Life in the Tubes

No one tells you that the worst part of your first colonoscopy isn’t the six feet of rubber tubing going where no tubing should go. (You can’t even feel it!). Oh no. It's the 24 hours before the procedure, at which point you must fast, drink only clear liquids and consume a gallon of a truly horrific cleansing substance whose taste I can only describe as rancid lemonade. The rancid lemonade’s formal name is Polyethylene glycol, and if you Google “colonoscopy prep” you’ll see universal disdain it receives from all those forced to bow down and consume its nastiness.

The new pill version of the aforementioned process touts its biggest benefit as bypassing said “bad-tasting liquid,” citing a study* that revealed that the bowel prep process is the top reason people skip preventive colonoscopies. Colon cancer is the second leading cause of cancer deaths in the United States, and although it’s among the most preventable, only 43% of adults follow the recommended screening guidelines. Worse, 61% of cases are identified only after it’s metastasized.** This begs the question: why has it taken so long for someone to make the experience more palatable so procrastination doesn’t allow detectable stage 1 to progress to an untreatable stage 4? I seriously doubt that a more pleasant tasting version would lead to a rise in prescription fraud, as all those who have experienced the intended effects can tell you. “Hi, my name is Frances, and I’m addicted to colon prep solution.” Doubt it.

We’re big fans of the non-health crowd using their superpowers to improve an experience or rethink a broken system. Look to what the Cleveland Clinic’s partnership with Diane Von Furstenberg and her infamous wrap dress did for the poorly designed hospital gown. They took what was one of the least dignified parts of a hospital stay (whose idea was that open back, anyway?) and made it cheerful, comfortable and even stylish in comparison to its predecessor.

I’d like to see what would happen if the Jamie Olivers and Ferran Adriàs of the world applied their talents as chefs to medical solutions like the above. If these guys can make apple into caviar, surely improving the taste of something as abhorrent as colon prep powder can't be that difficult. And unlike the caviar, which does look incredible, it may save some lives along the way.

Between the fear of the unknown and knowledge that the results will be life changing, no medical test comes without stress. And although incremental changes are coming in the form of improved hospital gowns and pills where liquids used to be, most every hospital stereotype–including the colorless waiting room filled with AARP and Cat Fancy magazines–is still alive and kicking.

Patient centered design is often about the simple, non-medical solution... so I’m still waiting for my meyer lemon and strawberry flavored prep liquid, Jamie. Want to get on that?

* OsmoPrep website

** Colonoscopy: Extremely Beneficial—Extremely Avoided

Go ahead. Giggle at the article Sexual Activity Tracked by FitBit Shows Up in Google Search Results. Then reflect for a moment on the huge potential of that data, even just in the world of online dating. Could sites cross-match their profiles with FitBit’s, allowing users to find those with compatible sexual styles and levels of vigor? How about determining if two people’s devotion to physical activity (other than in the bedroom) aligns–not just through self selected answers, but through the use of real data?  “I like long walks on the beach.” Oh yeah? Show me your FitBit profile.

If the quantified self movement has the means to radically affect things as seemingly frivolous as truth in online dating, just imagine what it could unlock when applied to patient care and tracing the origins and causes of disease. Hard core quantified selfers already have a glut of self recorded information, and the movement will only continue to grow as the techie generation comes of age, data storage costs spiral downward and cool new gadgets and platforms proliferate. The missing piece seems to be how this non-clinical but relevant data begins to integrate with our health care system and research.

Crohnology, one of Rock Health’s start ups, is a patient-to-patient forum for those with Crohn’s, colitis and other forms of IBD. Similar to Patients Like Me, it allows users to track and share their treatments, food sensitivities, histories and daily health in the hope of creating sense out of these diseases, many of which have no known causes. Crohnology’s founder Sean Ahrens built it out of his needs as a Crohn’s patient, and in response to the frustrations of others in the community. These platforms have enormous potential for researchers and pharmaceutical companies as a source of crowdsourced feedback around the efficacy of medications and in finding commonalities in those who have the disease. As a fellow IBD sufferer, I experience the annoying symptoms, and also have to live with the knowledge that its origins and causes are completely unknown. I’ve often questioned what I could have done differently or if anything could have prevented it, but do not have a detailed enough record of my childhood health and habits to draw any meaningful conclusions.

Companies like Curious give me hope that we'll start to find some answers. Curious is another Rock Health company building an open platform for people to experiment with and look for patterns and correlations in their own tracked and static data coming from a variety of sources, both personal and environmental. It has the potential to reveal patterns that would have previously gone undetected, but in aggregate, might bare the secrets of everything from diseases that until now have been impossible to trace to how the environment might affect your mood, and many other patterns. They believe it will attract not only the quantified self community, but anyone who wants to make sense of the flood of information in their lives.

Hopefully, the medical world will begin to find ways to cross pollinate with these highly motivated, always on and always tracking techies. And in the meantime, perhaps the more nimble online dating world will start enforcing a little honesty through real-time data.

Good communication has always influenced health care. And now, it’s a measurement that determines the quality of a hospital’s services.

