Patient platforms should be intuitive in design and execution [PODCAST]

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“Communication is both the sending and receiving of information. Data is as difficult to receive and act upon as the ingredients of a meal because much work is left to be done. Information is palatable, actionable, and leads to measurable results in the short and long term.

Patient platforms ought to be intuitive in design and execution, utilizing pictures, animation, mapping, and data-point conversion into meaningful associations with body systems. Developers will be well served to learn from the social sciences, learning theories, and from every 4-year-old using an iPad.”

Christopher Noll is a nurse and risk manager.

He shares his story and discusses his KevinMD article, “Patient platforms should be intuitive in design and execution.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow. Today on the show we have Christopher Noll. He is a nurse and risk manager. His KevinMD article is titled “Patient platforms should be intuitive in design and execution.” Chris, welcome to the show.

Christopher Noll: Thank you. Thank you for having me.

Kevin Pho: We’ll get into your article in a little bit. First off, briefly share your story and journey to where you are today.

Christopher Noll: I’m a nurse. I’ve been a nurse my whole career. I started in 1993, and throughout my journey I’ve worked clinically in critical care, oncology, hospice, and home care, lots of exposure there. I worked in management, managing people and nursing units, for 10 or 11 years, and then I had an opportunity to get involved in risk management for the last four years. It’s been a great career. I’ve been able to experience so much. It’s been a big blessing to be involved in so many people’s lives at so many different phases of their life and sickness, and to be able to serve.

Kevin Pho: As a nurse and a risk manager, tell us about some of the cases that you typically see.

Christopher Noll: Well, clinically, you can imagine, I took care of critically ill patients in the ICU setting. My favorite way to be a nurse, to be clinical, is either in oncology or hospice. I really enjoyed the hospice interface because in hospice I did the home care version, so I was in people’s homes. In that setting, you really help the caregiver more so than the patient. The caregiver takes care of the patient, and as a nurse I get to instruct, help, counsel, listen, and help them manage their loved one.

Then as a manager and a leader, what I really enjoyed about that role is taking care of the people who took care of people, by taking care of the nurses, taking care of the staff, and working with the providers, helping the providers have a good experience on the units that I worked in. I really focused on communication, clear pathways for how to communicate necessary clinical things, but more importantly, or equally as important, how to communicate errors and how to safely communicate when we fell short of the expectations. That really was a passion of mine, and it helped me as I carried over into risk management.

You know, sometimes I call risk management the bad news department. People don’t call me to tell me how great things are going. They call me to say, “Well, what happened was.” As a risk manager, I often see providers or frontline clinical staff who have had kind of the worst day of their lives, in some cases. Something’s gone awry. Something has happened that was never intended, and certainly they wanted it to be prevented. But things happen in health care. Health care is very complicated; there are a lot of complicated systems. So as a risk manager, I get to hear their stories, and then I really think about how they got to that error. I think about the systems that surround them and system failures. There’s always a human being attached to an error in health care, because we’re people taking care of people. But around all those people are systems and processes, and oftentimes the root of the error can be found there. Then I work on improving those systems to help better protect the provider, the clinician, or even better yet, make it more resilient and more obvious before the big error occurs, so people can pause and fix things.

Kevin Pho: Now, we have a lot of health care professionals who listen to the show, both clinicians and nurses. From a risk management standpoint, what would you say is your number-one tip that you could share with these health care professionals to reduce any risk going forward?

Christopher Noll: Pause. The biggest thing is to find that clinical pause. When things don’t seem right, when things seem chaotic, pause, because too often our initial reaction to life and the circumstances around us is impulse, intuition. We have recall bias. We’re human beings. We remember our experiences more than the instructions: If things worked out before, they’ll probably work out well now. We react. If we can pause, it gives our minds a moment to shift to that more analytical thinking. It gives us an opportunity to recognize, “Wow, things aren’t going right. Maybe I don’t need to use my intuition and instinct in health care.”

Health care is so complicated, and there are so many moving parts, that what I see is we as clinicians fail to recognize how complicated everything is, how intricately everything interacts, so we tend to oversimplify. So when we make an error, there are always folks who say, “Oh, we can just fix it by doing this.” As a risk manager, I push back against that. I say simple solutions to complicated problems won’t work. We need to slow down and really investigate and really analyze. And oftentimes, you know, we don’t make major changes to systems. So as a risk manager, a lot of my job is to get people to reevaluate and use that analytical side of their mind. And to that, I tell clinicians and providers: If you can find that clinical pause, you’ll save yourself a lot of grief.

Kevin Pho: All right, great advice. Let’s talk now about your KevinMD article. It’s titled “Patient platforms should be intuitive in design and execution.” You’re implying that they’re not already intuitive and not executed well. Now, for those who haven’t read your article, just walk my audience through it.

