The awesome work of my amazingly talented wife featured in USA Today’s College publication:

Susan Dawson, a training specialist from Genworth Financial gave a presentation that ran through the events each student had attended, goading them to spill what they had learned with tacky prizes of beer cozies and datebooks. She awarded points for connections made, cards received, coffee dates secured, and follow ups sent.

…

Before dinner, Macewan had called Q-Camp “life-changing.” When Dawson announced that Joe led all the top 120 business students at the university in points, Q-Camp really started to change his life. He had awoken, but was just beginning to emerge.

via Summer camp for business kids | USA TODAY College.

Dr. David Agus is a professor of medicine and engineering at the University of Southern California. A portion of his forthcoming book, The End of Illness,” was adapted for an article in the Wall Street Journal recently. It captures the absolute essence of how consumer oriented innovation will define how healthcare is delivered in the future.

The word empathy keeps coming to mind for me, as I consider these big, bold visions of the future – one which George Jetson would approve. They are empathetic towards what people actually want. Often, that’s now how businesses, like provider organizations, approach solving problems such as revenue or growth. We have to get better at thinking with empathy about designing how we deliver care. What do healthcare consumers want? That’s how new markets are created in other industries and, if Agus’s vision comes to fruition, it’s how we’ll all control our own health destiny in the future.

Also, note what Argus says about the role of the physician: “…doctors won’t just examine them once a year; they will continually monitor the next generation of patients, offering advice along the way.” Doesn’t that sound a lot like what empowered patients and the social media savvy ask for?

I see them being able to monitor and adjust their health in real time with the help of smartphones, wearable gadgets—perhaps like small, invisible stickers—to track the inner workings of their cells, and virtual replicas of their bodies that they will play much like videogames, allowing them to know exactly what they can do to optimize every aspect of their health. What happens when I take drug x at dosage y? How can I change the expression of my genes to stop cancer? Would eating more salmon and dark chocolate boost my metabolism and burn fat? Can red wine really lower my risk of heart attack?

From a drop of their blood, they will be able to upload information onto a personal biochip that can help to create an individualized plan of action, including both preventive measures and therapies for identified ailments or signs of “unhealthiness.” (Other body fluids—like tears and saliva—might be routinely tested, too.) They would be on the lookout for problems like imbalances in blood-sugar control, a risk factor for diabetes, and uncontrolled cell growth, which could signal cancer. Their doctors won’t just examine them once a year; they will continually monitor the next generation of patients, offering advice along the way.

via The Future of Personalized Medicine – WSJ.com.

“You can’t tell people you ran nine miles and expect to ever be treated normally again.” At least, according to Marc Parent writing his Newbie Chronicles article in the February 2012 issue of Runners World Magazine. “In the minds of most everyone…instantly you are done for, a gone. You are an “other,” a “them.” You’ll never be one of the old again again…”

I know what he means. Not just because I’ve taken up running – I’ll let you know when I hit nine miles – but it’s a universal truth isn’t it? When you cross over from casual to extreme in anything, you run the risk of becoming a “them.” Parent suggests, at least in running, there is a invisible line where people can imagine themselves running the same distance, say two or three miles. Beyond that line, you are into the extreme category.

That’s the thing about extremes, they are hard to relate to. Extremes are what attract us to action movies. The idea of someone stowing away to Hong King, kicking a door down, two guns blazing, jumping over fire and rescuing the damsel works because it’s a fantasy most of us won’t ever live. Extremes can have a way of alienating people. If we can’t imagine doing it, sometimes our reaction is to just shut down, or even to become defensive.

Innovations, particularly in conservative industries like healthcare, often trigger the latter reaction. What do you mean ‘open a low cost self pay 24/7 clinic in a drug store‘? That’s not how we do things! And yet, Minute Clinics are popping up everywhere. Anyone remember when the iPhone first came out? The naysayers took to the blogs like…will… internet naysays are wont to do. It will never work, it doesn’t even have 3g, they cried.

I’ve had a similar experience with my diet change. If you tell people you don’t eat meat, they generally react favorably. Hey, good for you, that sounds healthy….I’m trying to eat better too. They can imagine themselves having a salad instead of a burger. When you tell someone you are vegan, a perceived extreme, they tend to take a step back and look at you funny. Why the hell would you do something like that? What do you eat, beans and rice? See what I mean about extremes?

