In particular, I’ve been asked about input on certain designs from “the geriatric perspective.”
As I’d like for as many designers and developers as possible to help older adults, I’m going to share my top design consideration here. (As always, others who help older adults are more than welcome to chime in via the comments section.)
For now I’m not even hoping to see designs address “geriatric”
considerations such as documenting cognitive and physical function, screening for falls, or
detailed explanations of the plan for managing multiple chronic
Instead, my design interest at this
point is one that is relevant to the work of most internists, ED docs,
and physicians working with hospitalized patients.
My top design consideration: how well does your design handle medical complexity?
So, does your design hold up for a 79 year-old sample patient with a medical history that looks like this:
- 15 chronic problems
- Not uncommon among that subset of VA and Medicare patients who generate the bulk of healthcare costs
- 18 medications
- Note that medications in these patients are constantly being switched, revised, and adjusted.
- Designs that help patients and clinicians track those changes over time would be very valuable; I used to scroll back through the VA’s prescription records trying to figure out when the dose of a given medication had been changed.
- 3 hospitalizations in the past 2 years, one of which includes 2 weeks in the ICU
- Any general internist or ED doc comes across lots of patients like this.
- If you are a PCP you have probably had them show up post-hospitalization for a new patient visit too, because the hospitals will tell them “You need a PCP. Here, we made you an appointment.”
- 24 encounters over past 2 years, including 5 ED visits
- Does your design help patients and providers spot the more important encounters, when there are so many?
- 25 different types of lab results, with 5-30 reported results of type over the past two years
- Lipid panels are not checked often. CBCs and metabolic panels are.
- A hospitalization of 2 weeks can generate an incredible amount of lab data
- Multiple radiology results and diagnostic evaluations
- I’m just noticing that radiology results aren’t on this list of CCD fields but they are very important (maybe they usually end up under “Procedures”?)
- An older adult with multiple chronic conditions and multiple hospitalizations or ED visits will generate a lot of results from radiology and other diagnostic encounters
- Intubated ICU patients get one chest xray daily, sometimes more. This can overwhelm a radiology results section (it has certainly overwhelmed my fax machine on occasion).
There are of course lots of features I’d like to see in a good design for older adults, some of which I think may be feasible now using the CCD inputs, others of which will probably require a larger reimagining of the collaborative health record for the medically complex older adult.
I’ll address those in another post perhaps.
Shouldn’t all health solutions be designed for medically complex patients?
I’m not a designer or an engineer, but isn’t there some kind of principle that states that the best designs are the ones which are engineered to tolerate the maximum expected use, and then some?
If we were to apply this idea to healthcare innovations, then it seems that they should be designed to perform well when used by the kind of medically complex older adult who:
- Desperately needs help keeping track of all the medical mayhem,
- Is seeing multiple clinicians, who also desperately need help figuring out what’s been going on, and
- Is costing the system a lot of money.
If you can find a way to present a complicated medical history in a way that is visually elegant, intuitively organized, and usable for patients and families, then presenting the info of 52 year old Ellen Ross with her two item problem list and four encounters will be a piece of cake.
And don’t forget to consider making a clinician version of the printed info as well.
Summing it up
A redesign of the downloadable patient record should be robust enough to handle the complexity of an older adult who has multiple chronic problems, medications, encounters, and has also been hospitalized several times in the past few years.
These are the patients who need the most help keeping track of their medical information, and who have the most to gain from being able to share their downloaded information with other providers.
Hopefully the winners of the Health Design Challenge will be put through their paces before the project organizers move on to building their “combination of winning designs.”