Christopher Noll: Share the story of why I decided to write it. So in the States, you know, with the Affordable Care Act, with HIPAA, the titles of HIPAA and everything else, meaningful use, there’s this continual progression toward sharing information openly and transparently with patients, which is fine in and of itself. What’s happening more often than not is that organizations, hospitals, and health care governmental organizations are creating these patient platforms, and they’re responding to federal guidance and law, provider laws, Medicare, all that stuff, by just creating these portals and sort of populating them with data.

Well, data is complicated. It’s confusing. You know, if I go to my portal and I see that my doctor’s been tracking my blood pressure, and it’s 200 over 100, well, what does that mean? Well, it doesn’t mean much in and of itself. It means a lot in context. Maybe I have hypertension. Maybe I was out running. Maybe lots of things. So a number in and of itself doesn’t really help; you need the context. What I’ve found is that the portal, more often than not, is just providing our raw data.

And for us in health care, you know, we’re all college-educated, licensed professionals. There’s a lot of education that went into knowing what we do. Oh, and by the way, it’s not just generalized knowledge; it’s specialized knowledge. So now you’re dealing with folks who are highly educated and highly specialized sharing information with a generalist. A patient is a generalist: “I generally don’t feel good. I want to know what to do about it.” Well, looking at myself as a patient through a keyhole may not be very helpful. So I look at the patient portals and think, “Gosh, could we do better? Could we communicate more effectively? Could we accomplish the goals of legislation by looking at it a different way? Instead of just sharing the data, what would it look like to do a better job of that?”

Kevin Pho: No, I think that you bring up a great point. This happens often, where patients get the raw data even before I, as a physician, can see it, interpret it, talk to the patient, and provide that context that you talked about. So I think that it is an issue; it is a problem. So tell me some of the ideas that you have in terms of addressing something like this.

Christopher Noll: So I’m kind of a human factors engineering hobbyist. I’m not a human factors engineer, just to be clear. I’m a hobbyist, a systems theory hobbyist. When I look at the other disciplines outside of health care, I refer to the social sciences. I look at our psychologists. I look at people in art and theater. I look at other disciplines and think, how could their skill set be applied to what we do? Because at the end of the day, we’re people taking care of people. We’re trying to communicate effectively. Well, people come to us with varying levels of education and communication ability. You know, some people have low vision or low hearing. Some people, a lot of folks, don’t speak English; they only speak their language. So I think about what works well that we could reapply to health care.

I’ve done a lot of incidents, but one recent one that comes to mind is a patient who came in and had a wrong-site procedure based on miscommunication. A physician wanted a lymph node biopsied, and she ended up having something else biopsied. When I did the root cause analysis of that event, I asked the question of providers, “Who’s the one person left out of this whole equation, who didn’t know where the biopsy was to occur?” It was the patient. And I suggested back to the providers, “Could this have been solved with a coloring book?” They kind of paused and said, “What are you talking about?”

I said, “Well, you know, I think back to my Gray’s Anatomy coloring book that I had years ago. If I think of the head and the neck, and I think of the field, if you had literally drawn on that picture and colored the region where that lymph node was, and the patient had that with them, they could have easily communicated with the next provider where the biopsy was to occur.” And the physician thought about that. He said, “You know, that’s not a terrible idea,” and actually adopted that.

So how could we make that to scale? I look at kids using iPads. That’s an intuitive platform: communication through pictures and symbols, which communicate far more than words. Words can be interpreted, misinterpreted, and misapplied. So, pictures and symbols. I think about applying diagnoses to a medical avatar model. So if I’ve got a pulmonary problem, I can see it on my cartoon lungs. I can amplify it. I can look at the region; I can look at the lobe. I can understand a whole lot about myself and my own illness process, and what to do about it, from mapping, from digital representations of real things. That’s not being built right now. I think we could, and I think we could scale that, and it would help patients understand what’s wrong and what to do about it far better than we’re doing now.

Kevin Pho: So just to be clear, you’re not aware of any patient platforms that are incorporating some of the ideas that you just talked about?

Christopher Noll: There are attempts. There’s a lot of industry out there. Google, Apple, and other folks are, you know, creating wearables; they’re creating apps. But a lot of that, the health care industry really hasn’t adopted. We’re still kind of stuck in the EHR mode. There really hasn’t been that innovation. The technology exists; I just haven’t seen it applied just yet. I think we could. I would love to, you know, partner with Amazon, Google, all these folks, and kind of bring them together and say, “Hey, how do we bridge that gap?” I’ve talked to some folks about that, and usually they ask me, “Well, who’s the customer? How are they going to make money?” I don’t know.

