How do people REALLY make healthcare decisions?

Peter Jones Sensemaking, Wu Wei

Thomas Goetz in Wired Magazine highlights Alexandra Carmichael and her decision tree for health decisions, along with 2 other scenarios. Alexandra is the founder of the CureTogether open source health research community. CureTogether is an innovative service that facilitates finding effective ways to address health concerns by active participation by people living with certain conditions, especially those resistant to conventional treatment regimes, such as chronic pain.  (She is also an active and inspiring member in the Design for Care community, which is why I noticed and had affinity for her scenario). Goetz’s article on decision trees (methods of structured decision analysis) suggests that they are an effective tool making better everyday health decisions. The reasoning is essentially based on the assumption that better health is a matter of inputs and outputs, which can be mapped and judged to determine a preferred course of action. Better inputs – food, exercise, lifestyle decisions – lead to better outputs, which are improved health measures and a healthier experience of life. Wired online even provides a decision tree mapping tool you can try. Alexandra’s …

Collaborative Sensemaking & the Irreducible Burdens of Healthcare Information

Peter Jones Wu Wei

Are EHRs (Electronic Health Records) Error Inducing Machines? Thanks to Brady Anderson on the Design for Care community site who alerted us to Dr. Christine Sinsky’s “eNirvana – Are we There Yet?” I believe we are “not yet there.”  As long as the Medicare specification known as “meaningful use “criteria ignores design, usability, and the propensity for foreseeable error, we are not even close. The key quote from Sinsky illustrates the problem from the point of care and clinical use: While Google Desktop Gadgets make access to information as unfettered as possible, HIT systems often sequester individual tidbits of information at the ends of nonintuitive labyrinths, with needless hurdles along the way. Clinicians need clear access to priority information, not an obstacle course. As an EHR user, I have to keep a thought in mind until, five clicks and two screens later, I can find related information. Then, I have to park all of this developing thought for four more clicks, three screens and a slow download until I get to the screen where I can take action. Repeat this …

Infrastructure lock-in, Innovation lock-out

Peter Jones Wu Wei

Experienced systems and design professionals have increasingly raised their concern for the poor design of eHealth Records (EMR, EHR) systems for the last couple of years. The rapid increase in adoption and deployment, spurred by US government stimulus spending, has pushed vendors to roll systems to market in unrepentant haste. With interaction design that would make a 1980’s mainframe designer cringe (like me, I worked on AT&T’s TIRKS as well as with their Labs AI group). People working directly in the EMR world are building workarounds, add-ons, patches, and alternative displays to fit the data systems to their work contexts and institutional needs.While EMRs are enterprise information systems, they are tightly controlled by their vendors and generally not extensible. The ad hoc design/development process is unsustainable, could lead to communication and data breakdowns between the EMR and the multiple add-ons. Future maintenance of the workarounds is not guaranteed -a major EMR vendor upgrade could wipe out a year’s worth of work on integrated applications that were rendered incompatible . There are two huge issues at stake: 1) That poor design …

Designing for Care

Peter Jones Wu Wei

Reposted from the Rosenfeld book site / author blog. I am inviting experienced designers (and professionals and administrators) to review and advise the course of a new book, Design for Care. Interested and interesting people can register on the book’s community site at designforcare.com. Healthcare is a sector of complex interconnected systems. If we act only on the domains for which we have access and personal knowledge, we may interfere with or fail to account for other parts of the system. Therefore, the concept of this vertical book on healthcare design is to build bridges across the related systems, roles, and structures in healthcare. We hope to enable dialogue between designing for patient experiences, consumer health information, institutional experiences, and professional practice. I believe they are all interrelated, and the prepared designer will be more effective when they understand the problems, solutions, and methods in the realms of care experience they have not (yet) touched. Our design perspectives and methods must become collaborative, not only within our teams, but across health disciplines. In fact, information design and experience design and …