Three Designed Objects: A Metaphor for Healthcare and Healthcare Data

Look at these 3 designed objects.

The Uncomfortable Pot

Katarina Kamprani

The Slipper Spoon

Katarina Kamprani

The Chain Fork

Katarina Kamprani
Katarina Kamprani

These 3 objects are a perfect metaphor for the current design of healthcare, which remind me of these three inconveniently designed verticals in healthcare.

The silos of healthcare operations (clinical care), quality, and research.
“Learning Health Systems require the Effective Use of Data from the Electronic Health Record, Quality Improvement Science, Engagement in Collaborative Learning with Patients/Caregivers/Multidisciplinary Stakeholders, and a Virtuous Cycle of Learning so that research discovery can inform clinical care, and clinical care can inform research discovery.”

The foundation of a learning health system starts and ends with the optimal design of data. Without it there is no capacity to measure outcomes, support and sustain improvement, or iteratively learn and make new discoveries.
“The practice of medicine is the way you handle data and think with it. And the way you handle it determines the way you think…the very structure of the data determines the quality of the output.”

However, we have a fundamental problem in how we create, use, and take action with data because of the underlying design of the EHR. Our fundamental problem with the design of healthcare data is the metaphor/mental model that we are are using for the EHR.

What do you think of when you hear the words “health record”?

Our metaphor for the EHR is a Microsoft Word document, and we have designed our EHR systems accordingly.

Because of this poorly conceived EHR design, current forms of healthcare learning in the enterprise involve extensive chart review

We need a new metaphor/mental model for design of the EHR which is NOT “note-centric”. We need to move towards a model of “Data in once/Used many times”.

The Opportunity in Type 1 Diabetes

Use of a Quality Improvement Framework

Creation of Provider Tools to Capture Evidence-based Self-Management Metrics and Other Key Data

Creation of Patient Tools to collect Patient-Reported Outcomes

Integration of Provider and Patient Tools into the EHR Workflow

With the team-based EHR workflow, notes become a byproduct of structured data collection

What did we learn from the data captured from this EHR redesign?

6 key diabetes self-management habits: (1) checks glucose at least 4 times/day or uses continuous glucose monitor (CGM); (2) gives at least 3 rapid-acting insulin boluses per day; (3) uses insulin pump; (4) delivers boluses before meals; (5) reviewed glucose data since last clinic visit, and (6) has changed insulin doses since the last clinic visit.
Total Habit Score=Sum of all 6 key diabetes self-management habits per person.

We now had clear, actionable metrics associated with glycemic outcomes that we could continuously measure and tackle in QI interventions to improve the health of our patients. Furthermore, we identified greater opportunities to achieve health equity in diabetes outcomes, as we found that that the association of the six habits with the glycemic outcomes was similar across race and insurance subgroups.

I am excited to report that these metrics are on the roadmap for the @T1DExchange quality collaborative so that every center can measure them in a systematic way, to inform improvement at a national level.

Here are my Design Recommendations for the EHR

We can’t ask doctors to become data entry clerks for the EHR but there are key clinical and evidence-based metrics that require clinical judgment and can’t necessarily be inferred from the notes. We should take advantage to reduce the note writing burden of the providers and to increase opportunities for learning. Otherwise we are doomed to do chart review and stymie our efforts to do continuous learning for the rest of eternity!

Let’s move away from the metaphors of the 3 awkwardly and uncoordinated designed objects and “Microsoft Word for the EHR” in healthcare, and let’s move towards more coordinated design of information systems to support and improve outcomes for our patients across the operational, quality, and research divide!

See previous posts about EHR and data design and the role of metaphor in healthcare design:



Joyce Lee, MD, MPH, Physician, Designer, Researcher. #learninghealthsystems; #design for #ai; and the maker movement

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Doctor as Designer

Joyce Lee, MD, MPH, Physician, Designer, Researcher. #learninghealthsystems; #design for #ai; and the maker movement