11: Healthcare 🏥👩🏼‍⚕️ User Experience - Patients
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Part of my journey to adulthood was to find my own primary physician because my pediatrician told me that I'm an adult and I can't go to her anymore. So, but in addition to this being a very like emotional journey, it was also kind of stressful for me because she said when I turned 21, she said, you have to go somewhere else. Like I have babies to take care of. Right.

So that was a little bit interesting. I mean, I think the new doctor that I have now, I still don't quite trust her because she hasn't known me since I was like five. I'm picturing you, Nikita, like Kramer in a karate class with all kids. You're showing up for your doctor's visit and all the kids are getting like they're all in a line and they're all getting Flintstone vitamins. And then there you are, a full adult. Yeah.

Welcome to episode 11 of ideate where we're trying on some pants that are arguably too big for us. Pants you say? Healthcare pants. Some of us humans in our own corner of the world are a little apprehensive about using healthcare services. What can we learn from exploring the UX of waiting rooms, tongue depressors, x-rays, blood tests, and urine samples? And how can we take those lessons, put them in a box, and make better healthcare experiences tomorrow?

We're here with the Smythe Group design team, and they are in alphabetical order. Aaron. Hi, this is Aaron. Hiromi. Yeah. Nikita. Hello. Our user advocate, Rob. Hello. And I'm Paul. We're all full of our least, shall we say, pleasurable healthcare experiences. So maybe there's a starting point there. I've got lots of medical stories. I could tell a story about taking a bath in a meth bathtub.

What? Please tell that one. So I had a new apartment and didn't have a shower. And the person that lived there before me was clearly like a drug addict. And I took my first bath in that bathtub and I got like chemical burns from my neck down.

Oh, snap. Do you remember that, Hiromi? Like, I couldn't, like, lift things. Like, my whole body turned red. And then, like, I went to the doctor, and there was, like, that episode of Seinfeld. They're, like, calling other doctors in to come look at my skin. Like, they're all just like, whoa, look at this. What? I remember that happening to you, but I don't remember, like, it turning out that it was, like, a meth doc.

A meth bathtub. That's my theory now because it was my first bath. Okay, all right. I have basically no hospital experiences because I am blessed with the health of a god.

Well, fine then. No, I just, I probably have some debilitating disease. I just don't know about it. You've got a new disease. They're just going to call it Traha disease. Yeah. Traha syndrome. Yeah.

Yeah, I think it's probably readily apparent to everyone but me, whatever it is. It's very similar to Tourette's. That sounds actually about right. Yeah. Well, everyone's going to have to access health care at some point, and even Rob with his currently...

Perfect health. Yeah, so let's say we have a few years before Rob starts falling apart to overhaul some aspect of the healthcare system so that he doesn't have to go through those same things that we've gone through. So what is that? What's that look like? Aaron, you spent some time exploring the medical tech that's currently out there, yeah? As a nerd, most of my interest in healthcare has been around just technology.

New devices, new methods, new discoveries. So I'm interested in medical technology just because I've been interested in technology in general. But that all changed when one day my wife Krista started experiencing some migraine-like symptoms. So first I had an arc of flashing jagged lights in my vision and I had a really bad headache and then my right side went numb.

That's Krista, by the way. Hi, I'm Krista. Something like that. Krista had never had a migraine before. I've had plenty. So I just said, let's wait it out. But the symptoms just didn't go away. So doctor's visit, ER trip, CT, MRI,

All led to a phone call two days after those symptoms first presented themselves. The doctor told Krista, You've had strokes and you need to go to the hospital right now. So we rushed to the hospital and they do every possible test to determine the cause of these strokes. What did they find? Nothing. So they told us we could maybe never know what caused the strokes or it could have been caused by an irregular heartbeat known as atrial fibrillation or AFib for short.

We know that a normal heartbeat goes ba dum ba dum ba dum. But when someone's experiencing afib it's more like ba dum ba dum ba dum.

So it can't keep rhythm. It's like Steve Martin from The Jerk. Exactly. So here's the thing about AFib. It doesn't happen all the time. In fact, it can be months or years between an episode. So the chances of it happening while in the hospital, hooked up to all these monitoring devices is pretty rare. It's like that cartoon with the guy who finds the singing frog, but it'll only sing for him. Hello!