Innovation has the same challenges. If you propose something small, iterative, then people can generally wrap their minds around it. Let’s extend the hours of our clinic so people can come in after work. That’s understandable, we can imagine working an hour later, or flexing staff times. Suggest virtualizing primary care through a series of Skype visits and smart phone apps and you are going to the the nine mile vegan reaction. Why the hell would we do something like that?

I’m increasingly of the opinion a lot of disruptive changes are happening outside of the healthcare industry, in the consumer space. I had an experience recently where I was showing off some consumer oriented health and fitness related apps – blood pressure monitoring, weight management, pulse, and personal health record solutions. All of these are free sites or smartphone apps. The response from industry insiders is usually something like not everyone is as geeky as you are Nick. Maybe, but then why have some of the apps been downloaded millions of times?

It’s a catch 22 for healthcare. We are likely past the point of being able to make small tweaks to the model here and there. Regardless if the future holds ACOs, bundled payments, personal mandates or insurance exchanges, someone is going to be the iPhone of healthcare. Someone is going to do that thing the rest of us think is too extreme. They’ll run 9 miles, in Parent’s terms. The question becomes how we help get traditional provider organizations get onboard? Because, the bottom line is, as an industry, we need to get comfortable with rapid, extreme innovation. If we don’t someone else will. Someone else will create the app that diagnoses your patients and allows them to Skype a primary care physician in India. Someone else will sell your patients a health monitoring service. Someone else is going to make money on your re-admissions. Someone else is going to offer a no wait urgent care clinic.

I’m not a huge fan of what I call blatant marketing. You know it when you see it, particularly with interactive campaigns online. You want me to do what? Like this page, give you my home address, and retweet your link for a chance to win an iPad? No thanks. I avoid frequent shopper cards at the grocery store for the same reason. When Vail Resorts launched Epic Mix last year, I was skeptical. Vail wants to track every move you make, literally, on their mountains.

Vail installed RF chip readers in every lift line and started putting RFID chips in their lift tickets. You go through a line, and they know it. They also know your age, gender, address, family members and travel dates. With the tracking and demographic data, they have a pretty good idea about your habits at their resorts. You can even tie your credit card to your ticket for on-mountain purchases. I imagine the database thinking something like this (you know, if databases could think):

The Jones family starts skiing at 10am most days. Not surprising since they are from the East coast and have the time change. The kids are both in ski school today … cha-ching! Oh look, mom and dad just stopped for lunch at the high end restaurant and the kids are eating pizza at the casual on-mountain restaurant. Mom skis black diamonds mostly and is logging 2x as much vertical as dad. They seem to come out every year around the same two weeks. Judging from their address, I bet they make about $110,000 a year and take two major vacations. We should email them a month before, I’ll make a note of it. I wonder if they’d want a time share….

Pretty spooky huh?

So what did Vail do to change the value proposition of their data capturing? They launched EpicMix, a customer facing portal into the data. You sign up and register the ID number from your lift ticket. From there, things get social very fast. There is a FourSquare like game component where you earn pins – just like the real pins you see on people’s hats or jackets – for accomplishments. Ski 26,400 feet and you get the 5 Miler pin. Head into the Northwoods area and you get the Gone Wild pin. The service also tracks your runs and vertical feet per day and season and lets you compete against friends and family. There’s even iPhone and Android apps to track your stats in real time. And, of course, it all connects to Facebook and Twitter.

This year, Vail gave professional third party photographers the boot. Now, Vail’s own photogs hang out near huge EpicMix Photo placards around the mountain. Ski up, and they scan the RFID tag on your ticket and snap a few pics. That evening, the pictures are uploaded to your EpicMix account and can be shared on Facebook or Twitter for free.

Vail took customer tracking and turned it into a value added service. It’s a draw, something Vail’s resorts have which other ski areas don’t have.

