LifeTime

Data flow in medicine is broken


We don't have access to our own medical data

Medical practices and public administration offices are among the last places in Germany where most of the communication is still done paper-based or verbally. Important information, is written down illegibly by hand, gets only mentioned briefly - or in the worst case - is not handed out to patients at all.

Historically, the fact that people are not granted direct access to their own health data can be explained by the role of doctors as "gods in white". Patients weren't considered as wise and educated enough to be able to have a say in the matter and diagnostic details were considered to be only an overwhelming burden to them. This attitude can still be found with older doctors today.

In reality, I believe only in the field of psychiatry/psychotherapy, it sometimes is better if doctors are able to make diagnoses and take notes without patients having access to them. In all other medical areas, in my opinion transparency should be an absolute prerequisite for medical treatment.

It should be clear to all people that medicine is not an exact science and that it holds many uncertainties and decisions are often based only on probabilities or experience. In no other area with equivalent consequences for one's own life one would give up complete control to outsiders so readily and "hope for the best" without trying to figure on which basis decisions are made.

Doctors don't have access to the medical history of their patients

People - especially chronically ill people - who actually try to keep track of past treatments and diagnoses usually do so in form of a folder in which documents are filed. This folder is then carried from doctor's office to doctor's office and put on the counter at the reception desk before the appointment. The handling of these folders varies from place to place. In some facilities, the documents are all scanned in. In others, the doctor leafs through them briefly just before the treatment, hoping that something accidentally strikes her or his eye. In other facilities, the paper stacks are simply ignored.

It's not the doctors' fault. On average, they only have 8 minutes for one treatment and have no chance to process big stacks of files during this time. If a certain information of an earlier treatment is urgently needed, the current standard process is a phone call and a subsequent direct transmission of the file from doctor to doctor by fax. A technology from the 1970ies that almost nobody else has wanted to use anymore for the last 20 years.

Computers can not help doctors to take medical decisions.

If previous findings are not digital and do not contain any meta-information, such as the creation date or name and specialization of the previously treating doctor, the data is not very useful to computers. There are efforts to make medical documents understandable for machines through OCR software. However, the road to meaningful structured data is still long.

For your diagnoses, doctors therefore rely to a large extent on the data they collect themselves during treatment or on the few pieces of information that are collected through questionaires, handed out to patients preceding the appointement. A tiresome repetitive work for patients and who is really able to reproduce all the medical details of family members by heart? This information could be very valuable for a better diagnosis.

Our solution

Computer-assisted medical treatments

The path to computer-assisted medical treatment begins with a structured collection and aggregation of the patient's medical context. This data is then supplemented by new information that is created during an appointment or an hospital stay. And it ends with all newly acquired information and instructions being structured and fully returned into the hands of the patient.

Patients should be considered intelligent enough and allowed to have a say. They should be allowed to ask questions and to question decisions. Interfaces are needed to give them insights into their treatment processes and enabling them to browse through their medical history and draw information from it.

Physicians should be supported in their difficult work by the best possible data basis and clear and just as helpful interfaces, which aggregate this data base in a meaningful and understandable way and thus enable raw computing power to be used for medical purposes.

Designing mobile first

Several competitors have already unsuccessfully tried to solve the problem with centralized cloud solutions that include a log-in for doctors and a log-in for patients.

The difficulty always lies in building the link between the two areas. How can I, as a doctor, make something available to a certain patient? In some systems, the patient have to authenticate themselves by calling their doctor's offices. For others doctors have to hand over a one-time-password on paper.

All systems have in common that as a doctor you have to open a web app to send a file. In most solutions you have to log in to do so. Next the patient has to log in to the patient portal to retrieve the file.

The biggest flaw: The company that operates the system has a complete list of all patients, including their insurance and insurance numbers, and all health data flows through the company's server. And another problem: if the platform provider decides to discontinue the service, all data will disappear instantly.

With LifeTime, founded in 2014 by Dr. Johannes Jacubeit, a doctor, we have decided to go another way: LifeTime is mobile first. We have built an infrastructure that allows a doctor to send a file to a patient's smartphone via an end-to-end encrypted connection without the patient having to set up a user account beforehand. The patient does not even need to have heard of LifeTime before.