And instead of a singing frog, it's a life-threatening heart condition. So the heart doctor comes in and tells us, we'd like to implant this monitoring device into your chest. Near your heart is called a loop recorder. So, of course, this is near to my heart. Pun in

So I reached out to the manufacturer of this link loop recorder that was implanted in Krista's chest and they got me in touch with Dr. John Rogers. My name is John Rogers. I'm the co-chair of cardiology here at Scripps Clinic.

He specializes in diagnosing and treating heart rhythm disorders. And he shared some of the history of this amazing device. Probably around 1996 or 97, the idea of

why don't we take a pacemaker and just put recording electrodes on it and make it a diagnostic device, somewhat of an implantable heart monitor that can last for a year or more to help us to figure out what's going on with our patients that are having heart rhythm problems. Yeah, so they took off all those shocky parts and they just put in sensors and they're watching for irregular heartbeats like AFib. Hey!

Like, how big is this thing? Yeah, I'm sure that Krista is glad that she's not an early adopter and didn't get the first generation. That device was the size of a computer thumb drive that we would know of today, a USB drive. Yikes.

So like all technology, they're able to shrink it over time. It's about 90% smaller. It's like if you took an inch and a half off of the thick part of a chopstick. So this tiny little chopstick is constantly doing an EKG checking Krista's heart rhythm. Then at night, there's a device next to her bed that downloads all that information from the day. That device is connected to a cellular network and it transmits all that to the doctor.

and if it finds anything it'll give them an alert and then you'll get a call so we're treating them very aggressively such as come in this day come in today let us see you or let's get you in to see your doctor closer to your home today because there's some changes that need to happen in your medications to protect you from another stroke amazing right wow so i'm sure you can imagine that this device is not cheap by any means in fact

It also comes with a monthly fee to have that data analyzed, which we didn't really take into account. But really, it's a marvel of technology and it brings a peace of mind that that's just worth every penny.

So after all this, a few months later, I'm nerding out watching the Apple keynote. Of course. Of course, where they're unveiling this time the newest Apple Watch, the Series 4. And I hear this. Apple Watch can now screen your heart rhythm in the background and it sends you a notification if it detects an irregular rhythm that appears to be atrial fibrillation.

So at this point, I am sobbing uncontrollably. Fantastic. And the last time I got close at a keynote is when they introduced copy and paste for the iPhone. I got close. But in all seriousness, I think it was the prospect of knowing that that

That someone could not go through what we went through if they catch it early enough. Haven't that's already proven to be true too, right? Like certain people have had successful outcomes from that. Yeah, they have. In fact, here's a clip from ABC News on a story about a man whose Apple Watch found AFib.

As soon as it finished, it came back and said atrial fibrillation. I was like, that's odd. And so I figured, okay, it's just a glitch. I tried it on my left wrist on top, AFib. Left wrist on bottom, AFib. Right on top, AFib, AFib, AFib. I looked at it. I'm like, okay, there might be something to this. So you went to urgent care and the doctor said... He kind of laughed. He's like, do you own Apple stock? I'm like, no, I don't. He's like, okay, you may want to consider buying some. They may have saved your life at this point. Amazing.

But if you watch the news after the Apple Watch was announced, there are plenty of stories about doctors who are skeptical. And Dr. Rogers is one of them. Yeah, you people are the pioneers. You guys are the ones starting the revolution and someday it will get better to the point where I would trust it. For me, making decisions about medication, about blood centers, about procedures, it's not accurate enough yet for me to trust it. That makes sense, right? It's a brand new product, version 1.0, and...

You shouldn't be relying on it as the sole source of detecting atrial fibrillation, but as an added bonus, that's fantastic.

but what about that concern that you've probably heard about false positives all these people flooding emergency rooms thinking that they're having a medical emergency or how about now that there are off-the-shelf products that can be constantly monitoring our health starting with our heart rhythm how much data is too much data that actually came up in our conversation with dr john yositis

John Yosaitis, I am the medical director of what could be considered the education solutions department at a large healthcare system on the East Coast, MedStar Health. And I run the simulation department at Georgetown Med School. So yeah, so he's very interested in new healthcare technology. And this is what he had to share about his concerns about all this data.

