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Coping with Complexity in Healthcare: Enabling Sense-Making Through Great UX – UXPA Boston 2015

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Coping with Complexity
in Health Care
Enabling Sense-making through Great UX

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D I G I T A L . H E A L T H . I N N O V A T I O N . F O R B E T T E R L I V E S .
#AskMedullan

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Rebecca Lord
Director, UX
Tim Merrill
Sr. Manager, UX
Rob Gifford
Sr. Associate, UX
Who Are We?

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Coping with Complexity in Healthcare: Enabling Sense-Making Through Great UX – UXPA Boston 2015

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Current trends have expanded the role that people play in monitoring, managing, and making decisions about their health. Whether people are selecting the right health insurance plan, evaluating treatment options, or trying to comprehend and gain actionable insight from complex medical tests or their own fitness data, they are often faced with complex and unfamiliar information and data. Failure to make sense of this information can lead to anxiety, poor decisions, and missed learning opportunities. User experience professionals have an important role to play in improving health care by facilitating comprehension, clarity and actionable insight. In this session we will discuss how to design experiences that support complex decisions and sense-making in the healthcare space. You’ll learn how different types of users approach diverse health information and offer you practical guidance on how to improve their experiences.

Current trends have expanded the role that people play in monitoring, managing, and making decisions about their health. Whether people are selecting the right health insurance plan, evaluating treatment options, or trying to comprehend and gain actionable insight from complex medical tests or their own fitness data, they are often faced with complex and unfamiliar information and data. Failure to make sense of this information can lead to anxiety, poor decisions, and missed learning opportunities. User experience professionals have an important role to play in improving health care by facilitating comprehension, clarity and actionable insight. In this session we will discuss how to design experiences that support complex decisions and sense-making in the healthcare space. You’ll learn how different types of users approach diverse health information and offer you practical guidance on how to improve their experiences.

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Coping with Complexity in Healthcare: Enabling Sense-Making Through Great UX – UXPA Boston 2015