The major arbiters of effectiveness and care in hospitals, historically, were quantitative things like mortality and readmission rates. But not anymore. The poorly-named but consumer-driven Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS, (really? who comes up with these names?) is a survey that compares them not just by numbers and outcomes, but how effectively they are satisfying patient needs and expectations. This qualitative criteria includes communication with doctors and nurses and their general responsiveness, in addition to things like cleanliness and noise levels. And it’s all provided by those receiving the care; patients. These reports are published on Hospital Compare, courtesy of Health & Human Services, and available to anyone with internet access and an interest in making an informed decision regarding where they receive care.  

It turns out emphasizing strong communication from the top down lifts other operational areas as well. In this release by the Disney Institute, Scott Gordon of Arkansas Children’s Hospital recalls how making effective communication a priority transformed not only the patient experience and improved outcomes, but also made his team more focused and led to better staff retention and fundraising efforts. Calling it “a culture by design rather than default”, the thoughtful changes paid big dividends beyond patient satisfaction and landed the hospital in the Fortune 100 Best Companies to Work for the third year in a row. 

If good communication can work wonders while patients are in the hospital, just imagine what it can after they check out. One of our start-ups here at Rock Health, Pipette, is building an application that functions as a conduit between doctors and their patients, to help monitor and educate them during the entire course of their care. With stats like "Patients who do not have a clear understanding of their after-hospital care instructions are 70% more likely to be readmitted or visit the emergency department than patients who do," it’s obvious that something as simple as a daily mobile feedback mechanism has completely untapped and perhaps even greater potential to transform the patient experience.

While it could be argued that effective communication has the power to transform any industry, nowhere is it more important to get right than hospitals, where life and death can hinge on something as small as a single word, tone of voice or gesture. And now that it influences rankings and bottom lines, perhaps it will become an even greater priority. 

What happens when you take a kick ass designer, show him/her an inefficient system or horrible interface? A few years ago, Dustin Curtis opened fire on the airline industry's UI prowess (or lack thereof) by posting his redesign of the American Airlines’ homepage, accompanied by an open letter to the management beseeching them to consider a few improvements. Following this first assault, a second came in the form of  Tyler Thompson’s redesign of Delta’s boarding pass. A third came soon after when Zach Klein’s one hour rethinking of poor defenseless Delta’s Sky Club portal made their current site look like amateur hour. What’s amazing isn’t just the sheer design talent. It’s that enormous corporations with a plethora of resources left enormous room for improvement; and that in just a few hours, a single designer looked at a challenging interface, applied their superpowers and made it into something useful, simple and beautiful.

In the health world, a big change came this June when the White House unveiled the Food Plate, a replacement for the very 90s food pyramid. It’s simplified and more graphic, showing the basic food groups and their proper proportions. No more nebulous number of portions (and who knew how big a portion was, anyway?), just advice in the form of food groups and how they fit together to make a balanced diet. 

Wired Executive Editor Thomas Goetz's powerful TED talk “It’s Time to Redesign Medical Data” is yet another example of what a design-driven future might bring. He depicted how a fresh, graphic-driven approach to convoluted lab reports can radically change a layperson-unfriendly, multi-page, black and white printout, making it into a thing of infographic beauty.

While laying out and making sense of complex data is not what most designers dreams are made of, perhaps it should be. In this data-driven world, there is less need for empty, pretty pictures and much more for art and design with meaning and purpose. And nowhere is there a better opportunity to do this than health, because even the airlines have finally caught on.

Thanks, Eloqua & Joe Chernov.

"The story I'm interested in is about asking what drives a powerful person–what makes them tick? How do they make and then remake themselves?"

What happens when you take the story of Imelda Marcos, bring it alive through disco music and let talented vocalists intrepret each track?  "Here Lies Love" by David Byrne and Fatboy Slim is what. Conceptually, it's original and a fresh way to look at making a compilation. And with talent like Sia, Tori Amos, St Vincent, Nellie McKay, Roisin Murphy, Cyndi Lauper, Martha Wainwright and Santigold, musically, it's all there.

Check out the story in David Byrnes's own words below. And read more about the project and get the album here: http://www.davidbyrne.com/here_lies_love/

These guys never cease to amaze.

Blaise Aguera y Arcas, the architect of Bing Maps, demoed augmented-reality maps at TED2010. Flickr photos are integrated into street level views, which produce an interesting time travel experience, and the maps now have live video embed capability. Love seeing the power of augmented-reality harnessed for good.

More video brilliance from Grizzly Bear, directed by Allison Schulnik. I love the mixed media approach, and how they're rethinking what music videos can be.

What happens when you have a great idea, but clients aren't buying? Ji Lee, formerly a Droga5 and Saatchi ad guy shows how he brought his guerilla NYC thought bubble project to life.

"Bored with his ad agency gig and the uninspiring work he was producing, Ji Lee – now Creative Director of Google Creative Lab – decided to take matters into his own hands in 2002. The result was the ad-spoofing Bubble Project, in which Lee placed blank speech bubbles on ads around New York City. The masses responded and the project went viral, gaining Lee recognition and ultimately forwarding his professional career. Here, Lee talks about how he created, financed, and marketed the project single-handedly."