Well, one thing I'd like to say about all of the new technologies in medicine is we're figuring out what to do with all that information as we go. We've always had a problem in medicine of ordering tests that we don't know what to do with the results. That's one of the mainstays of medicine, what you learn in med school and residency. Don't order a test if the results aren't going to make you act.

or don't order a test if you don't want to see the results so a lot of times when there's over testing let's take an example these days they're doing full body ct scans

Well, we don't really know what to do with a full body CT scan. Now that everybody's walking around and they know their heart rate and they know how long they've walked. Some people take their own blood pressure. It's that's a lot of of data. And there is a risk of over treating the numbers.

Another example is the change in thinking about mammograms and colonoscopies, that these tests were being run too often, which led to too much data, unnecessary data, leading to unnecessary worry and unnecessary action. Invasive, life-changing surgeries. So could it be true that literally what you don't know can't hurt you? No.

It's funny, but in some cases it really is true. Just thinking that you might get a disease might actually cause you to get certain other diseases, right? Yeah. Was it like hidden brain recently? Or maybe it was this American life. It was talking about this woman that she actually made a movie out of it. But in Chinese culture, it's a kindness to not tell people when they're

suffering from a terminal illness. So they hid it from their grandma and the grandma didn't die from this cancer or whatever she had. And they believed it was because she didn't have the stress of knowing that she was going to die. That is just amazing. And I've seen that too. You know, someone gets a diagnosis,

or is it prognosis i think prognosis is what you're susceptible to and diagnosis is what you actually have right okay so diagnosis murder means you have been murdered so yeah you hear about people who who find out they have cancer and they just instantly plummet and the mind has to be part of that so that problem's just going to get worse as we start strapping on devices that are monitoring us all the time giving us so much data

So the problem presented to the healthcare industry, to doctors, is what do I do with all that information? How do I turn that into not things that cause anxiety and unnecessary action, but instead leads to better healthcare? Dr. Rogers says first, it's going to take time. They have to have that dedicated time to be able to access that information and be able to interact with those patients. So yes, it's going to take time, but it'll take training too. Coming in, we have to have the staff trained.

to work in remote and telemedicine. And there have to be systems put into place to process all this information. But it has to be integrated in order for it to be what's best for the patient.

That is a big investment. We're not just talking about actively monitoring someone who might have a medical condition. We're talking about a whole new way of actively monitoring every patient. This technology isn't going to reduce the communication we have with our doctors. It's really going to increase it. If that's true, what's going to determine its success is the same thing that's determined good health care and bad health care.

Here's Dr. Yousaitis again. Can only really be done by developing that doctor-patient relationship and spending time with the patients, having shared decision-making, learning what the patient's needs are, and for

for the patient learning what the doctor's experience has shown and together coming up with some decision on what the plan is. Patients just want a plan. There's not always a cure, but there should always be a plan that's agreed on both by the patient and the doctor. And like I said, that takes time. Time and good communication. Krista's heart monitor is basically a smoke alarm. If

If it goes off, the doctors are going to act. But based on these conversations that we had with these doctors, here's the user experience problem I'm seeing that could use our ideation. How do we foster communication in this sea of data we'll soon be swimming in? Absolutely. I would love to have better communication with my doctor because I feel like

To talk to him directly, I have to call the nurse because she's his gatekeeper. And then he calls me back like three hours later when I'm in the bathroom. So I miss his call. Then I have to call the same nurse back and then she has to talk to him again. And round and round we go in the ultimate game of phone tag. Phone tag. Yeah. Ridiculous. For me, I think I'd have a better picture of my health if I could reach my doctor more efficiently. Yeah.

I mean, how else am I going to tell if I have Traha disease or not? Let me tell you something. Let me tell you something about Traha disease.

You'll know it when you have it. You know what I mean? It's an extremely serious condition. What do you think is the best, provides you with the best picture of your individual health? Is it like an annual visit or some metric maybe provided by a device? Is it how you feel on a daily basis? Is it just that you're not dead? I feel like it's some sort of metric that I can see over time.

