So all you need is an #iphone and #gchat for a doctor’s visit right?

Google just announced that they are piloting a specific health focused service for Helpouts which apparently is a fully HIPAA-compliant system that allows patients to receive telemedicine from clinical providers.  They are currently partnering with One Medical Group, an “experience-focused” medical practice, which allows patients to “request a Helpout, and typically speak with a physician within 20 minutes. It’s recommended for people with cold and flu symptoms, rashes, or simple infections.

I love the idea of medicine finally moving away from the clinic and towards a digital future, and in our health system we are currently exploring ways that we can deliver telemedicine to our patients with diabetes.  But to do this effectively, we have to understand the elements needed for a health visit. One of my students helped me map out this diagram of a diabetes visit and it makes me realize that telemedicine is much more than just communication technology.  For a larger view click here.

image

How do you measure height, weight, and blood pressure of the kids to make sure that they are growing and developing and are not hypertensive? How do you check their injection sites to make sure they don’t have scar tissue affecting absorption of their insulin?  How do you obtain hemoglobin A1c, which is the 3 month measure of glycemia that we usually obtain in clinic to help inform our treatment decisions? And how do we review blood sugars from afar given that most patients walk in with numbers written on a piece of paper?  It’s not that simple, even with a number driven disease like diabetes.  I do believe the sky’s the limit in digital health, but for right now I don’t think the google solution will fly for us. Other options include using designated telemedicine centers, or even delivering co-managed care in partnership with general pediatricians; time will tell as we also try to figure out that horrible tangled web of reimbursement!

Acetaminophen (Tylenol) overdose: Unavoidable pediatric problem or the consequence of bad design?

Acetaminophen (Brand Name: Tylenol) is a parent’s and pediatrician’s best friend. It is probably the most widely used medication in children, who take it for the nearly universal complaints of fever and pain. There are other medications like ibuprofen (Brand Name: Motrin) that can also alleviate these symptoms but ibuprofen can cause stomach upset, so I often prefer acetaminophen as the first line medication for my kids when they get sick.

Despite that fact that it is so widely used, acetaminophen can be a very dangerous drug that can kill otherwise healthy children and adults. Kudos to Propublica and This American Life for their in-depth series about the dangers of acetaminophen. You MUST read “Use Only as Directed" and "Dose of Confusion" and listen to this compelling audio story, as this information applies to you and your family.

Children and adults who take too much acetaminophen can experience liver toxicity and death, and it is estimated that 150 people in the US die from acetaminophen overdose every year. Unfortunately that is what happened to little Brianna.

What makes acetaminophen so dangerous is that has “a narrow therapeutic index” which means that there is a small margin between a “safe” dose and a “harmful” dose of acetaminophen. T. Miller and Sean Cole discuss this in their podcast:

So with a drug like ibuprofen, Advil, it can cause stomach and gastric problems at the recommended dose. Aspirin, same thing. But it takes a lot of ibuprofen to kill yourself. In fact, there’s not a lot of cases on record of anybody dying from ibuprofen toxicity. In the only case he could find, it took 20 times the recommended dose to kill someone. Same with aspirin. You have to take six or eight times the maximum recommended dose for it to become toxic to your system. With acetaminophen, just twice the maximum safe dose, or even less, taken over several days could possibly get you into serious trouble.

I’ve known about this danger for a long time, since tylenol poisoning is a staple of the medical school and pediatric curriculum, and there’s a chart in the Harriet Lane Handbook of Pediatrics that describes when to use the antidote N-acetylcysteine, which was developed to counteract the toxicity of a Tylenol overdose. However, given my recent personal revelations regarding the poor design of the Epipen Jr., and my new perspective as a designer, I am just flabbergasted and disappointed that Tylenol overdose is treated as a common pediatric problem, as if it were some naturally occurring disease over which we have no control.

Stay tuned for the next post, in which we will talk about design flaws leading to acetaminophen injury and death.

Distinguishing the Hype from Reality in Mobile Health 
“Dear New York Times, please don’t serve us infomercial articles”
When you read the above tweet stream, you would think that HealthTap, a social network of doctors to whom patients can pose questions, is the next blockbuster drug of the century. The tweets link to this article in the esteemed New York Times:



Here is how the article starts:

While most start-ups feverishly track figures like the total number of users, Ron Gutman, the founder and chief executive of the health information start-up, HealthTap, is more interested in a different data point. This week, the start-up heard from its 10,000th user who said the site saved her life.


Which coincidentally reads just like the advertising that company is sending to my inbox:



And look, in the last few days since the the article was published, they’ve saved another 182 lives and prominently display this on their website!



