The conference, in its second year and organized by Mad*Pow and Claricode, brought together voices from the health care and design industries to grapple with big ideas in health care. Ranging from the eye-opening health implications of current U.S. food policy to the potential of open-source data to transform the way we experience health care, the day’s talks invited plenty of debate and spirited discussion. Common across all sessions was human-centered design’s role in improving the way health care is delivered and experienced, with a few key themes that we think merit special attention:

1. GET ALL THE STAKEHOLDERS IN THE ROOM — YES, ALL OF THEM.

If we’re redesigning an outpatient experience, we need to involve everyone, from the practice manager to the receptionist, in order to understand what their roles are and, more importantly, how those roles interact to create the experience patients have when they need care.

If we’re dealing with food, we should involve not only the farmer and the concerned parent but the industrial food producer as well. Many know the statistics indicating that our food is making us sick, or are appalled by the moniker “Generation Rx.” But in order to design a better future, we need to hear from all stakeholders. Bring the snack food company or the pharma giant to the table. These groups want to be included, and let’s face it, we need to acknowledge their influence, even if the ultimate goal is to move beyond it. Without taking the time to understand all points of view (even from the oft-maligned “bad guys”), we’ll never arrive at a solution with enough buy-in to become real.

2. DESIGN FOR FAILURE, BECAUSE IT’S GOING TO HAPPEN.

Since we can’t always prevent failure, especially when trying to help people make significant changes to their behavior and health, we must accept that failure is going to happen and design for it. Setting impossible expectations on a patient, and then “shaming and blaming” when they can’t meet them, or weighing patients down with so much information that they become overwhelmed, is not sustainable. Supporting success is good but insufficient. From medical devices to long-term drug treatments, we have to design safe ways to recover from failure.

Since we can’t always prevent failure, especially when trying to help people make significant changes to their behavior and health, we must accept that failure is going to happen and design for it. Setting impossible expectations on a patient, and then “shaming and blaming” when they can’t meet them, or weighing patients down with so much information that they become overwhelmed, is not sustainable. Supporting success is good but insufficient. From medical devices to long-term drug treatments, we have to design safe ways to recover from failure.

We can create controlled stops for undesirable behaviors, give people ways to start fresh, remember that human capabilities are limited, and design for evolving needs over time. The patient just diagnosed with HIV needs something different than the patient who has been living with HIV for 10 years, even if they are both on the same drug regimen. A doable solution is more effective than a perfect solution that gets abandoned because it’s too hard. When we let people fail and don’t give them a way to recover, we fail them as designers.

We can create controlled stops for undesirable behaviors, give people ways to start fresh, remember that human capabilities are limited, and design for evolving needs over time. The patient just diagnosed with HIV needs something different than the patient who has been living with HIV for 10 years, even if they are both on the same drug regimen. A doable solution is more effective than a perfect solution that gets abandoned because it’s too hard. When we let people fail and don’t give them a way to recover, we fail them as designers.

3. RIDE THE MOTIVATION WAVE.

Of course, reducing the incidence of failure is not a bad thing, and there are effective ways to do it. We can take advantage of “motivation waves,” the social scientist BJ Fogg’s term for the temporary window of opportunity in which people can actually do hard things. The big takeaway: Use motivation wisely. Be smart about where you ask people to direct their energy when motivation is high, and guide them in how to do it. Facilitate sustainable change by structuring future behavior, reducing barriers to good behavior, and taking baby steps to increase capability. Meet patients where they are, rather than where they “should” be, so they won’t give up when faced with something that’s too hard or doesn’t work.

4. DATA + DESIGN + INNOVATION = BETTER HEALTH

“Data” was a buzzword at HxD, thanks to Todd Park and others who brought home the point that while there is no shortage of health data being generated, the numbers need to be better understood and distributed for anyone to benefit. Park aspires to make health care data free and easily accessible, in order to fuel innovation and unleash “awesomeness.” If this is your thing, be sure to look out for his next “datapalooza” so you can get in on the fun and help rid the world of such absurdities as not being able to access your own health records.