It will come as no surprise I see a healthcare analogue in all of this. Rather than capture data about customers and keep it to themselves, Vail turned it into a customer-facing service. Does your doctor treat your medical records the same way? Can you go online and look at them? Do you get rewarded, even virtually, for losing those 10 pounds or controlling your asthma? Can you chose to share parts of your record with family or friends?  Can you chart your A1C scores over time?

Even with the rise of patient access into electronic medical records,  we’ve still got a ways to go before we reach the same level of understanding about personal data. I continue to see consumer devices and services leading the trend, which tells me two things: 1) people do want to own, collect, monitor and selectively share aspects of their health and 2) the consumer oriented companies can do it for cheaper. The later is likely owed to less red tape, regulations, research, etc. To be fair, there are iPhone apps which will graph your weight. And there are iPhone apps which will track your skied vertical feet. But the value of that data changes when it’s shared with your provider (not that it has to originate with them, mind you).

Any thoughts? Are you aware of any provider organizations who are going beyond MyChart (an example of a patient EMR portal) and offering value added analysis and services on top of YOUR health data? What kinds of things would you want to see, beyond direct, unfettered access to the record?

By the way, according to my EpicMix dashboard, in the last 12 months, I’ve skied 121,453 vertical feet at Vail resorts… not too shabby for busted knees!

Since I’ve basically given Vail a free ad, I might as well embed their EpicMix video, it explains the service pretty well:

It’s not surprising,  it happens to a lot of industries. Consumer devices and technology are making inroads where industry driven solutions are still struggling. People want access to health and fitness related data and so they are building their own solutions, outside of the provider-controlled walled garden. I suspect we’ll see a time when all of this merges together – consumer solutions, medical device makers, provider EMRs, etc. However, for now, it’s pretty clear that if you want to generate and control your own health related data, look towards the consumer space.

This announcement with Withings, maker of the popular Wi-Fi Body Scale (I love mine), highlights what is happening in the consumer world. Providers have been using sales sales with modem connected to your phone line to monitor weight gain in patients with congestive heart failure for years. They cost big bucks and the data goes into a seeming blackhole. The Withings scale is less than $150 and the data is available via API with existing interconnects to services like RunKeeper, FitBit, and now MedHelp (which is new to me).

We have recently discussed the Withings Health Cloud that allows users to import data from RunKeeper and Zeo into their Withings dashboard. The development of the Health Cloud however does not mean that we have given up our policy of making it possible for Withings users to export their data to other websites, quite the contrary. In the past weeks, we have added several new names to the list of our partners, both for the body scale and for the blood pressure monitor. Today, we’d like to shed some light on one of those partners: MedHelp.

via Withings and MedHelp have formed a new partnership | Withings blog.

This week, Apple released their latest disruptive innovation, iBooks 2 and iBooks Author. iBooks 2 is a free update to the iBooks app for iPads. iBooks Author is a free mac desktop application which enables anyone with some basic typing and drag-and-drop skills to create pretty amazing eBooks. eBooks can contain pictures, links, audio, video, rotating graphics, self study questions and more. This is the future of patient education, shared decision aids and pre and post visit care.

On the outset, the idea of combining text and video and pictures isn’t really that new. It’s been around since…well… the start of the web. But in the context of a book, there is something really strangely compelling about seeing a moving video in the middle of static text. I can’t quite describe it. After about an hour of tinkering with the app and pasting some images and text in from a keynote presentation, I had a nice little proof of concept. You can download it and see for yourself here.

There is something which draws you in when you see live action video playing within a frame of text. Adult education experts call this blended learning. We absorb more when we engage more of our senses.

So imagine this, your doctor tells you that you are going to need surgery. What’s that process going to be like? What do I do before hand to prep? What should I do when I get home, you ask?

“Well, you can just download my free eBook,” he says.

The book walks you through the pros and cons of surgery. It plays a video of the doctor outlining the procedure. A moving picture gallery shows you where to arrive, and what to expect the day of surgery. Another video shows you how to use the pre-surgical antimicrobial wash the doctor sent you home with. There are links to online communities from other patients who have been through the same process. There is even an embedded twitter search showing a real time discussion about your condition. Wow!

A few days after the procedure, you fire up chapter two. It shows a diagram of some basic stretching. The next page talks about nutrition. To make sure you understand the concepts, there is a short self test, don’t worry, it’s open book.

