, be a data-driven invisible economic gulag. People with mental health concerns will be identified easily because their data profiles will reflect their relative poverty and isolation from the main stream. Mechanized online psychological pre-employment testing has already become super-inexpensive. In the past month I learned of two people applying for jobs who were required to take psychological tests. One person was applying for a first job at Pizza Hut. He spent ten or twenty minutes answering a few dozen multiple choice questions. The other was applying for an executive level position at a healthcare system. This executive spent half a day working through a barrage of questions (many of them forbidden to standard personnel departments because they are plainly discriminatory). In the future, the very near future, job seekers will check a box and employers will just look this data up.

One consolation for me on this otherwise data-driven day was the opportunity to have a chat with my own cardiologist about his life in a very busy practice involving several patient offices across the city, as well as hospital work. We talked about the disconnect between the major layers in the healthcare system, about the difficulty doctors face getting to know the people they see every day in their office caseload, plus the logistical challenges of seeing patients when they have a hospital stay.

At some point, healthcare must confront and balance out the human element in the equation. Patient encounters make more sense to people at both ends of the stethoscope when they meet each other face-to-face. We have this primitive capacity and a need to know that what needs to be said has been heard, by a real person,  not just by some robot attached to the other guy’s phone.

---

Learn more about healthcare innovation in Cincinnati at http://www.innov8forhealth.com.

Read more »

Is your mental health expert smarter than a second year college student?

If we took what we know about how mental illness plays out in the world and let some second-year college students work on fixing it, would we end up with something better than what people experience today?

Today’s experience of mental illness, such as it is, developed through accretion. It is a mishmash of good and bad intentions, a clump of attitudes and practices, a basket of  traditions, economic and political factors, plus choices made since time immemorial. We have “cures” that include home remedies, scripts for talking with people, and manufactured pills and potions. We have “lifestyles” that include disempowerment, isolation, poverty, broken families, unemployment, poor health, even death.

What if we told our students to start from scratch, rejigger the whole thing. Redesign it,  using standard design techniques, a reasonable budget and some consensus-based mental health practices. What might this design team come up with?

Here are some of the principles the design team would use.

Unification.  The team would pull elements of the proposed solution from everywhere, not just from one discipline, but many. Whatever the origin, the product would work cohesively, as a unit.

Diversity. Designers are known to be self-referential. Men design for men, women for women, everyone for their own home culture. A diverse team delivers results appropriate for more people.

Accessibility. Users would know how the product functioned. The technology would be evident to the user.

Safety. The designer would understand the human factors involved, making sure the technology is safe for the user.

Simplification. Reducing the number of paths, parts and processes.

Problem solving. Addressing the user’s concerns, delivering something that makes a person’s life better.

Waste reduction. Reduce the burden of the product on the environment and on society at large.

Responsiveness. Deliver what the user demands. Create what the consumer wants, respecting the consumer’s motivations, even when the designer does not agree.

Appropriateness. Don't confuse commercial products with consumer products. Commercial products are money and process-driven, whereas consumer products must address the human needs of product users.

Deep research. Designers must immerse themselves in the user’s world to ensure they are reflecting the user’s desires, not their own.

* * *
Yesterday I watched as these principles played out at the school where I teach, Cincinnati State Technical and Community College. Six industrial design technology students presented their capstone design projects, products ranging from bike racks to assistive devices to squeeze bottles to trash can bags. A group of experienced designers from Procter and Gamble, GE Aircraft and other local companies coached and mentored the students. Over the course of the four-hour event, the advisors highlighted additional opportunities to learn from users. What does the client want? How do you know what the client wants? Was the client satisfied with what you delivered? When something wasn’t safe, how might you fix it?  Would the fix be satisfactory to the client?

Needless to say, this was eye-opening for me. Mental health services are consumer products, after all. Why does no one listen to service users, people the system calls consumers?

This classroom of second-year undergraduate-level design technology students were figuring out how to solve any problem by listening to people, applying some basic prototyping and fabrication, and checking to see if the user’s needs were met.

How many of today's mental health experts can honestly say they do that?

Read more »