Yeah. You know, like some sort of record of like, okay, this is how the last month has been. This is how the last year has been. And then it's really easy to tell where the anomalies are, I guess, and what might be a point of concern. But it's not something that I can understand unless I look at it at that kind of a scope. Yeah. To me, it's all about like abnormalities and

Really, you want business as usual. But even if you just started flying and shooting lasers out of your eyes, it would be fantastic. But you would question whether you were healthy or not. I'd probably see a doctor. If we all were doing what we thought was right, at least what we're expected to think is right, we'd be going in for annual visits to the doctor. But that's not really a good metric of people's health.

I found this Time article published in 2012. It says annual physical exams do nothing to improve a person's disease and mortality risks. So what is even happening on these visits? Why are these...

Annual checkups so pointless. Dr. Goral of Harvard Medicine explains: "Patients leave their doctor feeling, 'I didn't have time to give my story and to be understood, and I'm not sure where I am.'" That's a really good point, actually. I've never really digested why that experience is quite the way it is.

But you always go in there and there's at least one or two nurses that'll see you first. They're very attentive, very concerned. Like, you know, they're the ones that are asking all the questions and taking your blood pressure and really getting to know you. And then when it's time for the doctor to arrive, it's like he's playing whack-a-mole.

Or something just comes in there in a turbulent fashion and just say like, yeah, hi, your name is, yeah, okay, good to see you again. Yeah, okay, so you're dealing with, how's that going for you? Yeah, okay, well, I'm going to give you a little bit of this drug and see what we can do for you, all right? All right, anything else for you? Let's order a bud test. Pee in this cup. That sounds like a telemarketer reading off a script. That's exactly what it feels like every time I go to the doctor, yeah.

So we wanted to figure out why this is the case. So we interviewed John Yosaitis. So we asked him, what is going on in these doctors' visits? So in all fields, including medicine, there

There's a big journey from novice, in this case a medical student, a resident, to an expert, a physician who's been practicing for many years. As a novice, you need to go by checkboxes. You need to know every little piece. But then as you become more of an expert,

It becomes more of a conversation, more of what we say is an intuitive narrative. When the experience is replaced by checklists, it makes for not a better experience, but a worse one. But when checklists augment a patient and a doctor's ability to have a conversation together and to really get to know one another, that's an experience that we should want to get out of our experience with our doctor.

So should technology replace doctors? No, right? It should augment a patient's daily efforts and a doctor's timed out efforts to help both of them to develop a relationship together. Yeah, I think people, they don't want to feel like a product themselves. You know, I don't want to live in a world where I go to a doctor's office and there's just a kiosk with a bunch of checkboxes.

So how can we have a clearer picture of what doctors' tests reveal about our health and the kind of picture of our health that would be a means of providing an open dialogue, an open means of communication? And so really what you have to do is provide a tool that would allow us as patients to understand the tests and as doctors to be reminded of those tests. This is Sean Bina.

My name is Sean Bina. I'm a product manager here at Epic. Epic is a huge company. And if you work in health care, you certainly heard of them before. They've been working on a tool for patients. In about the year 2000, we first started developing MyChart, which is our platform for patients to be able to access and interact with their information.

You have kind of the beginnings of that type of tool, a tool that could augment a patient and doctor's experience so that they can have a better relationship. Once we had clinical systems, we really wanted to be able to start involving patients in this experience. It quickly became really being able to handle a wide variety of different things that you wanted to do with your health care. So you could make a...

an appointment, you can get appointment history, you get your lab results, like the moment that the doctor gets them or close to that, you can message your doctor, they can write back to you. They can, has health reminders, you know, you should get your tetanus shot. Epic runs almost all hospitals. Their systems are probably running

on Epic. And MyChart is like the one side that faces you, that you get to interact with. What we've done is created this integrated IT platform for people to access and be able to do, in our case, have a single patient record where everyone's accessing that same piece of data.