I am a physician researcher with specific training in biostatistics and epidemiology who studies health outcomes. I am also a technology enthusiast and I co-direct a mobile technology program for managing chronic diseases. I believe that mobile technology has great promise for making a difference in the lives of individuals with chronic disease, but we have to use real evidence to understand the impact.
I don’t see anywhere how HealthTap recorded or evaluated or defined how a “life was saved”. So much important health research is performed and never even gets the light of day in such an esteemed publication, yet we take some tech founder’s claims about health as a given? Let’s not forget that he obviously has an economic interest in touting his app’s effectiveness, and from what I can tell he doesn’t have any experience in assessing health outcomes.
Dear New York Times, I am an avid subscriber and reader of your esteemed publication. But please, do some fact checking. I would think that stories related to health (even if they are in the technology section) would be more carefully vetted for their accuracy. It is folly to give some founder’s claims about health outcomes equivalence to scientists and researchers who spend years and lots of resources and effort trying to assess whether a technology does really save lives. You should be providing objective reporting on new health technology service, not some sycophantic tech blog piece that is afraid to offend a popular Silicon Valley startup. I also posted a brief comment here and there are other comments which reveal a very different narrative of the company here, not to mention the fact that they tend to dabble in hyperbole as a practice.  High-res

Distinguishing the Hype from Reality in Mobile Health

“Dear New York Times, please don’t serve us infomercial articles”

When you read the above tweet stream, you would think that HealthTap, a social network of doctors to whom patients can pose questions, is the next blockbuster drug of the century. The tweets link to this article in the esteemed New York Times:

Here is how the article starts:

While most start-ups feverishly track figures like the total number of users, Ron Gutman, the founder and chief executive of the health information start-up, HealthTap, is more interested in a different data point. This week, the start-up heard from its 10,000th user who said the site saved her life.

Which coincidentally reads just like the advertising that company is sending to my inbox:

And look, in the last few days since the the article was published, they’ve saved another 182 lives and prominently display this on their website!

I am a physician researcher with specific training in biostatistics and epidemiology who studies health outcomes. I am also a technology enthusiast and I co-direct a mobile technology program for managing chronic diseases. I believe that mobile technology has great promise for making a difference in the lives of individuals with chronic disease, but we have to use real evidence to understand the impact.

I don’t see anywhere how HealthTap recorded or evaluated or defined how a “life was saved”. So much important health research is performed and never even gets the light of day in such an esteemed publication, yet we take some tech founder’s claims about health as a given? Let’s not forget that he obviously has an economic interest in touting his app’s effectiveness, and from what I can tell he doesn’t have any experience in assessing health outcomes.

Dear New York Times, I am an avid subscriber and reader of your esteemed publication. But please, do some fact checking. I would think that stories related to health (even if they are in the technology section) would be more carefully vetted for their accuracy. It is folly to give some founder’s claims about health outcomes equivalence to scientists and researchers who spend years and lots of resources and effort trying to assess whether a technology does really save lives. You should be providing objective reporting on new health technology service, not some sycophantic tech blog piece that is afraid to offend a popular Silicon Valley startup. I also posted a brief comment here and there are other comments which reveal a very different narrative of the company here, not to mention the fact that they tend to dabble in hyperbole as a practice. 

My Office as a Reflection of my Transformation from Doctor to Designer
I came back from sabbatical with the traditional hierarchical medical office: files, books and bookshelves, a large desk which takes up over half the office, a tiny little whiteboard on the door that was hardly used, and not a lot of room for collaborators.  So I did a little bit of remodeling to change the space that I work and change the nature of my work.  I got rid of pictures, bookshelves, and papers, turned the desk into one long table that now fits 4-6 people, and painted both walls with whiteboard paint so that as a team, my collaborators and I can ideate and create new prototypes and systems! B did a little bit of decorating for me as well, true to his design skills! (I think we need to work on getting that n into “design thiking”!)
High-res

My Office as a Reflection of my Transformation from Doctor to Designer

I came back from sabbatical with the traditional hierarchical medical office: files, books and bookshelves, a large desk which takes up over half the office, a tiny little whiteboard on the door that was hardly used, and not a lot of room for collaborators.  So I did a little bit of remodeling to change the space that I work and change the nature of my work.  I got rid of pictures, bookshelves, and papers, turned the desk into one long table that now fits 4-6 people, and painted both walls with whiteboard paint so that as a team, my collaborators and I can ideate and create new prototypes and systems! B did a little bit of decorating for me as well, true to his design skills! (I think we need to work on getting that n into “design thiking”!)

Blame and Burden: Is Hand-washing the Responsibility of the Patient, or the Health Care System?
On the heels of my talk about design and health care at the 2013 Cusp Conference, I wanted to comment on this article which recently came out in the WSJ. Hand-washing is critical for avoiding the spread of infections acquired in hospitals, but only about half of health care professional comply with hand-washing protocols, despite a variety of different interventions to improve hand-washing rates, including penalties, electronic sensors, and video cameras. @lauralandroWSJ reports that newer interventions are now focused on having the patient ask the health care provider to wash his/her hands.

