Most companies don’t consider the older medically complex patient

What user personas do healthcare technology designers and entrepreneurs have in mind as they create their products? And how often is it the family caregiver of an elderly person?

This is the question I found myself mulling over as I wandered around the Health Refactored conference recently, surrounded by developers, designers, and entrepreneurs.

The issue particularly popped into my head when I decided to try Microsoft HealthVault after listening to Microsoft’s Sean Nolan give a very good keynote on the perils of pilots and the praises of platforms (such as HealthVault).

As some know, I’ve been in search of apps and services that can help older adults and their families keep track of lengthy and frequently-changing medication lists. For years now I’ve been urging family caregivers to maintain some kind of online list of medications, but so far I haven’t found a specific app or service to recommend.

Why? Because they all require way too much effort to enter long medication lists. Which means they are hardly usable for my patients’ families.

Could HealthVault do better? Having heard generally promising things about the service these past several months, I signed up and decided to pretend I was the daughter of one of my elderly patients, who had finally decided to take Dr. Kernisan’s advice and find some online way to keep track of Mom’s 15 medications.

Sigh. It’s nice and easy to sign up for HealthVault. However, it’s not so easy to add 15 medications into the system. When I click the “+” sign next to current medications, I am offered a pop-up box with several fields to complete.

I can’t help but think that when HealthVault’s UX team worked on this, they must not have considered the case of the 58-year-old woman trying to enter the lengthy med list for her 85-year-old mother.

This is too bad, because if they had considered the caregiver of an older adult, they surely could’ve come up with some better options. For example, consider what happens when one signs up for a new social media platform these days. Usually, the service offers to connect to one’s email account or contact list to conveniently import useful information.

Similarly, if HealthVault had designed with lengthy medication lists in mind, they might have immediately offered the option to import medications from one of their major pharmacy partners, like CVS or Walgreens. (Oh wait. Looks like Walgreens and HealthVault broke up recently. Bummer.)

Unfortunately, as far as I can tell, most companies don’t seem to have considered usability with the needs of an older medically complex patient in mind, unless they are specifically focused on the aging/caregiving market. (And even then, I’m not always sure the design can stand up to the medical complexity of these patients.)

How to help healthcare tech companies design for the older medically complex patient

The number one health services problem facing the nation is how to provide compassionate effective healthcare to the growing Medicare population, at a cost we can sustain.

Healthcare technologies companies often gravitate towards wellness, prevention, and serving a relatively young, tech-savvy population. But if they really want to serve the needs of society, they need to help those patients who are the chronic high utilizers: the elderly.

How to design for these older patients, and the family caregivers who are often their proxies in healthcare?

Developers and designers would need to start by better understanding how usable their product feels when used on behalf of someone with multiple conditions and multiple medications.

(Of course, in an ideal world the product would be designed to be usable by the elderly themselves, but let’s start with the simpler scenario – and currently relatively common scenario – in which young and middle-aged adults use healthcare technology on behalf of an older loved one.)

Here are three things that designers of healthcare tech tools should do:

  • Create a “family caregiver for a medically complex older adult” user persona. In my experience, family caregivers are pretty stressed and overwhelmed by the substantial job of managing an older person’s healthcare. They need help, and that help needs to be easy to use. Hence, I’d be surprised to see them adopt any product that requires labor-intensive data entry.
  • Create or obtain a sample medical data file for a medically complex older person. I described a medically complex patient last fall when I blogged about the Blue Button redesign challenge. Obviously, design and usability will be tested in very different ways if a patient has fifteen chronic conditions instead of just two, or eighteen medications instead of just three.
  • Involve caregivers of medically complex elders in the user testing of your product. See what happens when caregivers try to use the product on behalf of an elderly person.

Of the three ideas above, the second will probably be the most difficult for companies to implement. That’s because a realistic sample data set for a medically complex patient is hard to generate from scratch.

One possible way to tackle this would be for some larger entity governmental or non-profit entity to create this, and then distribute to designers and developers so as to help them serve this critical user demographic.

Can anyone think of a way to encourage medically complex patients to volunteer their de-identified data?

Other ideas on how to encourage developers and designers to create products that work for the caregivers of the elderly?

Leslie Kernisan is an internal medicine physician and geriatrician who blogs at GeriTech.

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  • webhill

    Why not just use something like Evernote — have a note called “Mom’s Rx labels” and snap a photo of each Rx label. If a med is discontinued either delete that photo from the note or write “discontinued on [date]” next to it. Update as necessary. Doesn’t seem that hard. In fact every time I get an Rx filled for me or anyone in my family I snap a pic of the label, and put it into evernote with the tag “rx” and also the name of the patient. Works fine for me.

  • southerndoc1

    These apps don’t exist because there’s no market for them. So, when the public has demonstrated they have no interest sitting in front of a computer and wasting time doing data entry, the solution is obvious: a government subsidy of 44K to everyone who buys a lousy product rushed to market.

  • Kimberlee13

    I have an almost 93 year old (it’s less than 2 weeks now) at home. He is fairly tech savvy as he was a rocket scientist by profession, and worked with some of the earliest computers. Because he can use his iPhone, and Kindle people think he should be able to handle it all. As my generation ages I see serious gaps with technology. He has essential tremor – even using a stylus he sometimes has a miss in his phone which frustrates. As his macular degeneration worsens he has trouble seeing with low contrast – not being a touch typist he has trouble seeing the letters on the keyboard. How are these things going to be for those of us directly attached to our electronics? Can we figure out how to make these things easier for the gamers with hands crippled with arthritis? I’m an RN, I have updated med lists, copy of the DPOA, and separate list of major medical history and allergies in several cheap folders to take in an emergency. Sometimes have most recent labs. Not everyone can do that, or can think to do that. Hopefully, someone will get their act together and help families and older patients organize information.

  • Simon Sikorski MD

    I’d love to discuss this topic at the next Healthcare Pioneers event. Perhaps we can marry it with why the end users are not involved in designing new technologies.

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