The five revolutions of the medical record

Use Design for healthcare

The five revolutions of the medical record

The five revolutions of the medical record 1667 598 Use Design

Relaunched in November 2018 by Minister of Health Agnes Buzyn, the Shared Medical Record (DMP) for french patients has been part of our news last summer (Article in french), highlighting its success… on the patient side, but less on the health professional side. 

This digital health record is one of the components of the health record, which has long been used in paper or digital formats by healthcare professionals. This is the beginning of one of the revolutions in this sector, which has finally seen the Patient offered significant visibility on his medical follow-up. Visibility has multiple objectives and benefits for all stakeholders.

But why is it taking so long? Is it only for legal or technological reasons? Or even adoption in the broadest sense? 
Probably more of the latter, because this (r)evolution takes time, and Use Design’s many collaborations in the health field over the past 15 years have demonstrated this.

We have identified 5 themes that will help you better understand what this issue represents as a challenge for our future. Each of these themes is revealed by a figure from the PwC Tech for good 2019 study – Tech for Health’s key figures.

THE RELATIONSHIP 

#mirroring relations
#new human relationships (patient/health care provider)
#complexity of human interactions (inputs/outputs – emotions)
#the family circle more than the patient



“3 out of 4 doctors believe that remote medicine will be part of their daily work by 2030 (according to the French Health Insurance – Amelie.fr )”

From the moment when this patient record is no longer in the sole hands of a medical specialist or healthcare professional, the need to share the record to ensure its enrichment, disclosure and follow-up is then engaged.

From a one to one relationship (doctor to patient, specialist to specialist), which was already a small revolution in itself because it required benevolence and strong communication links, the revolution is now a one to many relationship (several specialists at the same time, the patient and his family or his companion) in a number of places and varied temporality.

This relationship is constantly reinvented thanks to the tools available, which have the advantages and objectives of proposing new, more “human” relationships between patient and professional. Relationships that are also diversifying through the opening to other medical modalities: in addition to the triptych diagnosis/care/healing, come upstream and downstream such things as education, information, accompaniment, support, follow-up…

The question to be asked is therefore: who might best support the patient? Family, friends, caregivers, pharmacist, employer? through this question we rediscover new bonds.


MATERNITY

# seamless experiences for all actors
#complexity of physical / digital interactions

“70% of hospitals have no traceability of their pre- and post-surgery follow-up (DGOS 2015 study)”

Once this need is established, which, as we can see, is perhaps multiple, we can glimpse, thanks to digital technology, all the possible ways of getting out of the paper record and proposing it in multiple formats that would be tailored and optimised for each context.

Here a patient portal for a medical analysis laboratory; there an application for monitoring pathology via the pharmacist’s advice; an app on a tablet for the on the move doctor; a touch screen for the anaesthetist in the surgical room… all these devices embed part of the patient file with them to provide the right information at the right time.

The challenge is not limited to the creation of new media or technological performance. Everyday, a new start-up is able to demonstrate its relevance on this front. Based on our experience, the major challenge resides in the quality of the experience of these new products or services, for these various user profiles.

Because users, be they patients or professionals, demand a “seamless” experience that gives them complete confidence in the quality of the product’s experience, as well as in the security and confidentiality of information.

TRANSVERSALITY

# Innovative scenarios
#multiple stakeholders / (responsive) devices / locations 
#mapping of actors




 

“75% of French employees expect their employer to regularly assess their health and to act as a coach to advise them in their daily lives (source: Malakoff Médéric study)”

Few are the innovations where we can see so many potential: from a simple repository of information, the possibilities are broadened with regard to usages, scenarios, actors, places, devices and temporalities.

However, there are many examples where these components are not isolated, but may overlap, or clash: remote diagnosis is a good example since it is possible to multiply the locations by the number of participants (even about a single patient, specialists are in dialogue, coordinating and making decisions/actions).

New players are emerging, and are adopting the patient record: insurance companies that want to check the health status of their customers to adjust their programs; pharmacists who are being assigned new monitoring roles and support services by authorities; Health unions, that facilitate the exchange of information to simplify repayment to customers.

This new landscape is in the making, ever richer and more complex, where everything will eventually have to converge.

SPEED

#Immediacy of the relationship 
#expected simplicity vs. complexity of procedures 
#zero training time 
#productivity

“70% of French people wish to book their medical appointments and manage their medical records online”

Faced with this complexity, which is already present, for example, in hospitals, the challenge is already to try to streamline it. It is not that easy to address, quite the contrary. To achieve that the exchanges and uses via the devices must be intuitive and arranged for the benefit of the end-users.

Everyone expects efficiency, speed and immediacy of service. However, the number of staff is shrinking, as well as their initial and, above all, ongoing training. It is out of question to spend hours learning about a particular application or new equipment; nothing must slow down or hinder medical activities in the first place.

Dieter Rams, who advocated the LESS IS MORE in its founding design principles, would certainly have provided a brilliant answer, not only aesthetically, but in the core sense of the term by combining the qualities of use, aesthetics, branding and by offering a simple and attractive interpretation.

INTELLIGENCE

#IA 
#data

 

“50% of patients surveyed would be willing to trade their General Practitioner for robots or AI.”

But behind the apparent simplicity that can be advocated to meet the needs of speed, transversality, materiality and relationality, lies the latest revolution that is still in its infancy: data and artificial intelligence.

Data first, because it is the wealth of today’s GAFAs, and obviously the wealth of all the data collected through the millions of patient records to come. The records feed this huge database with all the information that any marketer would envy: profiles, services and products used, networks of contacts, locations, important life events…
How might we benefit (if possible not only commercially) from all this abundance of data?

IA is a first answer, in the sense that through the richness of the data, algorithms can be taught to identify pathologies, through the analysis of images, data and situations. The first products are already there to help with diagnosis in cardiology, to facilitate diagnosis on MRI imagery, to conduct large-scale health studies, to ensure that laboratories will finally have access to a wider range of medical cases, which they do not have in the majority of clinical studies…

Intelligence is indeed this last revolution. Last, because it could not have surfaced without the basics of the patient record. It will thus feed on this endless supply of data, to offer us a thousand new usages and uses-cases, which, we hope, will benefit the greatest number of people.


Patrick Avril — PDG @ Use Design, une agence de design à Paris qui donne vie à des stratégies, des produits digitaux et des services innovants.

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