These tools are simple to create. They are easy to publish (for free). And, they are a tremendous value-add to patients. Apple has done it again. By disintermediating author from the publisher, they’ve given us all the ability to make robust patient aids. For that matter, patients could make them for other patients, and publish them on their blogs, or via the iTunes book store.

What are you waiting for, go publish your first eBook!

You can download my demo/work-in-progress book, Innovation in Healthcare: A Requirement For Success here. I’ll continue to update it after this post is live, however the point is not to provide a serious book about health reform and innovation tactics. Rather, the point is to demonstrate how the technology can be used in a healthcare setting (this book is more geared to the administrative types than patients).

The gallery below includes images and descriptions of features in eBooks. 

In 1984 my aunt, Phyllis, was the best female equestrienne in the world. That summer, she represented the U.S. in the Olympics in Seoul Korea. Phyllis has all the motivation in the world to ride. It’s her passion, it’s her profession and her reputation. Clearly, she also has the ability. And, she has Grandma Grace. When it comes to support, Grandma Grace, her mother, my grandmother, is a tour de force. What ever you are into, you’d be so lucky as to have her in your court. Grandma broke out her chain saw and tractor and built a cross country course on the family farm – jumps, water obstacles, galloping paths – so Phyllis could train. Where other U.S. riders had million dollar facilities and sponsors, Phyllis had Grandma Grace. She built a barn. Herself. Nuff said.

In 1984, Phyllis finished better than any other rider on the U.S. team. Support clearly matters.

It goes to 11

Lambs neck tortellini, see what I mean?

On a scale of one to ten, my carnorvosim went to eleven. If it had blood coursing through it, there’s a good chance I tried to cook it, or would have. And I’m not talking about being a steak and potatoes guy either. I was a fried pancreas, brains and eggs, deviled kidney kinda carnivore. I always thought I had a pretty decent diet, all things cosidered. We buy mostly whole foods and I ate veggies with just as much enthussim as I did a side of beef. But you know the punch line already, in September of 2011, Susan and I made some dramatic changes to our diet – we switched to a (mostly) vegan diet. It started as a four day expirement, then a week, and a month. In December I converted a wine refrigerator dedicated to dry curing sausages and other salty porcine parts back into, well, a wine fridge. It’s prominent place in our kitchen should give you an idea of how much meat was a part of our lives.

The costs of healthcare in the US are increasing at an unsustainable rate.(Although interestingly, the rate has slowed over the last two years). The problem, though, is cost means something different to each constituent. To the consumer (hint: that’s us, the patients) costs are co-pays, deductibles, and pay check deductions (premiums) for insurance plans. If you get insurance through your employer, then they are, in fact, the ones really footing the bill. If you are a provider – hospital, doctor’s office, clinic, etc, and you read about the “cost curve”, your thoughts turn to fixed and variable costs. Implants, food, meds, gauze, overtime, the CEO’s salary, debt financing, consultants….it’s all part of what goes int the infamous $15 aspirin.

So what’s all this got to do with meat? 

Yours truly, clocking in at 215 on Jan 1, 2011

In January of 2011 I weighed 215 lbs. I’m 5’8 (on a good day…with shoes… leave me alone). You don’t need a BMI chart to know that’s too much Nick to be healthy. I was active. I’ve had a life-long obsession with extreme skiing and, in order to maintain some semblance of ability, I’ve tried to keep in reasonable shape. I have a trainer at the gym – going 3 days a week – and could probably have run a mile. Who knows, I hadn’t tried in a long time.

If any of this sounds dire, let’s recalibrate. I’ve always liked the term bon vivant, it says it all about someone who loves the good things in life. Sure, I was carrying around some extra pounds, but I was still skiing double blacks; and if I could do that on a diet of veal tongue, brussels sprouts, and red wine, what’s not to love? The side effects are always in the fine print.

In 2004 my doctor diagnosed me with mild hypertension, high blood pressure. I freaked out a bit, I’m way to young for that! So he ordered a stress echocardiogram. A stress echo is a test that involves, at least my my case, shaving your chest, sticking some electrodes on and running on a treadmill while the cardiologist plays the name game to see if you work with any of the other docs he went to school with. The pronouncement: hereditary hypertension, there’s nothing I can do about it but take my meds. “You’ll be fine,” he said, “just take the pill and it’s nothing to worry about.”

