Chapter 4
Ideation
The Fun Part
The ideation stage is the next step of the design thinking process (Figure 4.1), and it's also the fun part. In this stage we combine the understanding we have of the problem space and the people we're designing for with our imaginations to generate solution concepts. Ideation is about pushing for the widest possible range of ideas from which you can select, not simply finding a single best solution. So taking the inspiration we gained, the problems we found (our criteria), and what we learned about patient desires, what does the ideal healthcare system look like?
Figure 4.1 Ideation is the Next Step of Design Thinking
Healthcare 2020
Last year, my friend and colleague Dr. Graham Hughes, who's chief medical officer at SAS, wrote a piece entitled “Healthcare 2020” that I think is appropriate to share in this chapter. Here are some of Graham's thoughts on a revolutionary healthcare system.
It's August 1, 2020, and my heads-up display just sent me a priority health notification. I wasn't surprised, because I had used my newly downloaded phone app to walk me through the process of configuring my preferences for health notifications. When I opened the notification, my smart health app recommended five things I should do now if I want to reduce my chance of hospital admission by 20 percent next year, minimize my (ever increasing) out-of-pocket healthcare costs, and keep myself and my family as healthy as possible.
I used to find these types of things irritating. Up to this point I'd wait until I met with my doctor at my annual visit to be chastised with generic recommendations that didn't take account of my personal situation (like lose weight and try to reduce stress levels). Even worse, none of the advice was specific or actionable enough to follow or even remember. So, imagine how surprised I was when my doctor suggested that I try out this new app.
I'm told the app is based on a big data analytics platform. This doesn't mean much to me, except that it feels like it knows who I am and, very importantly, it gives me very specific recommendations and can even (wait for it) book recommended appointments, provide reminders, coaching, and encouragement, and has real time features that let me interact with real people who can help with anything I find confusing.
Another thing I like is that none of these recommendations are shared with anyone else yet—nobody at all. I like that, even though I plan on sharing some (but not all) of what it calls my “plan for health” with my doctor and other information with other members of my recently updated health team. Oh, yes, and it doesn't nag—unless I want it to.
So, I've used this app for a couple of months now, and it keeps on adapting. It links to my computers, my tablets, my phones, my heads-up display, and my TV. It keeps track of what I've done and where I am and pulls data automatically from selected social media accounts as well as a few of the health and fitness apps and devices that I use. What's even cooler is that no individual interaction or recommendation is the same as one I've had before, and I like that. It's definitely getting to know what motivates me and those things I'll need more help with, without me having to ask.
Last week, it recommended a time to Skype with my doctor to let her know how I was getting along with the app. I clicked OK and when the time came for our video call my doctor explained a little bit about how the app worked. Apparently what it does is use data from the setup process I completed when I installed the app to pull data from all the electronic health records held by the different doctors that I've seen in the past five years and from the hospitalization I had last year. It then pulls more information from my health insurance company and merges all that with the other data—such as home address, local air quality data, my credit card and other purchasing information, banking details, social media and health app accounts, as well as recommended medical literature and research from sites I preselected.
The app then compares me to hundreds of thousands of other people like me and combines that with additional information I provided relating to communication and escalation preferences, such as phone, email, video, or snail mail. What happens next I didn't fully follow, but it has something to do with predictive analytics and customer intelligence applications. Apparently other industries have been doing this for years, and it had become so transparent that I haven't even been aware of it for the past 10 years or so while shopping online.
My only comment to my doctor was: If the technology was available in 2014, why did I have to wait until 2020 to be able to use it for something as important as my health? For the first time ever, my doctor was speechless.
Patient Empowerment
Perhaps the most obvious characteristic of Graham's description of an improved healthcare system is that of patient empowerment: a shift of power to patients. To create better patient experiences and ultimately a better healthcare system, patients must be placed at the core of the system. And they, along with providers, must be empowered to make good decisions. The patient, as the consumer of healthcare, must be informed, invested in his health, and connected with healthcare resources he needs. And the provider must be incentivized to focus on providing the best care possible so that patients can be their healthiest.
With patients taking on more ownership of their health, a huge paradigm shift in responsibility is being made. Today, in most of our healthcare experiences, doctors are at the core of the system, serving as the primary authority figure and regulator (Figure 4.2). But in a new system, patients manage their health, their health network, and their health information (Figure 4.3).
Figure 4.2 Today's System
Figure 4.3 New System
This shift is what will revolutionize the role of the patient, by making him a consumer of healthcare. Just think—rather than the doctor managing patients, the patients, or consumers, will manage their own health network. The consumer is the driving force within his “health team” of physicians and medical professionals, and has access to all of his personal health data, which follows him wherever he goes through all of his devices, be it a mobile phone or a wearable device.
Relationships are changed. The single relationship between doctor and patient doesn't exist anymore. Instead, relationships are more team-based, with continuous interactions occurring throughout the patient's health network. The relationship with the primary care provider is strong, and access to specialists isn't fragmented or difficult. Information is securely flowing to all of the necessary individuals and acts as the glue between teams of care.