  1. 1. Coping with Complexity in Health Care Enabling Sense-making through Great UX
  2. 2. D I G I T A L . H E A L T H . I N N O V A T I O N . F O R B E T T E R L I V E S . #AskMedullan
  3. 3. Rebecca Lord Director, UX Tim Merrill Sr. Manager, UX Rob Gifford Sr. Associate, UX Who Are We?
  4. 4. Innovation for better lives Improve the healthcare experience by designing and developing solutions which engage healthcare consumers and facilitate business transformation Our mission:
  5. 5. Product Strategy UX/UI Design & Testing Technology Implementation What Do We Do? We design solutions that engage users across the healthcare spectrum through:
  6. 6. Healthcare
  7. 7. Healthcare is huge. 17%of all money made in U.S. comes from healthcare Complexity in Healthcare
  8. 8. It effects us at every point of our lives.. Financially Well-being Complexity in Healthcare
  9. 9. Trends converging Advancements in Science Policy New Technology Users Highly regulated Legacy systems
  10. 10. It’s confusing. Insurance coverage Patient outcomes Care management Clinical research Wellness Managing chronic conditions
  11. 11. UX can help people feel empowered UX+ = Empathy Systems thinking Psychology Information design
  12. 12. Let’s dig into a few ways UX can solve health care complexity: Making decisions about health coverage Making sense of medical information Taking advantage of the sea of health data 1 2 3
  13. 13. And how? Experience models and frameworks Familiar design patterns Cognitive computing 1 2 3
  14. 14. Complex Health Coverage Decisions Rob Gifford
  15. 15. Meet Amy… 26 years old She just finished her Master of Social Work Degree Landed a job at a local non-profit First full-time job with benefits
  16. 16. Well, sort of… Rather than offering traditional benefits, Amy’s employer is offering health coverage through a Health Insurance Exchange
  17. 17. Health insurance exchanges are marketplaces for health plans. Millions of employees are now receiving coverage through public and private exchange. Health exchanges explained
  18. 18. That’s great for employees, right? Employers love exchanges because they make costs predictable and provide plenty of options for employees. Health exchanges explained
  19. 19. More choices often lead to more anxiety & regret and lower satisfaction. The Paradox of Choice
  20. 20. Unlike porridge and jam, health insurance is complex. Amy’s Paradox She’s being tasked to pick the option that will lead to the right level of coverage for her. More options = more confusion & potential regret
  21. 21. Traditional decision theory says the most accurate decisions are made using a weighted-additive approach How do does Amy decide?
  22. 22. Plans differ on a variety of attributes • Co-pay • Deductibles • Co-insurance • Out-of-pocket max • Amount of providers • In-network vs. out-of- network costs Insurance plans are complicated
  23. 23. This is Amy’s first job with benefits Things are starting to get complicated… Which attributes are important? There is a lot of uncertainty.
  24. 24. Currently, Amy is not in the happy quadrant. How UX can help How do we move her? Abilitydecisionmaker Simplicity of choice Decision Complexity
  25. 25. Educate her about which attributes of insurance plans are most important and remove irrelevant data Design information so that important plan attributes of a decision are prominently displayed How UX can help 1
  26. 26. How UX can help Ask Amy about her health care needs in plain language and analyze our plans for her. 2
  27. 27. Using our knowledge of her, we can narrow down plans to a few meaningful options framed in a logical order. How UX can help 3
  28. 28. We can format plan information to facilitate clear comparison between plan attributes that matter most How UX can help 4
  29. 29. By employing these techniques, we simplified Amy’s choice and empower her with a better understanding of her options. Abilitydecisionmaker Simplicity of choice Decision Complexity How UX can help
  30. 30. A High Deductible Plan with an Health Savings Account Why? She's relatively young and has few health conditions. It’s the most affordable option while also insuring she was prepared in case anything did happen. What did Amy decide?
  31. 31. Amy can have confidence in her choice. She also has a few extra dollars each month to pay for her vacation (she’ll need it).
  32. 32. Making Sense of Medical Information Rebecca Lord
  33. 33. Complex medical information surrounds us Making sense of it is challenging, yet people need to make important decisions, potentially life changing decisions, based on this information
  34. 34. And it’s not getting any simpler Full genome sequencing is becoming readily available and more popular It provides a map of your unique makeup and finds variations that may cause disease or affect your risk for disease Photo by Mario Tama/Getty Images
  35. 35. Our Challenge in UX… Make complex medical information understandable, meaningful, and actionable.
  36. 36. Meet Jack… Works for a software company in business development Married with two kids Loves running and getting outside Generally healthy guy
  37. 37. Jack decided to have his full genome sequenced two years ago. Why? Know thyself. He wanted a better understanding of who he was from a health perspective. “Is there something I can be doing to take better care of myself that I’m not aware of?” Also, geeky curiosity. Jack has a masters in chemistry and is passionate about the trends in genomic diagnostics.
  38. 38. Jack was excited when his results came in… Particularly since he could view them on his iPad!
  39. 39. But… When he logged in, Jack was left feeling confused and frustrated.
  40. 40. Primary screens don’t support confident exploration
  41. 41. Interactive visualizations too complicated to comprehend
  42. 42. Libraries of educational material too technical to understand
  43. 43. No tools to facilitate connection and collaboration
  44. 44. Despite the bad UX… Jack learned a few things.
  45. 45. Seriously, after many hours of exploring his genome, Jack learned: He has a variant on SCN5A gene which is associated with Romano-Ward syndrome. A common symptom is light- headedness during intense exercise.
  46. 46. This explains why: Jack passed out a mile from the finish line at the Boston Marathon a few years ago.
  47. 47. This surprising information gave Jack a sense of relief and motivated him to change… He only competes in shorter road races — half-marathons are just fine! And always runs with friends, just in case.
  48. 48. Remember, Jack is special… He’s got a masters in chemistry He’s familiar with and passionate about genomics He’s already pretty healthy
  49. 49. We’re not all chemists and for many people, seeing their genomic results will be emotionally charged. How can we make this a better experience?
  50. 50. We’ve already got the tools Familiar design patterns and principles can transform the experience of consuming complex medical information
  51. 51. Design for real people, not scientists Tool tips Auto-suggest Sorting & filtering
  52. 52. Support confident exploration and learning Search Faceted navigation Personalized spotlighting
  53. 53. Create a sense of community and support Forums Direct & group messaging Introductions & connections Donation tools
  54. 54. Enable continued learning and collaboration Bookmarks Notebooks/boards Social sharing
  55. 55. Using familiar design patterns and principles can transform the experience of consuming complex medical information.
  56. 56. Cognitive Computing Actionable Insights from a Sea of Medical Data Tim Merrill
  57. 57. Promote healthy behaviors Improve patient outcomes Improve quality of care Reduce costs Reduce re-admissions Challenging Themes in Healthcare
  58. 58. Help people make better decisions
  59. 59. Staggering amount of data at our fingertips
  60. 60. How do we help people make sense?
  61. 61. Traditional Analytics?
  62. 62. The Dawn of Cognitive Computing
  63. 63. Cognitive computing is the simulation of human thought processes in a computerized model.
  64. 64. Deep data mining Unstructured data processing, including natural language and images Awareness of context What does that mean?
  65. 65. Sounds awesome. And yet entirely impractical for my project.
  66. 66. Nope.
  67. 67. ‹#›page© Medullan Inc.
  68. 68. What can Watson do now? Understand the relationship between speech patterns and known personality traits Explore tradeoffs when faced with multiple dimensions of important data Provide a natural language question and answer service
  69. 69. What can Watson do for healthcare?
  70. 70. Radiology and Cardiology: Medical Sieve
  71. 71. CaféWell: Watson helps patients get health and wellness information
  72. 72. Watson helps doctors diagnose and treat cancer patients Watson vs. Cancer
  73. 73. Now it’s your turn.
  74. 74. Cognitive computing is a powerful tool for your UX toolbelt.
  75. 75. Watson’s Available Services (APIs) Concept Expansion Personality Insights Concept Insights Message Resonance Relationship Extraction Tradeoff Analytics Visualization Rendering Question and Answer Visual Recognition Speech to Text Text to Speech Language Identification Machine Translation
  76. 76. Personality Insights Demo
  77. 77. • Play: https://github.com/watson-developer-cloud • Find a good problem to solve • Gather the right data sources • Train it on the data - build a “corpus” • Design the interface • Plan for feedback loop How do I use it?
  78. 78. Wrap up
  79. 79. Great UX solves real problems in health care: Making decisions about health coverage Making sense of medical information Taking advantage of the sea of health data 1 2 3
  80. 80. And how? Experience models and frameworks Familiar design patterns Cognitive computing 1 2 3
  81. 81. Thank you #AskMedullan
  82. 82. • Watson APIs: http://www.ibm.com/smarterplanet/us/en/ibmwatson/developercloud/se rvices-catalog.html • Healthcare questions demo (https://watsonhealthqa.mybluemix.net/) • Gallery: http://www.ibm.com/smarterplanet/us/en/ibmwatson/developercloud/ga llery.html • Open Source Github Resources: https://github.com/watson-developer- cloud • http://aws.amazon.com/machine-learning/details/ Resources