The pill costs me $20 a month. Not bad, right? My insurance covers the remaining $30, which comes directly out of my employer’s coffers. Still, not a huge price to pay, all things considered. But, something in the back of my mind told me I was too young to be on BP meds; at this rate, what’s next?

The case for support

The last meaty thing I ate was an extremely large – and, I’ll add, quite tasty – pulled pork sandwich from a food cart outside the Petaluma Market in Petaluma, California. I remember it vividly, including my sauce covered fingers working to stuff the thing into my pie hole. It was damn good! I was on my way to pick up a vegan coworker at the airport and intended to adopt his diet as an experiment for the next few days. What was I going to do to stash the evidence?

That night we ate at white table cloth, rather high end vegetarian restaurant in the Mission district of San Francisco. “What do I order?”

“I’m having the tamales, they are totally vegan”

“That’s what I’ll have too then….”

I had the ability, we were in the birthplace of the fresh food revolution in America. I also had the motivation, I was excited to try a four-day experiment. Four days of eating in the Bay Area with an established vegan might be the best way to recalibrate your diet ever. It’s also all about support: the restaurants, the menu, the coaching, the lack of pressure since we were both on the same page food-wise…

When I got home, I told Susan about the trip and diet. “Here, let me cook dinner tonight, I’ll show you the kinds of things we ate…” And with that, I had one more day under my belt. And, more importantly, I had another notch in my support belt. Susan was eager to try her own experiment with diet change and together we could be mutually accountable. We could also cook for each other and not worry about having two separate menus.

There are also other, less obvious forms of support. The privilege of eating a plant-based diet of whole foods hasn’t been lost on me. It’s sadly more expensive to buy a grocery cart full of veggies, grains and legumes in this country than a cart full of subsidized corn-based processed foods. Having the financial support to make substantial diet change is not something I take lightly.

See what I mean? Support, particularly in any behavior change, makes a world of difference.

In part 2…

• Self Tracking
• Data
• My cost curve
• And the big reveal

It was a classic childhood scene, a mom pulled her young daughter in a cherry-red wagon. Both had smiles as broad as a their faces would allow. When they made the a turn to the left, a young lady stooped down to the daughter’s eye level and said something that put them both in a fit of laughter. There was something really special about how much fun they were having. It’s a simple thing really, but aren’t wagon rides kind of a childhood rite of passage? That wagon can be anything – a pony, a space ship, a semi truck or just a plane red wagon.

The young lady stood up, adjusted her scrubs and went back to the nursing station. Mom and daughter turned the corner for another lap down the hospital floor hallway.

Have you ever stayed in a hip, boutique hotel? You know that cool thing they do with glass walls and bright lights? Well, that’s pretty much exactly what I was not expecting when I stepped off the elevator at the University of Minnesota’s Amplatz Children’s hospital. My friend, J, was giving us a tour. He explained each floor has a story teller character, some animal who’s image is repeated as a design theme throughout the floor. The wall was bright orange and yellow glass. If there had been club music I would have assumed we were, in fact, in a W hotel.

“The whole place was designed with onstage and offstage spaces,” J explained. An onstage space is patient facing, it is their space where staff are expected to play the role of compassionate caregivers. Fred Lee, author of If Disney Ran Your Hospital, would be proud. Offstage spaces are where staff congregate, or push noisy carts – the kinds of things which wake patients up at night or remind you that you are in a hospital. The idea of onstage and offstage goes deeper than having a separate hallway for food service delivery. Being onstage reminds staff they are, in many ways, a guest in the space. Families, particularly in a children’s hospital, settle into their rooms and the surrounding environs. Being onstage means always playing the part of someone who loves children, and serves families, and provides care, and doesn’t mind getting a cup of shaved ice for the third time that hour. Need to huff and puff about it? Take it offstage.