"Some monitoring systems emphasize patient engagement and sound an electronic alert to remind patients to speak up when a staffer enters the room."

Really? Are we training our patients to be Pavlovian dogs? I am not sure how I would feel if I had to speak after a bell went off. 

"The nonprofit Association for Professionals in Infection Control and Epidemiology is kicking off a campaign this month including posters mailed to 15,000 hospitals with tips on how patients can take an active role. It suggests asking staff about hand hygiene and requesting that hospital rooms be cleaned if they appear dirty."

Patients have to first determine whether the room is clean (mind you the bad bugs don’t really make themselves known in an obvious way) and then they have to request one if it’s not? Is it not the right of every patient to have a clean room? 
As a “medical designer”, I have written previously about how we blame our patients instead of blaming the design of the health care system. But this takes things to a whole new level. I think it’s a pretty sad state of affairs for the health care system to ask patients to do our job for us. We are getting paid to do supposedly deliver high-quality healthcare, yet we are putting the burden on the patients to protect their own health, and we make them do it for free. Don’t our patients have other things to do, like focus on their illness and recovery? Not to mention the fact that “the white-coat barrier” keeps them from saying anything anyway.

"…one-third of patients surveyed at the University of Pittsburgh Medical Center said they observed doctors failing to wash their hands, but nearly two-thirds said nothing to their doctor about hand hygiene. Most didn’t believe it was their role to do so and said they felt embarrassed or awkward and worried about reprisal."

Let’s stop blaming and overburdening our patients, and let’s start using design thinking to find a truly patient-centered solution to improving this problem. High-res

Blame and Burden: Is Hand-washing the Responsibility of the Patient, or the Health Care System?

On the heels of my talk about design and health care at the 2013 Cusp Conference, I wanted to comment on this article which recently came out in the WSJ. Hand-washing is critical for avoiding the spread of infections acquired in hospitals, but only about half of health care professional comply with hand-washing protocols, despite a variety of different interventions to improve hand-washing rates, including penalties, electronic sensors, and video cameras. @lauralandroWSJ reports that newer interventions are now focused on having the patient ask the health care provider to wash his/her hands.

"Some monitoring systems emphasize patient engagement and sound an electronic alert to remind patients to speak up when a staffer enters the room."

Really? Are we training our patients to be Pavlovian dogs? I am not sure how I would feel if I had to speak after a bell went off.

"The nonprofit Association for Professionals in Infection Control and Epidemiology is kicking off a campaign this month including posters mailed to 15,000 hospitals with tips on how patients can take an active role. It suggests asking staff about hand hygiene and requesting that hospital rooms be cleaned if they appear dirty."

Patients have to first determine whether the room is clean (mind you the bad bugs don’t really make themselves known in an obvious way) and then they have to request one if it’s not? Is it not the right of every patient to have a clean room?

As a “medical designer”, I have written previously about how we blame our patients instead of blaming the design of the health care system. But this takes things to a whole new level. I think it’s a pretty sad state of affairs for the health care system to ask patients to do our job for us. We are getting paid to do supposedly deliver high-quality healthcare, yet we are putting the burden on the patients to protect their own health, and we make them do it for free. Don’t our patients have other things to do, like focus on their illness and recovery? Not to mention the fact that “the white-coat barrier” keeps them from saying anything anyway.

"…one-third of patients surveyed at the University of Pittsburgh Medical Center said they observed doctors failing to wash their hands, but nearly two-thirds said nothing to their doctor about hand hygiene. Most didn’t believe it was their role to do so and said they felt embarrassed or awkward and worried about reprisal."

Let’s stop blaming and overburdening our patients, and let’s start using design thinking to find a truly patient-centered solution to improving this problem.

This was Not a Medical Conference: CUSP 2013 

I just posted my slides (adapted for the web) from a talk that I gave last week at the 2013 Cusp Conference.  Cusp is a conference about the design of everything.  I was so honored to present at this event given the caliber of speakers in the line-up (just to name a few, a famous LEGO artist, a sword swallower, and Gary Slutkin from CureViolence).  It literally was the most amazing conference I have ever attended in my life!  My talk was about my personal journey from medical doctor to medical “designer” and why I think it is so critical for us as medical professionals to become design thinkers.  Thank you to Dave Mason and the folks at Multiple for an incredible and unforgettable experience!  High-res

This was Not a Medical Conference: CUSP 2013 

I just posted my slides (adapted for the web) from a talk that I gave last week at the 2013 Cusp Conference.  Cusp is a conference about the design of everything.  I was so honored to present at this event given the caliber of speakers in the line-up (just to name a few, a famous LEGO artist, a sword swallower, and Gary Slutkin from CureViolence).  It literally was the most amazing conference I have ever attended in my life!  My talk was about my personal journey from medical doctor to medical “designer” and why I think it is so critical for us as medical professionals to become design thinkers.  Thank you to Dave Mason and the folks at Multiple for an incredible and unforgettable experience!