At first sight, it seems difficult to apply design thinking in health care since the power granted to the medical community is huge. Traditionally, the relation between a doctor and a patient is top-down, hierarchical. Yet, in recent years, roles have begun to change. For instance, diabetic patients are often very aware of their disease. They require a service that allows them to access their medical data almost instantly. Patient-centricity emerges from a strong desire of patients to be considered in the process. Moreover, the raise of digital devices and usages sets the frame for patient-centric tools and approach. So, how design thinking and technology, through patient-centricity, are reshaping health care?
A mediatic example of this transformation could be the new Netflix documentary TV show Diagnosis. It follows Dr. Lisa Sanders as she attempts to help patients with unique illnesses. Her experience is anything but traditional. For instance, she inspired the Fox program Dr House with her popular Diagnosis column for the New York Times Magazine. In contrast to the Dr House series, which highlights a doctor who has all the knowledge, the 8-hour documentary Diagnosis focuses on researches for a diagnosis and cure using wisdom of the crowd methods. The principle consists in linking a medical case submitted by a patient on the Internet platform with a host of “medical detectives” who each offer their diagnosis or bet on a diagnosis. In this process, the patient is placed at the center and benefits from collective and collaborative intelligence to meet his needs.
#1 What is patient-centric approach?
Definition
Patient-centric or Patient Led approaches are about challenging health care’s thinking and practice to put the needs and perspective of the patient at the heart of the innovation process. It is also about prompting health care organizations to include the patient at the center of the process as opposed to somewhere down the line. The patient is co-creating his experience and his diagnostic, he is no longer a simple object of study but rather an active stakeholder of his disease.
Furthermore, patient and family-centered care ensures the active collaboration and collective decision-making between patients, families, and providers to design and manage a customized and comprehensive care plan. In this model, Patient and Family preferences, Values, Cultural traditions, and Socioeconomic conditions are respected.
Patients require services that go “beyond the pill“. By engaging directly with patients and partnering with them across the entire pharma value chain, pharma companies can re-invent their business and operating models. Healthcare providers had to change and were made more flexible to meet patients’ needs. For example,a new position has emerged in pharmaceutical companies: Chief Patient Officer. The responsibilities include ensuring that the voices of the patients and patient associations are heard by the group, from the early stages of research and development to the commercialization of new health solutions.
Patient centricity is rooted in design thinking
I would like to share with you a very well-known example of design thinking that I find very meaningful and appropriate for this article.
After spending two and a half years working on an MRI machine project for GE Healthcare, Doug Dietz went to the hospital to observe the first use of his machine. He witnessed a little girl in tears getting prepared for anesthesia. Doug learned then that 80% of pediatric patients have to be sedated for their scans because — out of fear — they can’t lie still long enough. If an anesthesiologist isn’t available, the scan has to be postponed, creating additional costs and a new worrying episode for the patient and his family.
In collaboration with IDEO, the leading design thinking company, Doug started by observing and talking to young children at a daycare center, and life specialists to understand what pediatric patients went through. Next, he created the first prototype of what would become the “Adventure Series” scanner. Indeed, Doug helped transform the MRI “horror machine” into a kid’s adventure story, with the patient in a starring role. They also created a script for machine operators so they could lead their young patients through the adventure. Not only did it reduce the fear of young patients, but it also reduced the costs of anesthesia and rescheduling.
The patient is the “expert in living with his condition“
Patients with a chronic health condition, “live with” it 24 hours a day and 7 days a week. Therefore, they know more about its physical, psychological, and social impact on their lives than anyone else. “The University of Patients” proposes to rely on the expertise of patients to share the diagnosis and cure of their disease. Launched 8 years ago, the University of Patients allows people with chronic diseases to train at university alongside medical students. The University started in 2009 and to this day, such universities exist in Paris, Marseille, Grenoble, California and Montreal.
#2 Patient-centricity and technology
Patient-centricity could also be referred to as on-demand healthcare, a healthcare revolution wherein patients are more proactive concerning their health care and require obtaining the services they need, at the preferred time based on their feasibility and availability. One of the best to do so is to resort to new technologies.
Innovative healthcare initiatives that put the patient at the center
“EldriCare”, in India
The role of follow-up care companies like EldriCare has proven indispensable as life coaches. It is a patient centric technology platform based in Bengaluru and servicing all of India which allows hospitals, doctors, nurses and patients to access related medical information in a secured manner. EldriCare follows up with patients over the phone, counsels them and reminds them about their medications, nutrition and the need to visit their doctor.
As a result, it also helps to reduce hospital readmissions. It enables a doctor to arrest the complications early enough and mitigate issues at the outset, thus keeping patients out of the hospital. Reducing hospital readmissions also had positive financial outcomes for health care organization. Thus, the benefit is twofold: it strengthens the doctor-patient relationship and lowers the cost for chronic treatment.
“Connecting to Care”, in Canada
Launched as pilots in two cities in 2015 with initial government funding of 1.5 million Canadian dollars, Connecting to Care mines administrative data to identify the subset of patients who account for an outsized proportion of health care utilization and costs. According to the Health Quality Council of one of the pilot cities, 1% of patients accounted for approximately 21% of hospital costs. Connecting to Care uses proactive outreach to prevent hospitalizations and emergency room visits by focusing on timely use of community-based services, including support for medical, mental health, and addiction treatments, as well as assistance with social needs. A team of providers coordinates personalized plans for each patient in the Connecting to Care program. Technology plays a critical role, including use of electronic health records (EHRs), connections with community support partners, and mobile phones to check in with clients, such as reminding upcoming appointments.
