Simple Design: What Health Care Can Learn from a TV Remote Control

Medicine is fundamentally not a simple enterprise, but the delivery and access of health care should be.

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For patients, navigating the medical system is a struggle — even when they are relatively well. It’s worse when they’re sick, such as patients with complex medical problems requiring urgent attention, like work-ups for cancer. Simply trying to coordinate appointments between specialists can be incredibly frustrating and time-consuming. And because specialists often work in individual silos, they don’t communicate with one another, leaving hapless patients and their families to shuffle themselves and their reams of information from one specialist to the next.

A recent survey commissioned by ZocDoc, which is trying to apply an OpenTable-style online scheduling model to health care, found that young adults are especially frustrated with the current health-care infrastructure. More than half of 2,000 18-to-34-year-olds surveyed said they delayed getting medical care because the process is a “pain.” More than 60% of these tech-savvy Gen Yers — who are accustomed to scheduling their lives with the touch of a screen — said they felt they were at the mercy of their doctor’s receptionist just to make an appointment.

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Patients aren’t the only ones suffering. Navigating new medical technology can be equally frustrating for doctors. Take the computerization of medical records, which is supposed to help reduce errors by improving documentation and making it easier for physicians to access and share information. The problem is that many digital systems are not designed well, actually making doctors less efficient. The overly complex process of electronically documenting medical records pulls doctors away from the bedside to the computer; computerized charting systems dramatically increase the time it takes to enter patient information when compared to the old paper-based systems.

Another example: electronic prescriptions, which are supposed to reduce medical errors by eliminating the age-old problem of illegible doctor handwriting. In one study, electronic prescriptions actually increased medication error rates, in part because the drug order process itself was clunky, complex and required too many clicks of the mouse and keyboard. In other words, the system facilitates mistakes. The issue is not that doctors can’t use the new-fangled technology; it’s that the technology is not user-friendly for them.

Recently one of us saw a patient in the ER, who had a host of known medical problems, plus new complaints of severe headache and vomiting. Her son brought in her digitized personal medical record on a thumb drive, which was supposed to help us make the most informed treatment decisions. The good news was that some information was actually helpful: patient allergies and medications were organized on one part of the screen, past tests and procedures on another. The trouble, though, was that there was just too much information to be immediately helpful — at least eight separate brain MRIs whose results each referred to the last, and hundreds of blood test results, many of which were repeated over time. The record had all of the patient’s medical data, but it was nearly impossible to sort the signal from the noise in the time frame needed to make decisions in the ER. We needed not a complete medical record, but a smart record.

So, can we make health care smarter just by making it simpler to use for patients and doctors?

Of course, in many ways medicine is fundamentally not simple. The same disease affects people differently, and people respond differently to the same treatments. Other parts of health care also can’t be simplified easily, like the complicated regulatory rules and the backward incentive structures that underlie health care economics. These issues unfortunately scare off some of the brightest innovators.

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But before we discount design simplicity as a primary goal in health care reform, consider how other industries have eliminated frustrating complexities and made products much more user-friendly. How about those heavy, hundred-button VCR remote controls from the 1980s that required a Ph.D. in electrical engineering to operate? Three decades later, even the most technologically challenged viewers can easily record a whole season of House with just a few clicks of a slimmed down remote that has no more than four buttons.

Of course, Apple is the standard-bearer of simplicity, having revolutionized personal computing by simply taking away buttons — this despite that fact that computing, like medicine, is inherently complicated and dependent on variable end-user needs. The iPad, Steve Jobs’ design masterpiece, is so simple to use that even 3-year-olds — and 93-year-olds — can figure it out intuitively.

How can health care learn from Apple and remote-control evolution? The first lesson is to consider carefully the user interface before marketing a new product. New ways of delivering health care should be designed in clever ways to make the patient-user or the doctor-user experience smoother. Smart design means that it should be easy for patients to navigate the system and for doctors to exchange information. It means that doctors should have electronic charting systems that allow care to be delivered and documented in fewer clicks and keystrokes, that suggest evidence-based testing or treatments in helpful ways, and that really reduce errors by making it harder, not easier, to make a mistake.

This means a system that streamlines doctors’ interaction with computers and builds in alerts that recognize errors before they happen, without sounding too many false alarms: in current systems, there are innumerable pop-ups that alert doctors of possible errors that are rarely relevant — so many that doctors have simply learned to tune them out.

Does health care have any chance of becoming more user-friendly? Well, there are many reasons to be hopeful. The health care industry has just started to create applications that may actually make it a little easier to be a patient or a doctor.

ZocDoc’s new scheduling model lets patients go online — from a computer or smartphone — and search for open appointment times with local doctors, even specialists. If this catches on, maybe patients won’t have to argue with hostile front-desk staff anymore.

(MORE: When Patients Share Medical Data Online)

The government has even started its own initiative, encouraging entrepreneurs to develop innovative consumer-oriented applications using government data. Leveraging the power of information from prior patient experiences may be the key to designing smarter systems that can better predict which patients will benefit from expensive tests and treatments, and which won’t, and present this knowledge directly to doctors and their patients.

We have been living for way too long in the era of the giant health care VCR remote with too many buttons that no one knows how to use, where navigating specialists is a full-time job, understanding insurance options is more complex than fixing your own car, and using computerized medical technology creates more problems than it solves. Have we reached a tipping point yet, where the pressing issues of high cost, variable quality, and universal frustration with the health-care status quo collide?

Back in 1996, when Jim Clark, founder of Silicon Graphics and Netscape, outlined his strategic plan for a new company, Healtheon, he argued that health care just needed good software to make it all simple. He drew three boxes: one for the patient, one for the provider and one for the insurance company. He was mocked for implying that all we have to do is connect the boxes. At the time, the simplicity of his diagram seemed naïve. Well, maybe not. This could be the time for the simplicity revolution in medicine.

Meisel is an assistant professor of emergency medicine at the Perelman School of Medicine and medical editor of the LDI Health Economist, both at the University of Pennsylvania. Follow him on Twitter at @zacharymeisel.

Pines is the director of the Center for Health Care Quality and an associate professor of emergency medicine at George Washington University. Follow him on Twitter at @DrJessePines.

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