But the next frontier is really making it so it's that way for the patient, so that the patient's experience isn't fractured when they're moving across a single integrated health system, let alone moving across multiple different healthcare organizations. It seems like maybe this is where technology can help to serve in us as patients having a better experience and providing a bridge in time for the doctor-patient relationship so that conversations and interests can be appropriately shown.

With all this information available for the first time in the hands of both patients and doctors, you can only imagine the potential of what you could learn from all this information. Like, for instance, what would you say is the most influential aspect of your health? My diet. Genetics. Genetics. How much water do you drink?

I would have guessed any of those things. We already know that one of the most important things in your health is your zip code because where you live oftentimes is a better indicator of your health than just about anything else. What?

Yeah, right? Like, it's kind of crazy to think about. And he explained that. Imagine what that information could do for a doctor who is trying to help you to make better decisions so that you can influence your health on a long, long term scale. Zip code. Now I want to know where I need to move.

Just knowing where someone lives can allow a doctor to know much more about what to help a person with in the small micro decisions, the things that actually make a difference. And if we provide tools that help a person to track their actual lifestyle so that they can augment a doctor's ability to have conversations, to develop a relationship, and that will enable them to create a better experience for both patients and doctors.

And in one of these interviews that we did with a sort of future looking company was a company called Cognoa. And it was with Brian Young. So I'm a iOS developer at Cognoa. He was able to explain to us a little bit of like what exactly they're doing. Cognoa is a pediatric behavioral health company. We use machine learning wrapped up into an easy to use app.

for doctors and parents to recognize behavioral conditions in their kids. Machine learning is like a student in a classroom and the teacher asks the student, "What is 6 + 6?" And the student says, "42." And the teacher says, "No, it's 12." And the student replies, "No, it's 12."

And it's like, like you're just letting this computer, a computer guess at the answer to something. And then you just tell it what the correct answer is. And then now it knows the answer.

What machine learning essentially is, is a way to systematize and organize the knowledge we already have. It's just a way for the computer to recognize patterns. But essentially what they're trying to do is use machine learning and information provided from parents to discover behavioral learning issues with children at an early age so that doctors can make appropriate decisions on it.

And he said that it's not like a catch-all thing that will be able to replace a doctor, but rather help them to be guided into the right sphere of activity to do more appropriate tests to actually diagnose patients.

a young person. We're going for that higher bar of being able to actually become a diagnostic tool for the doctor. And what that means is the doctor is still in charge. The doctor's judgment is still involved.

They get to decide whether the tool was giving them something that they believe to be correct or not. So the doctor gets to make that choice. But by using tools like this, we're going to be able to meet the demand much quicker, much easier than they would be able to do on their own. I think that if I was to sort of sum up all of what we've discussed, it's that

We shouldn't look to technology to replace anything. We should look to it as a tool that could help a doctor, but not one that could supplant one. The idea of a yearly checkup where you're doing blood work is pointless. But the idea of a yearly checkup where you're literally just sitting down talking to a doctor is more valuable than any test result.

And I think that's really the point. It's not that we should only deal in the necessary, but it's that we should deal in the personal. Right. I really found that point interesting about the zip code.

It's those things like, yes, we're going to have a problem. Yes, we might have some weird symptom and you need to go to the doctor and get tested. But if technology could do more analysis and the busy work and things that computers are good at, if doctors kind of changed their job description to be more about partnering with you and knowing who you are, your doctor's visit is a

you go out for tea. The doctor's office is just a tea shop and you sit down and then they have this conversation with you and maybe they come to your house and they see what's going on in your everyday life. They're analyzing your heart and all that stuff through technology and they can be on the lookout for

larger patterns that you don't get from a doctor's visit. What does that system look like where you're making a social network with your doctor? Yeah, actually, when you said that, that sort of keyed into me, this sort of system where every doctor that has it

can create that sort of a social network between them and their patients where they're more like, you know, the hub and the administrator, you know, them and their, and, and those who work at their clinic. And if they have that tool, then shouldn't that make it more possible for their patients to be distributed, you know,

more far and wide than based around a community and where they live. And I'm not an expert in law and licensing medical professionals between states and things like that, but could something like that enable people to maintain a relationship with their doctor for a longer period rather than having it just be centered around where they live at a specific time in their life?

and eliminating the need for them to have to go through that exhausting process of getting to know a new person or multiple persons who are in charge of such a personal thing like taking care of of their of their mind or body like posting just even trivial health observations to a feed that's obviously not public but that could be shared amongst

healthcare providers, they would be perusing it like a Facebook feed. And so and so says, my leg feels heavy today and my arm has this rash on it. And they're just like scrolling through it. They see something that's, oh, that's sign of this condition. I recognize that and pass it along or respond immediately.