Editor's Notes

  • National Healthcare Expenditure (NHE) is projected to hit over $3 trillion this year
  • It effects us at every point of our lives…

    in ways that are core to who we are,

    both financially and, more importantly, our health and well-being
  • Rapid changes are taking place in Policy, Technology, and Science are placing more responsibility on the consumer
    Science: Genomics and new treatments

    Technology: Mobile adoption, big data & analytics, wearables, Internet of Things

    Policy: ACA - Affordable Care Act
  • So while we live in an incredibly promising time, navigating choices and making sense of data can lead to confusion, paralysis and bad decisions
  • As User experience professionals we’re uniquely positioned to use our skills in: empathy systems thinking psychology information design to help people feel empowered and make better decisions
  • This is great time in Amy’s life…
    One of the lucky ones who gets a job right out of grad school!
  • With traditional benefits, employees simply enrolling in her employer’s health plan
    In Private Exchanges, employees are given a defined amount to help pay for the health plan of their choice
    They are then, required to choose their plan out of as many as dozens of plans and carriers.
  • set stipend = predictable costs
  • More choices often lead to more anxiety and lower satisfaction.
    Iyengar & Lepperand ‘s findings on shopping for jam
    After a certain point, the value of additional choices decreases.
    Each additional choice also has negative side-effects: confusion, regret, self-blame (if things don’t turn out well)
  • She's being tasked to pick the option that will lead to the best outcome for her.
    Best option = the right level of health coverage (not too much and not too little)
  • Identify the attributes across all options that are important to you (weight them based on their importance)
    Calculate the value of each option’s attributes relative to your desired outcome and sum them.
    Then, comparing the utility or value that each option provides relative to other options.
  • We can even help her develop her own utility function by asking her about her own needs
  • Facilitate comparison between these options.
    Amy retains autonomy but avoids feeling overwhelmed.
  • Facilitate comparison between these options.
    Amy retains autonomy but avoids feeling overwhelmed.
  • Amy chose a high deductible plan with an Health Savings Account
    Why? Because she's relatively young and has few health conditions, she decided it was the most affordable option while also ensuring she was prepared in case anything did happen.
    In the end, we were able to transform the experience by removing choice complexity, while finding a new option that she wasn't aware of before.
  • EKG?