Results: hospital inpatient days were reduced by 84% (from 120 days to 20). Each day spent out of the hospital versus in it saved an average of 1,400 Canadian dollars. The Connecting to Care program shows that liaisons focusing on an individual’s needs, rather than the provision of a particular type of medical service, can be effective in averting costly hospitalizations and ER admissions.
“PatientsLikeMe”, in the USA
As discussed in the introduction with Diagnosis, collective intelligence is a valuable tool in health care. The Heywood brothers understood this when they launched PatientsLikeMe, an online portal and mobile application that allow people with health conditions to share information and data relating to health and clinical trials with other patients and researchers with the aim to improve patient outcomes and involvement in research. Currently, the platform has a network of over 600,000+ patients who have collectively contributed 40 million points of data about disease. PatientsLikeMe has collaborated on a number of projects with pharma companies in an endeavor to be closer to what concerns patients most, including with UCB to create a patient community around epilepsy, and Shire Pharmaceuticals to track and share experiences for patients and their care givers living with rare diseases.
The company uses patient-generated data, big data and AI so everyone can understand how their medical, behavioral and environmental factors may advance or mitigate disease and optimize health. Indeed, one of the most promising fields where big data can be applied to make a change is health care. Big health care data has considerable potential to improve patient outcomes, predict outbreaks of epidemics, gain valuable insights, avoid preventable diseases, reduce the cost of healthcare delivery and improve the quality of life in general.
However, deciding on the allowable uses of data while preserving security and patient’s right to privacy is a difficult task. Some 76% of patient groups who responded to a Deloitte study stated that patients have ‘high’ or ‘some’ trust in health apps developed by patient groups, but only 32% could say the same for apps produced by pharma.Thus, it is essential for pharma companies to find a way to ensure the security and confidentiality of these sensitive data and gain patients’ trust.
#3 The future of health care: is any technology desirable for a patient-centric approach?
The biggest innovations of the 21st century will be at the intersection of biology and technology. Steve Jobs
Pharma is seeing digital technology’s potential for creating a new patient-centric business model that combines connected devices with big data analytics and AI to develop new, more personalized, drugs for smaller groups of patients while monitoring and managing patient adherence and health outcomes.
Gamification and Wearables: flourishing sectors
Several studies have shown that gamification can have significant, positive effects on patients’ health by promoting adherence to treatment, fostering resilience, and increasing motivation to fight diseases. Global healthcare gamification market is planned to exceed USD 40 billion by 2024; according to a research report by Global Market Insights, Inc.
Wearables (or clinical-grade wearable technology) contribute to pharma’s ability to engage with patients to create a more patient-centric ecosystem, often in tandem with smartphone apps. Wearables are smart electronic devices worn on, or implanted in, the body, such as: fitness-tracking bands, smartwatches, smart glasses, etc. They incorporate practical functions and features that can be used to identify changes in vital signs at an early stage.
Here are more precisions to understand this graphic, by type:
The smart watches occupied a major share of 29.82% in 2018
Exoskeletons are expected to register the highest growth rate of 37.35% on the forecast period.
And geographically:
North America accounted for a share of 35.73% of the market studied in 2018
The Asia-Pacific regional segment is expected to register the fastest growth, up to 23.85%, over the forecast period.
Neuralink: when technology supplants humans
An example of a futuristic wearable: Elon Musk is developing a way to merge your brain with a computer with his startup Neuralink. At an event in San Francisco in July 2019, the Neuralink team revealed it has been developing a brain-computer interface (BCI) made of thin, thread-like implants. This could one day work with (or, more specifically, within) humans, allowing us to control technology with our thoughts.
The Neuralink team believes the medical uses of its brain-computer interface could be the most promising. Potential applications could include amputees regaining mobility with prosthetics, or the tech being used to treat spinal cord injuries, as well as aiding vision, hearing and other sensory issues.
If commercialized on humans, this technology would be extremely powerful. But is the creation of brain-machines part of a design thinking approach? Rather than human-centered, wouldn’t it be more transhuman-centered?
To conclude, health care is clearly redefining itself with the patient-centricity revolution, which is accelerated by cutting-edge technologies. However, digital tools can sometimes exceed human capacities and create an ambiguity on whether they are used in humans’ service. The question of health care data privacy also arises here. We live in a world where personal data is increasingly debated and there are attempts to control it. Health care data is the most sensitive of all and yet sharing and using it can save lives.
However, even before discussing the benefits of certain technological advances in the medical field, there are solutions that are quite simple to implement to undertake a design thinking approach. Indeed, setting up a multidisciplinary team makes it possible to tackle an issue by considering all the areas it may concern. The “One Health“ approach designs and implements programs in co-creation with professionals with a range of expertise who are active in different sectors. One Health promotes multi-sectoral responses, for example with the OhTicks! multidisciplinary project bringing together veterinarians, doctors, scientists and sociologists to better characterize tick-borne pathogens. Even though patient-centricity is key, one must not forget about breaking silos and think across expertise as health is complex and multifactorial and no one detains all of the keys to improve it.
Rédigé par Cloé Marche, Consultante Acceleration Tactics
Bibliography – Monitor Deloitte, “Gamification study”, 2015 – Deloitte report, “High-value health care: Innovative approaches to global challenges”, 2016 – Deloitte Centre for Health solutions, “Pharma and the connected patient: how digital technology is enabling patient centricity”, 2017 – IDEO – Eldricare – PatientsLikeMe