As technology continues to advance in this field too, I mean, you know, a few years ago, the idea of even what an Apple Watch can do now would seem pretty science fiction-y, right? But as you go further in time, you know, they're going to be able to track if you're dehydrated on a daily basis. They're going to be able to track UV radiation. They're going to be able to track...

all kinds of various things that people have to use these more invasive techniques to track like diabetes, blood sugar level tracking. You'd be able to do that from an Apple Watch or a device that is strapped on you that is not invasive. And I saw Apple's partnering last, just the other day, they started partnering with some company to use Apple Watches, current Apple Watches to detect dementia, onset dementia in patients.

So as you start to combine that with potentially a social networking type thing, as you were just describing, that is like user-generated.

like something that happens ambiently and then user submission, right? Like, you know, that seems like a tool that people would get onto, right? Because it would be something that would allow a doctor to reach out to you, like you said earlier, Nikita, right? Like you're tracking this information and it's just being automatically uploaded. And then a doctor can automatically

monitor that information, maybe be notified to look at certain patients based on perhaps machine learning algorithms that could point to some problem areas that need to be looked at by a person. Now we're talking about a service that actually seems like a real, like a nice solution to whatever the next step of healthcare probably should be.

Yeah, I love that idea of all this ambient or passive reporting that's happening through the different devices we're doing. But then combining that with social networking and we have this

desire to share. You could have it where you're sharing what you ate, how you're feeling that day. And over time, that active sharing, it could see artificial intelligence. It likes some of your posts and the person thinks it's the doctor liking it. So they're incentivized to share this information, but the doctor is getting up these roll-ups, these snapshots of

of how is this person doing over time? What is he eating? How active is he? What's his mood been? Finally, someone has to look at my food pictures I post. Exactly. That's the one reason to take pictures of food so they could see what's going on in it. But they could put all that together and then the doctor can be interacting with you on a fairly regular basis and just posting to your feed and saying how

asking how they're doing and, and I have a video chat with them where I asked them to come into the, come into the doctor's office. And, and there you've got like this, you're leveraging technology and, and fostering a relationship.

Yeah, I really like the idea ideas that we're talking about here, because I feel like it gives a little bit more power to the patient without putting a whole lot of responsibility on them. I think one of the things I hate about my annual checkup is like, I just I feel like I have no indication of my health up until that point when I when the doctor tells me, okay, like, here are your blood test results, and like, you're doing fine.

So I feel like if there were a more regular checkup, I feel like I'm more in control of my health. It's not just the doctor. And it's more of like this relationship that we have that's making it better for me. I mean, the nice thing about it is from even from a financial standpoint, you could see where there could be tiers of response. I'm sure there's one tier where there's a lot of this could be taken care of by a nurse or someone that's

you know, not necessarily the doctor. There could be another tier where it is like taken care of by machine learning. And then it needs to bubble up to a doctor who maybe is, has downtime between like a canceled appointment or whatever, where you can check this feed and address a bunch of the things that bubbled up. But it's, it's an efficient model that could lead to

more affordable care. Well, and isn't it interesting too that like just about our conversation earlier about the anxiety that might come from knowing that you have a disease, like, or the comfort that comes from knowing that you have someone sort of like looking after your health in that, you know, ambient way, or in that passive way, someone is looking over your shoulder, so to speak, at your health for you. Could

could provide you with less anxiety, therefore potentially lowering the risk that you may actually have something wrong with you just because it's providing a measure of anxiety diminishing. That's an interesting thing to think about too, to me. And what if there was a page for the doctor where they could grab these ready-made machine learning modules that you plug this person's data into?