    http://challengepost.com/software/clayr-the-lab-form-ocr-synthesizer
    http://www.panoramatest.com/sites/default/files/images/results_22q.png

    http://www.scandirectory.com/images/bloodchart/p1.jpg

    http://challengepost.com/software/clayr-the-lab-form-ocr-synthesizer
    http://www.panoramatest.com/sites/default/files/images/results_22q.png

    http://kimschoof.org/wp-content/uploads/2012/01/pathologyReport.gif
  • As you can imagine, the results are highly complex and mind-boggling.
  • The human genome is HUGE! There’s lots of data to consume. Jack’s tool didn’t give him any information scent. He had to hunt a peck his way through chromosomes to look for warning signs.
  • Time consuming, not confident he’s looking at the right stuff, worried he’s missing something important in all of this information.
  • You’d need a degree in medicine to understand the terminology. What does “unknown clinical significance” mean? how do i know what’s good or bad?  

  • Jack has questions about his results, but no one to ask them of. He also knows that researchers need more data. No way to donate his data or join research studies – he wants to be of help, but how?
  • What do his genes tell him?

    http://transhumanisten.com/tag/23andme/
    https://www.dukemedicine.org/
  • That he has a variant on SCN5A gene which is associated with Romano-Ward syndrome. A symptom of Romano-Ward is light-headedness during intense exercise.
    This explains why Andy passed out a mile from the finish line at the Boston Marathon.
    It also explains why, when he was younger, he often had moments of dizziness when he pushed too hard on the soccer field.

    This actionable information gave Andy a sense of relief.
    He changed his habits and expectations... Maybe he’s not a marathoner after all.
    He now runs shorter distances and trains with buddies. He’s given them warning signs and instructions in the case that he passes out.
  • Use patterns we’re already familiar with that aid comprehension and understanding.
  • Tooltips, search within, sorting.
    Give me some education about what I’m looking at. Don’t expect me to remember my high school bio classes. Wouldn’t it be cool if I knew what each chromosome was all about before I dove in? If instead of diving in, you also gave me options to learn more about the particular chromosome.
    What if I could sort by the chromosomes that had severe mutations I should be aware of? What if I could search for a condition I’m curious about and it told me where to start exploring?
  • Pull together all the information the user needs to learn. Use patterns like faceted navigation help people explore the depths of the data and make valuable insights. Anticipate the user’s natural questions (am i at risk? Are my children at risk?) and support their follow-on questions.
  • People will inevitably have questions they can’t answer or worries, doubts, fears they want to express. They’ll want to rely on experts and people in the same boat for support. Researchers need more data to fuel their studies. Use very common online community patterns (forums, videos, etc.) to connect people.
  • Let me collect and share information that’s important to me. Use patterns like clipboards or bookmarks. Evernote for test results.
  • So we’ve been talking about some challenging themes

    Not just for consumers and patients, but for
    clinicians,
    providers,
    researchers
    and insurance companies
  • …In so many formats:
    standardized text,
    but also natural language,
    voice recording,
    video and photographic data
    And in many languages

    All this information at our disposal makes the challenges of a UX professional a bit overwhelming
  • how do we help people use this data to make better decisions?

    how do we find patterns, make connections, change the way we think about things?

    How do we extract meaning from pure data?

    - how do we scale and share our knowledge
  • The human brain remains unrivaled for processing and analytical capabilities.

    Our entire lives are spent learning,
    creating patterns of understanding,
    which we can use to uncover meaning from data.

