October 19, 2016 — Blog Post
Clarity Through Design: Helping People Take Medications
When people don’t take the medications they’re prescribed, it creates a huge problem in the American healthcare system. Often, it’s a problem for patients, whose health may not improve. But it’s also an enormous burden on the system; estimates for the annual economic cost range from $100 – $330 billion (see: here, here and here). That roughly 3 to 11% of the entire amount Americans spend on healthcare every year.Now, say you want to do something to improve that. As you consider the problem, you think about how you always forget to take your fish oil. What if you made a phone-based reminder system? You can make it customizable, easy to set up, and cheap.
You build it, launch it into the world and… the results aren’t as spectacular as you expected. Sure, there’s small a boost in people taking their meds, but there’s still a large group who don’t take them.
What’s going on?
Well, most studies show medication reminders do increase adherence. A 2016 meta-analysis published in JAMA Internal Medicine showed that text (SMS) reminders increase adherence rates from 50% to 67%. On one hand, a 17% increase in adherence is nothing to sneeze at – and it can be done with little work from the healthcare providers. On the other hand, it still misses one third of the population and why they’re not taking their medication. How do we improve?
Without a clear design process, even the best executed solutions fall short. Take the time to thoroughly understand the fundamental problem, and stay oriented to that problem. In our case we ask: how might we help people take medications?
STEP 1: Gather Perspectives
First, it’s critical to understand the lay of the land so you can find and solve for the real problem. Here, we want the perspectives of any group involved in medication adherence. So, certainly the perspective of patients and healthcare organizations – but also of insurance companies, pharmacies, the caregivers, and possibly others.
Let’s start with the patient. What are some less obvious factors beyond forgetting? As it turns out, many patients fear side effects, lack transportation to pick up their medication, or worry about cost. Also, many patients tagged as “non-adherent” aren’t even aware they aren’t meeting their care team’s expectation in the first place or never agreed to take the medication. Proof improved health literacy and communication is key.
Next, let’s think about the healthcare organization. We know their goal is improved medication adherence. But that doesn’t tell us a whole lot. What diseases, conditions, or particular medications do they want to focus on? Is there a particular patient population that is more at risk? How will they measure success? How is someone defined as “non-adherent” in the first place? Will it be possible the patient no longer needs to take the medication? The responses will lend clarity to what kind of intervention will work best.
STEP 2: Merge Perspectives
Now, make those goals work together. Since the patient is the one required to take action, much of our job here is breaking down the barriers patients say stand in the way of taking their medications. To support that process, we bring in what we learned from other parties – like where to direct someone with cost concerns, or how to address confusion when someone thinks they’re already taking all their medications. To save time for the healthcare organization, we want to tackle everything we can through our own system, then delegate to outside resources (like doctors, pharmacists, and case managers) when appropriate.
STEP 3: Execute
Now our design must take shape in phases: ideation and refinement.
Ideation is about, well, coming up with ideas. It means coming up with as many answers as possible to the question: How might we help patients take their medications? Some ideas (like the reminder call) are more practical than others (like creating a piece of headgear with little arms that pop pills into a patient’s mouth at the right time). It’s okay to spend more time on the practical ideas later, but for now, let out all of the ideas. Even impossible answers can lead to insights that inform the end solution.
Next, refine those ideas through the lens of viability, feasibility, and desirability. The solution has to make business sense for the client (viable), has to be something the patient wants (desirable), and has to be something our team can actually create (feasible).
As a final consideration, we need to design the system in a way that facilitates testing it for efficacy and for future iterations. Which brings us to our final step.
STEP 4: Test Everything
Our product is built and the solution is going to be released into the real world! But it’s not yet nap time. We have to look at how this product works in the wild, and use that to improve. That requires clarity upfront about how success will be measured and what metrics we will consider to be important. For instance, do we ask patients to text us when they take their medications? Do we track pharmacy refills? Reminder call answers? Considering each of these points will help us build a coherent testing strategy that can be used to improve our product in the future and to add to our core body of healthcare problem-solving knowledge. Having clarity up front is important to ensuring that you have the right data you need in the future.
Tie it All Together
Clarity in the design process means having a laser focus on solving meaningful, specific problems. It means not considering the project complete until we can say the specific goals we set are accomplished. And ultimately, that clear vision leads to clear products that enable diverse audiences to understand what’s going on, feel empowered about their own health, and take action.
Tarah Knaresboro is the Voice User Interface Design Manager at Emmi. Her main focus is on supporting preventative care and transitions from hospital to home. @tknaresboro
Anthony Duran is a Product Manager at Emmi responsible for the applications used to create Emmi’s content and some of the infrastructure used to deliver that content to patients. @DSGNforDelight