Prevention is the norm, and we've moved from managing “sickness” to maintaining and improving “wellness.” Connected by the data of the patient, all members of the health network are empowered with information that helps improve patient health.
Say goodbye to expensive sensors and devices. Our daily tech devices are our medical devices. And so are our nontech devices. Maybe our refrigerators are connected to our phones, which are connected to the lights in our office. We're provided with notifications and alerts for things like a prescription medicine that was left on the counter today, an alert that the irritation of the skin was caused by a new laundry detergent, or an alert for an abnormal heart rate that was sensed by a watch.
While there are already numerous tools out there, like Jawbone UP, Nike Plus, FitBit, and diet- and wellness-tracking apps, that are creating an immense amount of data on our health and lifestyle, most applications today aren't helping to measure progress and give feedback. In our new healthcare system, analytics works behind the scenes to deduce all of the rich information that is generated through multiple devices into digestible tidbits of insights that help us understand how our activities, habits, and behaviors promote or take away from our well-being. This provides us with a range of feedback, like early signs of disease and risk factors. More important, it provides us feedback on how we can improve our health each day.
Healthcare is less clinical and more personal, and it's become a part of our lifestyles. As consumers of healthcare, we're able to measure, assess, and be educated on our own health, as much or as little as we want. The new system encourages us to be preventive and proactive, and gives personalized a whole new meaning, as it becomes about the total experience rather than a single event. And my experience is completely unique to me; yours is to you. It even becomes fun. With rewards and incentives built across applications, we're encouraged to reach goals, self-diagnose, and consistently stay on track with a plan.
Our social network is connected to our health network, too. Our Facebook, Twitter, and Instagram accounts all feed into our repositories of data, adding an extra, crucial layer of information to our “personal health cloud.” This addition provides insights on those things that affect our health that aren't directly part of our healthcare system—like how our relationships, the places we visit, the foods we eat, and even the people we interact with affect not only our physical but our mental health and well-being.
The Personal Health Cloud
The personal health cloud is where all of the magic happens. It's where all my health data is stored, analyzed, and shared from. It receives data that I generate, that my doctors generate, and others, like my insurance company, generate. But most important, the data I create makes my health cloud entirely different from yours. It gives me the freedom to include data that's relevant to my lifestyle and needs. My health cloud may include information such as my meals, my yoga schedule and the calories burned in each class, my sleep schedule, how many hours I sat on a plane, my travel schedule, and other things. It lets me pick what I want to include and ultimately looks at all of this information to find patterns and trends.
For example, the inputs of my health cloud may look something like Figure 4.4.
Figure 4.4 Example of Inputs Into a Personal Health Cloud
In a connected world, the health data cloud captures relevant information from all sorts of channels, which is what makes it so cool. Traditionally, data platforms only allowed decision makers to see a limited view of a person's healthcare, for example, just cost data from medical claims. But in the new system, we have the technology capability of collecting and assessing multiple views that can be shared with those we involve in our health—be it a doctor, a therapist, a dietician or other medical specialist, our friends and family, or even our employers. And most important, the personal health cloud is used regularly by me—the patient, the consumer.
By pushing and pulling data to and from our everyday devices, it integrates seamlessly into our lives, so much so that we don't even know that it exists. Contrary to most of today's tools, it guides our behavior rather than just tracking it, and provides nudges, reminders, and suggestions to help us change our unhealthy behaviors.
But there's more to it than my cloud and your cloud. It's part of a larger platform, a larger health cloud. The larger health clouds capture information from personal health clouds to help our entire healthcare system (Figure 4.5). Individuals decide whether they want to contribute to a big data health cloud, and do it anonymously, so that people don't actually know who they are. By gathering information from billions of individuals, everyone from researchers to clinicians to patients benefits.
Figure 4.5 Health Cloud Receiving Information from Personal Health Clouds
Because of new types of information—specifically, self-generated data—in the cloud, we find patterns and associations that help us learn about healthcare in new ways. It brings us to really insightful learnings about nonclinical factors that affect our health. And since 80 percent of health is impacted by factors outside of the healthcare system,1 these findings create a novel, modern approach to healthcare.
Clinicians use the health cloud on a regular basis. It's easy to find similar patients to theirs to identify the best treatment plans. And by similar, it's not just, for instance, two females who are 34 years old, of Asian descent, and weigh 130 pounds; it's also these two people with similar lifestyles, behaviors, and patterns. The health cloud automatically mines all of this data and reduces it to consumable insights really fast—and spits out information that clinicians can use for treating patients. And sometimes clinicians don't have to search for anything at all; this information is automatically generated and delivered on their patient's profile or health record. In other words, it lets clinicians interact effortlessly and gives them exactly the information they need at exactly the right time.
Patients also use their health clouds regularly. Besides getting personalized notifications, alerts, and reminders consistently, they also can share their personal health clouds with each other, create their own health clouds with their families, and receive helpful insights based on their family history (Figure 4.6).
Figure 4.6 Personal Health Clouds can be Created for a Family
It empowers patients to be an active partner in their health, and to have better, more meaningful interactions with their providers, families, employers, and others involved in their health. The result is everyone is more informed and more engaged, and patients are more active participators in their own health than ever before.