Mitch Higashi of GE Healthcare joined a chorus of speakers in noting that the next big challenge in health care won’t be about research, technology, or economics but about making data more visual, so that people can actually use it to make complex decisions easier. Rather than poring over Excel spreadsheets, we should be able to use data visualizations to help decide where to put the next hospital to save the most lives, or how to best treat low blood sugar. Perhaps this can be best summed up with the sentiment that while information is cheap, understanding is expensive.

5. THE PATIENT OF THE FUTURE WON’T WANT TODAY’S CARE.

To reiterate a conference theme, you have to know your user--and anticipate his or her needs. Gaining a holistic and contextual understanding of the people you’re designing for will help ensure an experience that will resonate. Meredith DeZutter, from the Mayo Clinic’s Center for Innovation, pointed out that our current models of care are largely the result of the social and economic forces that shaped the attitudes of patients in the early part of the 20th century and that today’s patients live in a different world and expect very different things from their health care.

Historically, the health care debate has focused on the sickest patients and those with chronic conditions. But we shouldn’t overlook the fact that the bulk of patients seek basic medical care: an annual physical, a simple procedure, or other less dire needs. We can’t only design around the most complex cases; one size doesn’t fit all. DeZutter also discussed how increasingly, health care is about connections, not spaces and tools. Families expect to be involved in the care of their loved ones, multiple specialists may need to coordinate, and data must be shared among institutions. Relationships and networked communication are the backbone of health care in the future.

Historically, the health care debate has focused on the sickest patients and those with chronic conditions. But we shouldn’t overlook the fact that the bulk of patients seek basic medical care: an annual physical, a simple procedure, or other less dire needs. We can’t only design around the most complex cases; one size doesn’t fit all. DeZutter also discussed how increasingly, health care is about connections, not spaces and tools. Families expect to be involved in the care of their loved ones, multiple specialists may need to coordinate, and data must be shared among institutions. Relationships and networked communication are the backbone of health care in the future.

Keeping all of these themes and guidelines in mind can seem overwhelming in its own right, but the important thing to take away is that health care is changing--quickly--and the role of design in health care is becoming more visible and more powerful. The real question is what are we, as designers, going to do about it?

The HxD conference, organized by Mad*Pow design agency and Claricode, a developer of medical software, gathered academics, designers, developers and user experience experts – from MIT, Stanford, Mayo Clinic, Kaiser Permanente, Siemens, Allscripts and more – for a day-long confab aimed at rethinking the ways design and philosophy could be brought to bear on electronic health records, mHealth apps, medical devices, clinician workflow and the patient experience.

Park, exuberant and enthusiastic as ever, sang the praises of the galaxy of innovative apps developed so far under the auspices of the Health Data Initiative (HDI), launched during Park's stint as Health and Human Services CTO, in conjunction with the Institute of Medicine, which has unlocked troves of government health data, seeking to catalyze an "self-propelled, open ecosystem of innovation" by which private-sector developers put that data to use and improve health.

The project is in "turbo-overdrive," Park said – and should only go forward further and faster now that HHS will be doubling the amount of data on healthdata.gov in next six months.

Earlier in the day, however, Devorah Klein, principal at Continuum, a Boston-based design consultancy, cautioned that not all mHealth apps are created equal – even when a lot of thought is put into their design, some fail to achieve the desired effect: actual, real-world health improvement.

She mentioned the "marginal and sometimes even negative impact of certain well-designed approaches" to apps addressing wellness issues such as smoking cessation and weight loss – areas which are fraught with risks of setbacks and failure for even the most-well-intentioned patients.

"If you can't prevent failure, you need to accept that it will happen and design for it," said Klein, who noted that information overload and "shaming and blaming" are entirely counterproductive strategies. Good wellness apps will have mechanisms built into their design approaches for the inevitable slippage: "People need the tools to fail, not just to succeed."

