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Published On January 24, 2018

TECHNOLOGY

The Shape of Things

Design choices pervade the health care system, and pediatrician Joyce Lee wants to make them smarter.  

Joyce Lee is a professor at the University of Michigan and a pediatrician at C.S. Mott Children’s Hospital in Ann Arbor. Over the past several years, however, she has made a name for herself in a different specialty: design, which is the art of deciding not only how a product looks but also how a process functions.

Design in all aspects of medicine can feel like an afterthought, says Lee. Effective design takes its cue from users’ experiences and is shaped to suit their habits and preferences. Medical culture, on the other hand, almost universally solves its problems from the top down, she says, from doctor or administrator to patient.

She leads a collective, healthdesignby.us, which educates health care professionals about the importance of design in their work. It also hosts events where lay inventors can meet to share ideas, and conducts research on patient-driven design. Lee is frequently invited to lecture about these ideas at conferences, academic centers and federal agencies, including the Food and Drug Administration.

Q: When did you realize that design was overlooked in medicine?

A: I was on sabbatical in the Bay Area with my two small children. They both have life-threatening food allergies, so I needed to teach the person taking care of them how to use an EpiPen. The design of the EpiPen and instructions for using it are wildly counterintuitive. The cap end, for instance, is not where the needle comes out, which is misleading and which studies have shown may lead to unintentional sticks. My son and I decided to make our own amateur instructional video, which went viral. That experience gave me the push to start thinking and writing about this.

Q: How else can design cause problems?

A: In health care a lot of design just happens—and fails to consider the end user. A classic example occurred this year when an insurer sent letters to more than 12,000 of their customers who take HIV-related medications. They used a windowed envelope that visibly displayed the beginning sentence of the letter, revealing the individual’s HIV status to anyone who saw the front of the envelope. This represents a series of sloppy design choices—letter formatting and envelope selection—that might seem minor but may have had catastrophic consequences for the patients.

Q: How receptive is the health care industry to making changes?

A: Design is still a pretty foreign concept here. When you look at industries in consumer technology, such as Apple or Google or Airbnb, user experience is one of the first things they think about. But when you think about how health care systems are developed, there are rarely any patients at the table.

Q: Are there exceptions?

A: I’m excited about patient-driven design and the maker movement, which are both relatively new paradigms. The maker movement has this do-it-yourself ethos that places low-cost electronic computing tools and 3D printers into the hands of patients and caregivers so they can develop their own personalized solutions.

One really amazing example is an online group called e-NABLE, which works to design and print 3D prosthetics for kids with upper-limb deformities. It’s made up of teachers, students, scientists, tinkerers and artists from all over the world. It was started by a guy who designed a mechanical hand in 2011 as part of a costume, which he filmed and put on YouTube. Someone in South Africa saw the video and said, “Oh my gosh, I lost my fingers. Can you make a prototype for me?”

Q: What are you working on now?

A: I’m looking at the design of our electronic health record interfaces, to minimize the frustrating number of clicks required to perform any simple task, such as putting in a treatment order. I’m trying to figure out new opportunities and incentives for our patients to input their health data through web and mobile apps, which can help their doctors keep a better eye on their health between visits.

There’s a big learning curve for this kind of work, but design is one of several new competencies in medicine. In 2017, as physicians, we need to know about more than physiology. We need to think about the structures and hidden messages of the health care system we inhabit, too.