The assignment between physician and patient is created using the insurance number and the mobile phone number when asynchronously sending data via LifeTime. Normally, doctors' offices already have both stored in their systems. It is also possible to send files directly to patients via a local encrypted WLAN without any patient information at all.

With LifeTime the patient is in full possession of his data and the only one who is able to decrypt it. The app runs natively and if it is being discontinued in the future, the patient has enough time to export the data to another system.

The components of LifeTime

On the doctor's side, LifeTime consists of two components: LifeTime Desktop and LifeTime Hub. The LifeTime Hub is an optional hardware for doctors' offices. Over the hub documents can be sent to patients and documents can be received via a local WLAN, even without the doctor's office being connected to the Internet. The second component, LifeTime Desktop, is an Electron app for asynchronous, encrypted transmission of files over the Internet.

On the patient side, LifeTime provides an Android and an iOS app. Since 2010 I am responsible for the design of all four components as well as the web pages, the print and promo material and many company presentations including the pitch that lead to the company getting its first capital.

The Android and iOS Apps

Originally, I had designed two relatively different apps for both platforms to meet the platform-specific requirements. To connect to the LifeTime WLAN, you had to click on a central custom designed button with the LifeTime icon, because we considered it to be the core action of the app.

Gradually, we have brought the apps closer together as the general design differences between Android and iOS became smaller in time. A fact that also saves a lot of design effort and enhances the branding with the uniform look and feel.

Creating trust in the product has been the biggest challenge for LifeTime from the very beginning. That's why we gradually eliminated all patterns people did not already know from other apps. Both the custom connect button and a connetion gesture that consisted of bringing the smartphone near the LifeTime Hub in the doctor's office gave way to common patterns and buttons with text instead of icons. Custom icons are now only used to add delight, not in places where the meaning of icons is really critical.

People are already using apps with similar features every day (e. g. chat apps, scan apps or cloud storing apps). We noticed over time that the app is much better accepted when mostly using known patterns and only teaches new patterns in a bite-size manner.

The best interface is no interface

On the doctor's side, we had a completely different picture. There are no comparable applications and only a few common patterns. Doctors and medical staff already use many different programs in their daily work, each with its own interface: appointment management, practice information systems, image viewer, etc. All of these programs are often large legacy systems with unintuitive design.

In the beginning, I tried to create a design for another interface for sending reports and documents to patients. In the next step I tried to eliminate steps in the process step by step in order to omit unnecessary elements. At the end there was nothing left. The LifeTime Desktop Interface became invisible. It only appears when it is needed.

Doctors only need to log in once. From this moment on, they just have to click on print or alternatively put a file in a special folder on their desktop. The minimalistic dispatch window pops up and stays in the foreground of the screen to avoid being "lost" when the user tries to copy a mobile phone number from the practice system into the window. As soon as the user clicks on send, the interface disappears again.

The challenge in this case was not the visual design of the buttons, but the brainstorming and mockup process to achieve an optimal UX for the practice team.

The hardware

Another challenge in medical facilities is the often outdated and fragmented IT infrastructure. Some doctors still use dot-matrix printers and do not have an internet connection at the reception desk due to fear of hackers. The only thing all computers have in common is a USB port. In addition to the LifeTime Desktop App, we have therefore built our own custom USB-hardware for doctors' offices, which provides a uniform interface for patients via a local WLAN.

I designed the first drafts for the hardware in Blender 3D. Alex Hofmann helped me out to translate the files into CAD and printed the first prototypes using a laser-sintering process.

Outlook

We live in exciting times for digital health. Apps are maturing slowly and the acceptance of tools that really help doctors and patients in their daily communication and interaction is increasing from day to day. Digital health has long been synonymous with fitness and nutrition apps or quantified self tools. The real potential will only unfold when software not only helps young, healthy people to stay healthy, but actually supports (chronically) sick, elderly people and others really in need of care. When software really helps doctors in their daily work and creates transparency for all sides.

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© 2017 Gabriel Adorf   |   Imprint