“You know, it’s funny, everyone thinks I’ve gotten into IT… I haven’t, I’ve gotten into connecting people and making the experience for these kids a little less scary.” J played a considerable role in the design of the hospital. One of his many contributions is the design and implementation of a state of the art video conferencing system. The system, available in about half of the rooms, consists of a wall of video monitors, including a 42″ screen, and a motion tracking video camera. From a bedside touch panel, kids can dial up family members who may be hours or many miles away. Some kids have even been able to attend school using the video linkups. “It’s a way to maintain some sense of normalcy and connection, ” J told us. Amplatz is a regional draw, servicing a wide swath of the midwest. Video conferencing can enable the dad who can’t take off work to talk to his child several times a day. Doctors can plug in a computer on wheels and do a split screen between the patient, the parent and the medical record, effectively hosting a virtual care conference. How cool is that?

I’m with J, the people aspect is by far cooler than the enabling technology. And the technology is impressive to be sure. The design aesthetic is also – and I say this with no hyperbole – the best design I’ve ever seen in a care space of any kind. But what really stands out at Amplatz is the atmosphere, the total package. It’s not the iPod docks, rainbow walls, x-box enabled video conferencing onstage touch screen dohickies…. it’s the utter selflessness that working around sick kids demands. You simply cannot bring your own baggage onto a floor where a family is fighting for what could be their last hours or months together. Kids level the playing field. Check your ego at the door.

Why does it work so well at Amplatz? I’m not entirely sure. There is undoubtedly some combination of culture, training, design and technology which enables the care environment. There is attention to design, particularly around experience. Hospital committees met and drew the initial brush strokes. A parent’s council then came in and refined the ideas. The ultimate decisions, however, were made by a council of children patients. It’s pretty hard to get the typical non-patient-centric committee compromises when patients get the final review. Clearly, you also have to give staff room too. I don’t mean physical room, but rather latitude to be empathetic, personable and compassionate. I didn’t get to observe the culture long enough to understand how Amplatz enables culture, although it is clear they do something right for their staff.

Every healthcare provider has a responsibility to be as good as Ampltaz. Here are some of my key takeaways from our short visit:

• Patient centered design with patient input and review
• Onstage and offstage spaces
• Give staff permission to be empathetic (here’s an example, at Ampltaz, any patient care conference supersedes staff conferences. If staff are in the conference room for a meeting and a provider wants to discuss care with a family, the staff all leave and reschedule their meeting…wow!)
• Enable connections, relationships and remove fear – that will drive your IT choices rather than letting them drive you
• Don’t be afraid to have fun – the space was fun. There were games everywhere. Each room had an Xbox! Why do we paint hospitals in muted tones and use dim lighting? No one wants to convalesce in a depressing cave.

The University of Minnesota Amplatz Children’s Hospital is a joint venture between UMN and Fairview Health System.

You can follow Amplatz on twitter here.

It was the best of times, it was the worst of times.” Dickens wasn’t exactly talking about graduate school, but he might as well have been. After two long years, Susan graduated top of her class in 2010 from The American University with a Master’s of Science in Organization Development. In 2011 she was invited to become faculty in the program, giving her more opportunities to visit Toni and George (Susan’s parents).  In January 2011, Nick started an Executive Master’s of Hospital Administration through the University of Minnesota. Somehow, we’ve still found time to have some fun.

Susan traveled for work: England, Ireland and Spain. Nick was asked to speak a few times: Colorado, Las Vegas, Palo Alto, Chicago. Together we skied everywhere that had snow and a hill.

The early cold months of 2011 gave Susan time to perfect her passion for brewing. In January, she began Suze Brews – a very limited release of some seriously premium beers.

Summer gave us an opportunity to come together. George (Nick’s dad) was diagnosed with a tumor on his common bile duct. After a complicated surgery,  with his strength and your thoughts and well wishes, he’s doing great!

Between papers, dog training, and half marathon training, we’ve also found time to keep our 1973 Series III Land Rover on the road. This summer, we tackled the Mid-Atlantic Land Rover Rally with our friends, the Thews. It was four days of mud, Rovers and fun in the wilds of central Virginia. Ippa had a blast!

In the fall, Susan and Rosemary (Nick’s Mom) finished the Richmond half marathon with record times. Nick is training for the Monument 10K in 2012. Together, we started this vegan thing in September. Collectively, our belts are looser, steps lighter and hearts happier. What a year!