    Able to take in just small pieces of a puzzle and construct the bigger picture

    But we don’t scale.
  • Consuming and learning from vast amounts of data

    Understanding colloquialisms and patterns in images

    Augmenting understanding with a sense of the environmental situations
  • I bet you’re starting to wonder how the hell this applies to your project. You don’t have a supercomputer. You aren’t working on AI.

    But several companies are working on this:
    Google acquired DeepMind, a British AI company, in 2014
    Amazon has released the Amazon Machine Learning service
    IBM has developed Watson…
    How many of you have heard of Watson?
  • Guy from that great Sherlock show
    Never quite sure if he’s…
  • Back in 2011, IBM’s Watson simply dominated two top Jeopardy contestants.

    Look at that guy’s face. These guys aren’t used to being the smartest nerd in the room.
  • It’s 2015

  • IBM is investing heavily in using Watson to solve healthcare issues.
    New division: Watson Health (2,000 employees!)
  • Problem:
    Many hospitals have a shortage of radiologists on site
    Eye fatigue is a common problem with radiologists. An emergency room radiologist may look at as many 200 cases a day.
    Due to the volume overload, and limited amount of clinical information available as part of imaging studies, diagnosis errors can occur

    Solution:
    - Researchers trained Watson using thousands of frames of CAT scans
    They taught it to recognize arteries and arterial abnormalities
    And then they paired it with medical records
    Pairing that with a patients CAT scan, Watson was able to recognize and recommend areas of concern
    It reduces the viewing load of clinicians without negatively impacting diagnosis

    Source: http://researcher.watson.ibm.com/researcher/view_group.php?id=4384

    Scraps:
    advanced multimodal analytics, clinical knowledge and reasoning capabilities
    qualified to assist in clinical decision making




  • - CafeWell’s Concierge app leverages Watson
    - Process questions asked in normal human speech and search large datasets for answers.
    - Learn from each interaction to theoretically provide better and better answers
    - Answer users based not only on their question but also on specific information like their location, health status and health benefits available from their insurer, physician or local pharmacy


    Source: http://mobihealthnews.com/43442/six-new-health-related-initiatives-for-ibms-watson/
    http://mobihealthnews.com/27414/with-watson-api-launch-ibm-turns-to-welltok-for-patients-md-buyline-for-docs/
  • Partnerships with provider networks

    Problem:
    Diagnosing a patient’s particular type of cancer is complicated
    Determining the right drug combination for an advanced cancer patient is alarmingly difficult
    Requires a complex analysis of various sources of big data, rapidly emerging clinical trial information, and personalized gene sequencing

    Solution:
    Pointing Watson at a patient’s DNA produces personal insights in minutes, not weeks.
    Pointing Watson at the sea of cancer studies, external research, and patient data produces possible treatment plans for the physician to consider
    Making their decision faster and better informed


    Sources: http://mobihealthnews.com/43442/six-new-health-related-initiatives-for-ibms-watson/
    http://mobihealthnews.com/20255/ibms-watson-interns-at-memorial-sloan-kettering/
  • IBM and Amazon have released APIs
    to let anyone build apps
    that tap into this incredible tool
  • Concept Expansion
    maps natural language (euphemisms, colloquial terms) to more commonly understood phrases
    Personality Insights
    uses language analytics to infer cognitive and social characteristics (input social media, blog posts, email; use for personalization)
    Concept Insights
    map your input data to underlying concepts (uses training on Wikipedia; it can broaden the user’s investigation (Google search is just based on exact keywords)
    Message Resonance
    analyze your draft content and determine how well it’ll be received by users, based on learned data about them
    Relationship Extraction
    input large amounts of data (e.g. clinical trial data) and explore relationships based on concepts (as opposed to mere keywords)
    Tradeoff Analytics
    Helps users make better choices to best meet multiple conflicting goals, combining smart visualization and recommendations for tradeoff exploration
    Visualization Rendering
    built-in, interactive data visualizations which can be customized
    Question and Answer
    direct responses to natural language user inquiries fueled by primary document sources
    Visual Recognition
    Analyzes the visual content of images and video frames to understand the content directly without the need for a textual description
    “Helper APIs”

         - AlchemyAPI – query the world’s news like a database
  • https://watson-pi-demo.mybluemix.net/
  • Admit this probably sounded like an infomercial

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