And, and it can, and it can help them to identify health patterns that could lead to an actual like healthcare plan. I love it. Something like that. That's awesome. We solved it.

All right, let's build it. Here now we see our friends from the IDA team getting to work, gathering boxes of sprockets and gears, retrieving rare radioactive materials deep in the Earth's core, melting down blocks of iron, using diamond-bated drill bits. Here now they train artificial intelligence to... Now they appear to be fighting bitterly.

Now they look sad. Yeah, I don't want to rain on anyone's parade, but this is just such a huge thing to tackle. Is there anything from that concept, as grandiose as it is, because we know that to create a social media platform for...

for the medical industry would take a lot of time and it would be a pretty big project. Is there anything that we could, the principles of that, that we could pull out into something bite-sized that we could implement today? So I guess my thinking here is that we could either bounce ideas off each other right now like we usually do, or we could just take a second and then just go around the horn. We'll play some Jeopardy music and then we'll come back and I'll be like, hey,

So what do you got, Hiromi? What do you got, Nikita? What do you got, Rob? Yeah. I'm on it.

All right, pencils down, everybody. Who wants to go first? Okay, so I think I was talking about this in our last discussion, but one thing I really hate about my doctor's visits is the only contact that I have with my doctor is once a year. That makes me nervous every time I go to the doctor, but then...

It also kind of makes me feel irresponsible because I'm not like daily taking care of like how I feel maybe. And so something I was thinking about is I'd like something that tracks or allows me to track persistent elements and that that information is being monitored by my doctor and like a place where I can interface with them. Maybe something like that.

There's still a lot like a surprising amount of like red tape to make use of telehealth. I feel like I have to like, like go to the website and then log in and then get my user ID from some bill somewhere. And then, you know, I don't know. It's just, it's, there's a lot of hoops and I don't see why it would need to be like, if we could associate your mobile number with telehealth,

your account, couldn't you just text a number with, hey, I'm not feeling well today. Like, you know, I just, these are my symptoms. With that simplicity, I feel like you would be more likely to use a system like that. And then all that would be needed on the doctor's side is a way to aggregate those responses. Being able to dismiss the easy ones and respond quickly. I mean,

maybe we could save time for the responses that, you know, are really important. I, you know, I can't really get this holistic approach out of my head, this, this big system, but like we were talking about previously that we have that watch data, which is covering your exercise, your sedentariness, is that a word? Your heart rate, then, um,

it's relatively frictionless to be able to, to capture like things you've eaten, um, you know, what your other habits just to actively, um, share these things. And, and I think we can go down two roads. One, the big one, which is all that stuff is just being fed to a system. And, and like you were saying, Hiromi, it's being monitored and, and,

through machine learning or artificial intelligence, whatever you want to call it, it's looking for patterns and like saying, Hey, this person's heart rates like this, and they're not standing enough. And maybe it would send a alert to your, to your device in behalf of the doctor's office. I think that's a little different from your phone, your watch saying, Hey, you should stand up and it's your watch telling you, but if it was your doctor saying, get up,

It might have a little more weight and maybe you'd have less weight. Get one. Get another masterpiece. Thank you. But then if things are concerning, then it could be elevated and sent to the doctor and they could send you a message, a real one. So...

to maybe distinguish between like general reminders on behalf of your care team. And then like, Hey, you know what? It's, it's time for you to do this or try to try to eat less sodium or something like that. Like you could have this not overwhelm the doctor with, with constant alerts, but just when something gets a little worrisome, then that's when they could, they could step in. Yeah. I like that.

I'm not, I'm personally, I'm not a big fan of like having to track things manually just because I know that I'll won't do it. So like I'm kind of a fan of, you know, I put here, it's like a, just a heading and these notes that I have is just like ambient tracking, right? Just takes the metrics provided by any connected health device that you have and provides information to a healthcare professional for review.

One thing that I think we talked about, or maybe we didn't talk about, one thing I think would be interesting from an app that you really couldn't do with like visiting a doctor in real life is this idea of asking a doctor anonymously about maybe a medical problem that might be more embarrassing. And I think that that might be

enable people or empower people to ask about things that they don't actually ask their doctor that they have a good relationship with, you know, because I think that that's probably a real issue. People just feeling embarrassed to ask the question. It's one thing if I'm bleeding out and I need to go to like the ER, that's like an immediate health need.