Thank you for being a part of our life. Here’s to seeing you more in 2012!

Nick ,          Susan,                Ippa,       Turley        &       Sydney

The 4AM Wake Up Call.

My friend was in the hospital a few weeks ago, nothing serious, a precautionary measure more than anything. I went to visit her and we sat and chatted. I always ask people about their experience. “What’s going well, what would you change?” At first, you hear a lot of kudos. “Everyone has been really nice.” I don’t doubt it. But, you can’t improve on compliments. I’ve found you have to ask people at least three times to get the juicy stuff.

“Well, I don’t understand why they keep waking me up at 4 AM to take blood. Is my blood only good at 4 AM,” she joked.

I know why they do it.

In The Accidental Mind, David Linden talks about the evolution of the human brain in Gladwell-like simplicity. He says evolution didn’t just pop out this perfectly coordinated mass of nerves and synapses. The brain, in fact, is the result of years of renovations, additions and remodels. One part developed to respond to the needs or deficiencies of another. The process of healthcare, unsurprisingly, isn’t much different.

Doctors usually want to round on patients first thing in the morning, around 7am. It frees them up for surgical cases or office visits early. When they round, they want to see the latest lab results. Lab tests take a few hours to coordinate and run. Thus the 4 AM blood draw.

It would be easy to point the finger at the doctor and say the patient is being inconvenienced to fit the doctor’s schedule. But, much like the human brain, it’s not that simple. Could the lab speed things up? How do we even get specimens to the lab, is that an efficient process? Well, that depends on who’s eyes you are viewing the process through.

Designing for experience

Designing for experience is about true customer focus. It is deeper than what we traditionally think of as customer service, which describes the way people interact with each other. Designing for experience requires an almost painfully high degree of empathy for the person using your product of service. You have to not only be willing to see it through their eyes, but also feel it the way they might. Getting to that level requires a holistic attention to detail. After all, how much of what we feel is defined solely by our verbal interactions with someone? How much comes from environment, ambiance, touch, visual details, perceptions, waiting times?

In 2001 Susan and I were living in Paris. No, there are no buts, it was that cool. One weekend in July started like so many others. We descended into the local metro station, Odeon, out of the sun and into the belly of Paris. After an hour of riding, including a transfer to a regional train, we began the ascent back towards the surface. The first thing we saw was a giant, antiqued sign proclaiming our location to be Main Street U.S.A. It was utterly surreal. On one corner was a 1950s themed ice-cream parlor. Across the street was a video arcade. There was even a mini Statue of Liberty. Somewhere in the distance Its a Small World After All was floating through the air.

At that moment, we weren’t in a field outside of Paris, we weren’t even in France. We were in Disney’s world. We were 12 years old, wide eyed and ready to run through the park at 100 miles per hour. They had gotten every detail right. The writing on the street signs, the food vendors, even the rides. It was a classic Disney experience.

Disney is a master of designing for experience at its resorts. That’s not a young French girl playing Snow White. It is Snow White. That’s not a facade in front of a concrete building, it is an honest old-time ice-cream pallor. It has to be, because if we saw behind the curtain, if the magic were revealed, then our brains would instantly unplug from the illusion and we’d feel like we were, in fact, in a field outside Paris, or marsh outside Orlando.

The challenge with designing for experience in healthcare, and probably most businesses, is the historical precedent of designing by censuses and compromise. Politics have become part of our corporate culture. If we do X, does it upset the person in charge of Y? If so, what is the compromise? And there’s the rub. When we compromise to satisfy internal politics or business pressures, more often than not, we are making an even bigger compromise for the patient. It’s how we get the 4 AM blood draw.

The PocketPC and importance of the foot fetish

In 2002, I had a PocketPC device. Its marketeers clearly took liberties with the size of the average pocket, but nonetheless it was a fairly compact thing for the time. It had a stylus-based touch screen, miserable handwriting recognition and very limited Windows PocketPC software. But, I like to live on the cutting edge with gadgets, so I picked one up.