What I do know, from my experience in home care and hospice, is that it would be really amazing if the elderly couple who’s at home taking care of one another, it would be really amazing if in this scenario he could pull up everything wrong with her and show that to me in a picture format, instead of trying to translate what doctors have said. You know, I think of the mother taking care of the medically complex child, or the parents taking care of the medically complex child. How often do they have to see a new specialist after years and then explain seven or eight or more years of medical complexity? Well, wouldn’t it be nice if all that was in a pictorial format? You know, I just think we could do that. It would take some effort. It would be a heavy lift.

You know, one of the biggest social determinants of health in the States, and probably around the world, is where you’re born, what ZIP code you’re in. So it’s not necessarily access to clinics and other things; it’s where you’re born and what happens in those ZIP codes. Well, people have different levels of education. They have different access to resources. But, you know, these iPads and other communication devices are pretty ubiquitous now. They’re around a lot of places. People could carry their health care information around in a digital format, in this medical avatar format, quite well, and transfer their personal information to their loved ones and to other providers quite well, if we were able to build it.

Kevin Pho: Now, I think you alluded to the cause of why this isn’t happening, and it’s primarily because of money: Who’s the customer? How are you going to make money from this? So short of money being the issue, do you see anything on the horizon that can spur these companies to innovate in this particular area?

Christopher Noll: So there’s a push, a legislative push, to be more transparent. I know that there’s an opportunity there. I think that the right folks aren’t talking to each other to make it happen. Unfortunately, a lot of innovation in health care comes because the payer says we have to do it. You know, so gosh, do we sit around and wait for them to do it? I don’t know. I think that it would be great if maybe a state said, “You know what, we’re going to create this platform for all of our Medicaid patients, because a lot of kids are on Medicaid, and we want to make sure that they’re getting the right asthma treatment.” Well, if we put it in a format that they can understand, and a kid’s supposed to do a certain activity over time, you know, maybe we can measure that. Maybe we can measure when prescriptions aren’t filled. Maybe we can measure and give feedback. Maybe there’s a back-and-forth that we could develop to better communicate the care that’s prescribed and the care that’s adhered to.

And then if you have a population, say a ZIP code where you have 80 folks in that ZIP code who are in this, well, if there are three of them who aren’t following the plan of care, that’s where we could aim our resources and say, “You know, I’m going to send home care out there to visit these three families.” Maybe that’s where social services can get involved. Is it a matter of understanding? Is it a matter of access to pharmaceuticals? Is it a matter of financing? You know, we have limited resources, and right now we just use this broad-brush approach and measures that aren’t terribly effective at getting the resources to the problem. I think if, you know, our political leaders could understand more direction of resources to where the actual issue is, maybe that’ll spur some interest in this. You know, this technology already exists. The formats, the processes already exist. We just haven’t applied it effectively to health care.

Kevin Pho: We’re talking to Christopher Noll. He’s a nurse, and he’s a risk manager. His KevinMD article is titled “Patient platforms should be intuitive in design and execution.” Chris, what are some of your take-home messages that you want to leave with the KevinMD audience?

Christopher Noll: We’re replete with data. We have a lot of data. Year over year, we create more and more data. If we look at the number of X-rays, images, that are taken of a patient in 2022 versus the number of images that were taken in 1978, it’s a dramatic difference. We have access to laboratories; medications are more complex. So we continually add more and more data that providers are challenged to interpret and to do plans of care around. We’re flooding data. There’s big data out there. We’re flooding all this information in the inpatient hospital settings.

My message is, you know, more data won’t necessarily get us where we need to be. We need to think about information and how we convert that data into meaningful, actionable information. I think the technology exists, but really, a lot of this could be done with simple formats. Like I mentioned in the beginning, you could do a lot of this with a coloring book. I’m just talking about taking that and digitizing it and then scaling it. We know it works. We know what intuitive platforms are.

One of the examples of an intuitive platform that I like to use: I talk about blocks, building blocks. That’s the standard. If I had a bag of building blocks, you know, little square wooden blocks, 12 blocks in a bag, I could take that back to any country on the planet, hand it to any kid who’s, you know, four years old, five years old, and they would know what to do with them. That’s the standard. That’s how simple it needs to be, and that’s intuitive. When something works that well, then it’s transferable. Information can be transferred effectively, and we can arrive where we need to be. I really think as we make health care more complicated, that’s great, but it’s harder to understand for the patients, and patients really need to understand what’s going on. We need to work on that to help them better digest this information and then act on it in a meaningful way.

Kevin Pho: Christopher, thank you so much for sharing your time and insight, and thanks again for being on the show.

Christopher Noll: Really appreciate you. Thank you.

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