But a lot of times it's like these embarrassing things that we don't want to ask about that will lead to our ultimate death in a short frame of time. So could you anonymize the ability to ask a question to a doctor?

that they don't know who you are and you don't know who they are. It's just some anonymous person that you can ask a legitimate question to. - It could be called I have a friend dot dot dot. - Yeah. - I like that. - Exactly, exactly. And that friend is me. And then you could use all that information that's collected either by ambient tracking and by response from this anonymized doctor

to have a conversation with your actual doctor, you know?

Yeah. Yeah. I like all those ideas. You know, it sounds to me like there's kind of a tiered solution here, right? Like at the, you know, at the high level, maybe a social platform where people can communicate freely with their doctors and doctors can, you know, bubble up various needs on the back end and, you know, get expertise from other doctors and communicate freely with their patients. Yeah.

a pretty grandiose solution. But a level down from that, and we have ambient tracking from just

the data that's available on an Apple watch that the doctor can just be alerted to when some troubling situation arrives. And then at the core level, maybe what we might consider an MVP or minimum viable product is like taking the data that a user or a patient can send from their Apple watch and just being able to

associate that with a profile, right? Like Aaron was saying. That's sort of what we're talking about is taking the already collected data and figuring out a way to apply machine learning to it to create something that is pretty low-hanging fruit to do, but might provide some value to an end user. So we have two visions, really, right? That one that's more active, it's

It's still passively, it's getting that ambient data and it's connecting it to the doctor. And then the other smaller implementation is just making it so that you can share it your own way with a doctor. Am I capturing that?

I think that it's a subscription service that you pay a few dollars a month for, and it's just working in the background for you, right? It's like health insurance, not health insurance, life insurance, right? It's very inexpensive, but it has like this sort of

that's just sort of working in your behalf all the time and has real people involved. There's a conversation going on in our industry about like, is algorithm-based curation better or is human-based curation better? Well, what if we did both, right? Just apply machine learning to earmark things and then the earmark things go to actual people.

And you know, you could have, you probably need to have a pretty large threshold to make sure you don't miss anything. But I think that would be the, the idea, you know. And that's kind of what is happening with Krista's heart monitor, right? They're watching it and the system is looking for abnormalities and then it escalates that to the doctor. And then the doctor responds, takes a look at it and responds. So we're just expanding that to, to this other data that,

that is now available to us through these different monitors that we're strapping to our bodies. Yeah, don't you see how that incentivizes people to get more on board with some of these devices, right?

Like, you know, even just the scale that like every time you step on it and check your weight, like it takes that data, sends it back to the health app on your phone. And that data is now available for this app to like consume and associate to this thing, right? It's kind of interesting how much...

that adds to the data, you know? Like your heart rate, if you weigh 120 pounds and your heart rate, if you weigh 300 pounds are very different, you know? So anyways, yeah. Yeah. And I really, I hadn't really thought about the subscription thing. Like would I pay $5 a month or $10 a month to know that a doctor is just kind of keeping an eye on things? I think I might. Yeah, I think I would. Yeah. Like it's funny, like you're, I'm already like sharing my,

running data with random strangers on Strava. Like why? You know, like every time someone follows me on Strava, I'm like, why do you care whether I'm running or not? You know, but we're already doing this. Like it might as well be with people that we trust and that actually whose opinion actually matters. I love it. Well, that I think we got some good stuff in there. I say, yeah,

Let's build it. Yeah. We might as well. It'd be rude if we didn't. So rude. I mean, we might as well. Uh-huh.

That's all for this episode of ideate. Many thanks to our guests, Dr. John Yusaitis from MedStar Health, Dr. John Rogers from Medtronic, Sean Bina from Epic, and Brian Young from Cognoa. While we're getting to work on modern healthcare, what ideas do you have? Reach out to us on Twitter @ideate team or @ideate.team on Instagram.

If you have a complex problem that needs design-driven solutions, visit us on the web at ide8.team or thesmythgroup.com.