What I really wanted was to watch movies and TV shows while at the gym. The problem was that it used some obscure file encoding. Not only that, the videos had to be perfectly formatted for the screen size. I found that if I ran a video through two different programs on my desktop PC, I could manipulate the file enough that it would usually play on the PocketPC.

I was the only one at the gym watching their own personal video screen.

I’ll never forget the reaction of a friend who saw me on the elliptical one day: “you really are a huge nerd aren’t you?” It was a friendly jab. At least I think it was. Fast forward to today, almost every runner on a treadmill has an iPod, iPhone or small personal device. This morning I saw one musclebound guy in a weight belt and tank top entering reps onto his iPad which he carried with as much pride as his protein shake. I dare you to call him a nerd.

What once was once a niche use case, is now the norm.

This summer, at Stanford’s Medicine 2.0 conference, the precursor to the recently announced Medicine X series, Dennis Boyle from IDEO spoke about design thinking. He flashed up a slide of a stocking clad leg disappearing into a bright red high heel shoe. “If you want to make the best shoes, ask someone with a foot fetish to review them, they know more about shoes than you do,” Boyle told the audience. What a line!

The past few years have given rise to a new term, e-Patients. These paradigm changers are empowered, engaged, informed, and most of all, desiring to participate in their care and planning as an equal peer. An e-Patient can be someone who googled symptoms before going to the doctor, or someone who studies their lab results with the veracity of a Rhodes Scholar.

The Pew Internet and American Life Project reports, “one in five Americans have gone online to find people with similar health concerns.”

Still, not everyone one is convinced. One doctor privately quipped to me, “thats just what we need, more people using Dr. Google.”

I understand his reaction. The perception is e-Patients come with inaccurate information, too many questions, or have unrealistic expectations of a doctor’s availability. That misses the mark. The value of e-Patients, in addition to arugably reducing the burden on providers, is as the extreme use case. What if they are high-contact and high-need? Embrace it. They are the early PocketPC users who can tell you why using two programs to put videos on a device is seriously flawed. They are the ones with a foot fetish who can tell you why that color red isn’t ideal.

They are the ones who can tell you why a 4 AM blood draw is not a good idea.

Facing the future

Designing for experience in healthcare requires a wholesale change to the way we plan for and implement services. Rather than design by committee, teams need to focus on putting themselves in the patient’s perspective. If you want the ideal inpatient blood draw, sleep in a hospital room, and have someone wake you up at 4 AM two days in a row. By the third day, you’ll have some creative ideas for solving the problem.

Boyle suggested being pushed around your hospital in a wheelchair, not once, but hundreds of times. See if from the eye level of someone sitting down. You’ll notice how most nursing stations have counter tops higher than the eye level of someone in a chair. A hospital CEO once remarked to me, “you know it doesn’t really matter what art we put on the walls, all of our patients are laying down and only see our drop tile celling, and man is it ugly.”

Designing for experience also requires a high degree of empathy for the customer. It means you have to open yourself to feeling what they feel. Imagine being scared or confused or sedated. Empathy means thinking about what you would want in the same position. Have you sat waiting for 45 minutes in a doctor’s waiting room? Do you like it? Then why do we think our patients will. There are solutions to these problems, but they require us to design for the patient experience, not the personal or political needs of the organization.

If you think designing for end user experience comes at a high cost or the sacrifice of revenues, just look at Apple’s current market valuation. It can be done.

Designing for experience also means embracing the fringe use cases. Look towards our most frequent users, our e-Patients or our squeakiest wheels. What can they tell us about what works and what doesn’t? What feels like fringe today will probably be the mainstream of tomorrow. Do we want to be ahead of it, or behind it?

Experience is a differentiator. In describing my experience at Thomas Keller’s restaurants in this post, I said I expected the food to be amazing; it’s was a given. What makes the meals memorable are the experiences. It is the same thing which sets Disney’s parks apart from Six Flags. The Disney visit is a complete experience. It is the same thing which has made the Ritz-Carlton a world famous brand. We make choices based on emotion first, and reason second. Emotional connections are made with experiences. We expect excellent clinical care whenever we walk into a hospital. (If it’s not excellent, we have bigger problems.) Experience makes the competitive difference.

If we want a healthcare system which works, is high quality and patient focused, we have to start designing for experience.