On the EHR front, Jill Reed, user experience research manager at Allscripts, described how the firm went about trying to design an iPad-based health record that "physicians will actually use – and not loathe."

Among its approaches: recognizing that no single device is perfect for each situation; ensuring that the task at hand is the "right one for the device," rather than vice-versa; maintaining a focus on the family physician, rather than on a multitude of specialists with wildly different workflow needs; examining floor plans to gain knowledge about physical workflow and "interaction points"; and keeping an eye on the bigger picture rather than "bit by bit functionality."

Too many doctors, said Reed, have to "sift through mountains of data," much of which is "not relevant to what they're doing."

Scott Lind, director of user experience at Siemens Healthcare, echoed those concerns – and described some of the challenges of designing EHRs for clinicians' "highly variable workflows."

Oftentimes, "creating a good user experience is … a power struggle," he said. With many competing interests and layers of bureaucracy at stake, knowing what's best to do and actually doing it are too entirely different things. "Everyone believes in good user experience," he said. But too often it gets short shrift, since "it's always something that can be put off."

Good design "takes resources," he said, and with developers still focused first and foremost on meeting a long checklist of meaningful use mandates, sometimes it can suffer. Nonetheless, he argued, it's important for EHR architects to make the case for good design, and "cultivate a culture" where it has a "voice."

In her presentation, Meredith Dezutter, senior service designer at the Mayo Clinic Center for Innovation, telescoped out to explore how the patient experience is evolving, and what healthcare will be designing for in the future.

Currently working on multiyear initiative to redesign Mayo Clinic's outpatient practice, Dezutter has spent a lot of time thinking about the "patient of the future."

Recognizing that "health is not just a medical issue," Dezutter analyzes social drivers, economic and environmental factors and more to try to see into that crystal ball. Already, she said, with new developments in crowd-sourcing, cloud computing. remote monitoring, data mining, we're seeing big changes afoot on both the patient and provider sides of the equation.

All this change is "challenging orthodoxy that expertise can only come from medical professionals," said Dezutter – adding that "we are all patients; we should create the systems and experiences we want."

At the HxD closing keynote, athenahealth CEO Jonathan Bush gave a funny and spirited summation of the challenges and opportunities facing healthcare in the coming years.

He also fielded some tough questions from audience members – one of them a physician who opined that most docs think most EHRs "suck."

Certainly most of them have some work to do on the design front. For a nation of consumers having grown quickly accustomed to the smart and elegant designs of Apple's iPhones and iPads, the ungainly and ill-conceived interfaces of many EHRs leave them wanting more.

Bush agreed. The electronic health record "has to be beautiful," he said; it has to have "a simple and elegant expression of purpose."

Clark, whose firm bills itself as specializing in "design strategy and user experience for a mobile, multiscreen world," sought to help designers and developers steer clear of some of the "pitfalls of the last few years" as the market for smartphones, tablets and apps has exploded.

Different platforms and screen sizes and network capabilities mean that "mobile's pretty exciting, but it's also a huge pain," Clark joked.

Also complicating things is the so-called "anthropology" of mobile tech users. There's a "range of mobile cultures," he said; "lots of mobile mindsets." He was talking about consumers in general, but the same can be said for clinicians and other caregivers, with their many different needs.

To avoid the risk of making "patronizing" or "dumbed-down" apps, Clark spotlighted these seven myths, and suggested that by avoiding them, developers will have a much better chance of creating useful and exciting apps that healthcare professionals will actually use.

1. Users are always rushed and distracted. Mobile isn't just "on the go," of course, said Clark. It's also "on the couch." (And sometimes – according to one survey he spotlighted, to much laughter – "on the throne," so to speak.) But assuming that users are too busy to appreciate good content can lead to stripping out useful features, down to the bare bones, he said. "Don't arbitrarily remove content."

