Technological innovation in medicine aims to improve the patient experience, reduce the burden on health services and improve the quality of care.These innovations are primarily focussed on the following types of users:
- Healthcare professionals
- Patients
But how ready are these user groups to use the innovations being created for them? In particular, the patients. Putting in place a digital service and ticking that box without making any provision to ensure that the service can/will be used is not going to improve your cost reduction.Those of us interested in Health Tech know that ensuring innovations will be used by patients is vital to success. However, this step often gets missed because assumptions are not tested, and when it is done the test group is usually self selecting and not a true representation of the target patients. A systematic review of patient participation in technology monitoring in BMJ Open stated that qualitative feedback suggests that the acceptability of monitoring is related to:
- Perceived validity
- Ease of practice
- Convenient technology
- Appropriate frequency
- Helpfulness of feedback
- Impact of monitoring on participants’ ability to manage health and personal relationships
‘Convenient technology’ being the important phrase here, as digital skills are still low in Britain.
Approximately 12.6 million adults lack basic digital skills, while 5.8 million have never used the internet at all. This is bad news for those of us driving digital innovations to improve health care:
“…these people are most likely to be suffering from poor health. They are also those most likely to be further disadvantaged by age, education, income, disability, or unemployment. The fact is that there is a huge crossover between those who are digitally excluded, those who are socially excluded, and those at risk of poor health.”
For example, patients aged 60–80 years old on a cardiology ward were talking about how they just wanted the medical staff to fix them without bothering them with the details. When offered information by relatives, patients would turn this down as they considered it not their concern - the doctors will fix it.
This is the group that is often the sickest and utilises the majority of health services. They are difficult to incluence, hence when designing health tech aimed at patients we all need to ask ourselves. Could my Mother use this?
Inclusive Innovation
A part of modern product development is known at ‘inclusive innovation’.
This term refers to the creation of innovative products and services that are useable by people with the widest possible range of abilities, operating within the widest possible range of situations. When this is achieved, a product can be termed ‘accessible’.Accessibility is so much more important than a requirement to stay compliant. It should be considered a prerequisite considered from the very beginnings of any project. Attributes to consider when planning accessibility can include:
- Low user literacy
- Poor language skills
- User’s technical knowledge
- Disabilities – visual, auditory, mobility-related, cognitive
- Access to technology like smartphones
- Slow internet connection speed
Examples include things like apps which record clinical data, prompt users to undertake activities like exercise, remind patients to take their medication or provide patient education. The paradox is that the people who stand to gain the most for these innovations may not be able to use them.For example, If you were designing a product, and you don’t understand your customers needs, habits and problems it is likely that your product is not going to be very successful. The same applies with medicine.
We can create very advanced assistive computerised systems, but if the patient lacks the tools or skills to understand it, how can they expect there to be long term benefits. A product vision must include usability by the target user, otherwise from the outset, whatever is created will be compromised.New skills are needed both by the creators of the products and the users, as patients are not going to understand this without help and support.
Skills for the creators
Developing Inclusive Products
None of the activities needed to create successful products are taught in Medical School or on the wards, in fact most of these are delivered by specialists such as user experience experts or behavioural psychologists. Here is a list of questions and thought experiments worth trying when planning out your product that will help you think in a more user centric way:
No Technology
To really boil down your solution into its most simple form, ask yourself the question ‘How could I achieve this without a computer?’.
That may sound impractical, but you may surprise yourself with the solutions you find. This also forces you to consider how you could benefit users with limited access to modern technologies and potentially find simpler and smarter ways to solve problems.
Include Accessibility Considerations In Personas
Personas are fictional characters which represent a subset of the users you are trying to target with your project. They typically have a name, picture, age, income, behavioural traits and a goal that describes the problem they want to see solved.
Persona’s help us develop sympathy for users and patients, and encourage us to embrace a user-centric approach. Depending on who you are targeting be sure to include disabled and impaired.
Challenge Your Assumptions About Disabled Users
One of the biggest assumptions about accessibility is that disabled users represent the minority - this is not strictly true In 2008 the Disability Rights Commission estimated that 19% of the working population have some form of disability 3.
Keep It Simple
It is impossible to know everything about accessibility, but we should always aim to represent things in the simplest way possible to provide the widest possible accessibility. This can include:
- Avoiding unnecessarily complex language
- Providing language options
- Using non-literal text (i.e. avoiding sarcasm and metaphors)
- The use of colours that take into consideration colourblindness
- Size and resolution of graphics and text
Put yourself in your user’s position
Try and use your solution the same way your users would. For disabled users, you may want to try and use assistive devices like the JAWs screen reader or turning on the accessibility functions on your smartphone.
Don’t be afraid to discuss it
Speak to your users throughout the product development lifecycle. If you’re inclusive and design for accessibility all users regardless of ability will be more than willing to help inform your design and development – you do user research and listen to user feedback.
Skills for the users
Developing Digital Skills
As already stated the patients with most complex health needs are also the most likely to be disengaged from technology, so how do you create digital tools that will be used?
First of all, follow the advice given above. This gives you a great chance of creating a product that is fit for your end users. You may also need to consider how you approach embedding digital innovations for your patients as a whole.Supporting patients to use digital tools requires an understanding of the tech they are already comfortable with, and designing for that if possible. If not possible, consider investing in training and mentoring these users to utilise more complicated tools. Prof Talya MS calls this “beyond the app” in her blog here.The Tinder Foundation has developed the blueprint for successful models to help patients engage with technology. These activities include:
- Running community outreach events
- Social prescribing
- Running digital surgeries to engage and train patients
- Embedding digital health within digital skills training
- Embedding digital health within other informal learning
- Training health and care professionals
This resulted in significant cost savings to the NHS. Evaluation showed a potential annual saving of:
- £3.7m in saved GP visits
- £2.3m in saved A&E visits
Conclusion
Getting the execution right for your audience has the potential to be effective in empowering patients. Get it wrong and you could be left with an expensive mistake.References
- http://www.bbc.co.uk/news/business–36510266 (accessed 16/01/2017)
- http://nhs.tinderfoundation.org/wp-content/uploads/2016/07/Improving_Digital_Health_Skills_Report_2016.pdf
- Disabled Living Foundation. http://www.dlf.org.uk/content/key-facts. Accessed 10/12/16 16:00
- Tinder Foundation Health & Digital: Reducing inequalities, improving society. An evaluation of the Widening Digital Participation programme. July 2016 http://nhs.goodthingsfoundation.org/ Accessed 19/12/16 07:20