2. Mobile should be "less." Relatedly, it's a myth that mobile sites should be more bare-bones than their desktop counterparts, said Clark, noting that 25 percent of mobile Web users only use mobile Web. "As we do everything on our phones, and sometimes only on our phones, don't confuse device context with user intent," he said. As clinicians increasingly come to embrace mobile devices, "don't limit functionality because of screen size."

3. Complexity is a dirty word. People don't want dumbed-down applications, said Clark. They want "uncomplicated" applications. A good app might have guts and functionality that's complex, yet still be "comprehensible." As a funny example, he showed two imaginary iPhone apps that might help a pilot fly a plane. One showed a virtual rendering of a cockpit's many gauges and gizmos. The other had just two buttons: "FLY" and "LAND." It's important to know your audience and their needs, he said. And to remember that no matter what they are, "in a mobile interface, clarity trumps density."

4. Extra tabs and clicks are evil. In the olden times, when an Internet page might take 45 seconds to load, this made sense: making extra work for your users was bad. But with 4G speeds all but eliminating that concern, it's alright to broaden the experience. Healthcare has taken to mobile technology with such passion because of the limitless and conveniently accessible knowledge it represents. "If the information is readily available, and fulfilling, an extra tap is OK," said Clark.

5. You've got to have a mobile website. "Design something that will look good on any platform," said Clark. Don't have separate mobile sites because there's no such thing as a "mobile Web" – URL stands for universal resource locator, after all. First there were desktops, then laptops, then smartphones, then tablets. Who knows what's next? "Build a common back-end that can support any interface," he said.

6. Mobile is about apps. It's not. "An app is not a strategy. ... It's just an app," said Clark. As clinicians expect to be able to access information in the office or at the point of care, it's important that content be "agnostic about platform machinations." Users "expect our content to flow and be wherever we are," he said. "You can't start from scratch and design for every platform."

7. "CMS and API are for database nerds." Clark quoted user experience designer Ethan Resnick: "Metadata is the new art direction." In other words, content design – the way it appears on a doctor's desktop computer, or on his or her smartphone – is affected nowadays by back-end folks, and the filters and parameters they devise, to a degree it wasn't before. Content itself is what's being repurposed, not just design, so it's key for designers to know how it all works together.

But I want to push the conversation in yet another direction. While the main conference sessions focused on the aforementioned themes, the case studies presented in an adjacent ballroom spoke of analog applications for experience design.

Jessical Floeh, founder of Hanky Pancreas, talked about her series of fashionable products for wearable diabetes technologies–Could a social model be a more effective way to increase disease management? Patients are people and yet, many products and solutions are designed through a clinical lens, sufficing medical parameters but often forgetting the person at the center of the experience.

Health is not just a medical issue.
— Meredith Dezutter, Senior Service Designer at the Mayo Clinic

David Rose, founder of GlowCaps and instructor at MIT Media Lab, challenged the growing obsession with everything mobile. Mobile apps have limitations and perhaps, the opportunity is to look at everyday objects surrounding us instead. Furniture, for example, has incredible advantages over mobility, including durability, the affordance of natural gestures, and glanceability. Case in point: The energy clock could tell time in addition to our energy consumption habits. So then, how could we “appify” everyday objects to serve our needs, particularly in healthcare?

On the train ride to the conference with me in analog, Benjamin in digital–Both valid approaches and both so necessary depending on context. Could even this be tied into our healthcare experience?

We’re people first and patients second. We’re children, we’re adults, we’re elderly. We’re women, we’re men. We’re athletes, we’re lovers. – Amy Tenderich, Founder and Editor of DiabetesMine

The patient experience is evolving in radical ways and the focus on big data is certainly an influential factor in this shift. But the more significant takeaway from my conference experience is that data is a medium, and our opportunities for healthcare delivery actually lie in considering our audience as people first and patients second.