The “iPatient”

I read an article from Abraham Verghese in the Wall Street Journal this morning entitled “The Myth of Prevention.” Verghese, author of Cutting for Stone and professor and Senior Associate Chair for the Theory and Practice of Medicine at Stanford University, was responding to Obama’s recent speech to the American Medical Association on health care reform. Verghese argued that the current health care system incentivizes doctors to perform often unnecessary tests on as many patients as possible in order to make more money from patients. He contrasts this to the image of the doctor in Sir Luke Fildes’s painting “The Doctor” who is dedicated to the care of the patient, staying late into the night by the patient’s side in the patient’s own home.

An interesting point that Verghese raises is the virtualization of the patient into the “iPatient.” Verghese states that:

“A computer cannot take the place of the doctor in Fildes’s painting; an electronic medical record (EMR) may or may not save money (it won’t be anywhere as much as is projected) but what it will do is ensure that we doctors, nurses, therapists, particularly in hospitals will be spending more and mroe time focused on the computer, communicating with each other, ordering and getting tests, buffing and caring for our virtual patient – the iPatient is my term for this phenomenon – while the patient in the bed wonders where everybody is. Having worked exclusively for the last seven years or so in hospitals that have electronic medical records (EMR), I have felt for some time that the patient in the bed has become an icon for the real focus of our attention, the iPatient. Yes, electronic medical records help prevent medication errors and are a blessing in so many ways, but they won’t hold the patient’s hand for you, they won’t explain to the family what is going on.”

I have many colleagues who are working on digital or telehealth care (e.g. Hyoumanity, Amita Telemedicine, and TIER projects). While digital technology allows patients more control over their health care and increases patient access to medical care, it indeed can be seen as a mechanization of personal care. In some regions (e.g. rural) where medical care is limited or unavailable, digital technology can serve as a bridge between providers and patients, allowing a patient in rural India to receive eye treatment that would otherwise be impossible. However, in regions where medical care has been available and provided by a dedicated personal physician, a computer can be seen as imposing a layer of foreign complexity between the doctor and the patient.

Designers of digital technology for health care must consider the relationship between the patient and the doctor and how the technology will impact that relationship. Health care in its truest form is a most intimate human experience. Digital technology cannot at this time replace that experience. Designers of digital tech for health care must design technology that promotes patient-provider interaction, rather than replace it.

Bill Buxton on How to Be a Good Designer

Bill Buxton (www.billbuxton.com) of Microsoft Research – a pioneer in interface design – visited my User Interface Design & Development class this Tuesday. Bill spent most of the hour and a half discussing the role of design in Apple’s success.

ICTD Project Proposal: Interactive Agricultural Knowledge Database

My goal over the next year and a half is to design an interactive agricultural knowledge database (including agricultural sciences, market information, and resource coordination) accessible on any mobile platform (including widely available mobile phones like the Nokia 1110). I plan to work with a variety of people and organizations, including Tapan Parikh, Jenna Burrell, Question Box, Kurtis Heimerl, Neil Patel, and Ken Banks of Kiwanja.net. These people are approaching agricultural knowledge exchange from diverse angles, including voice messaging, radio, telephone trees, live operators, and text messaging.

My next step would be to analyze these various approaches and identify which is the most scalable model. To do this, I would need to further explore the limitations farmers face in exchanging knowledge across distances. After identifying the approach that best responds to these limitations, I would like to work with the project lead to design a growth plan or respond to the project’s key challenges or next steps.

Aravind Eye Hospital, Mobile Life Center

Sonesh Surana, a student from UC Berkeley’s CS department, presented his work with the Aravind Eye Hospital in Designing Rural Computing Applications this week. I unfortunately missed this presentation. I instead attended a presentation on innovative mobile design by Lars Erik Holmquist from the Mobile Life Center in Sweden.

Neil Patel: Jatan Certification System and Avaaj Otalo

Neil Patel, a CS PhD student at Stanford, visited my Designing Rural Computing Applications course on Tuesday. Neil is studying ICT in agriculture in rural Gujarat, India. He presented two projects he’s been working on: Avaaj Otalo and Jatan Certification System. Neil explained that most international certification systems are designed with a global standard in mind. The problem is that local farming practices are diverse – organic doesn’t mean the same thing in all countries. Additionally, certification systems often leave out smallholder farmers, as they often require the infrastructure provided by cooperatives and other organized farmer associations.

Rural Public Healthcare and CRM

Our presenters to the Designing Rural Computing Applications course this Tuesday were four UC Berkeley students: Brian DeRenzi, Roxanne Miller, Alison Bloch, and Charlene Chen.

MILLEE: Mobile and Immersive Learning for Literacy in Emerging Economies

Deepti Chittamuru spoke in Designing Rural Computing Applications on Tuesday. Deepti worked with MILLEE over the summer of 2008 implementing and evaluating MILLEE’s learning applications in India.

UC Berkeley Student ICTD Research and Field Work

We were graced with three presentations this Tuesday in Designing Rural Computing Applications. Three Berkeley students, from the schools of Computer Science and Public Health, presented the progress of projects with which they have been involved.

CAM – mobile phone software for rural applications

On Tuesday, Tapan Parikh spoke in his class, Designing Rural Computing Applications, about some of the work he has done in this field. For Tap’s PhD thesis, he built a technology called CAM that was designed to alleviate information exchange complexities in microfinance, agriculture, and public health applications. He described CAM as “a mobile phone toolkit for distributed data collection in the rural developing world.”

In his presentation, Tapan stated five considerations for rural computing application design:
-    Paper formats are important for data backup.
-    Local language audio builds trust.
-    Numeric input and output must be accessible.
-    Users must be guided through the task initially.
-    Realistic icons are better than abstract icons.

For more information on how CAM is being used today, visit www.ekgaon.com.

Telemedicine – Overcoming Distant Healthcare

The visiting lecturer to my Designing Rural Computing Applications course this past Tuesday was Terrence Lo. Terrence discussed telemedicine in rural India.

Telemedicine appears to be one of the greatest promises of ICTD. Healthcare in rural communities is sorely lacking – clinics and practitioners are sparse, treatment is expensive, and transportation to visit hospitals in nearby cities can be costly and arduous. The ability to serve a patient remotely presents many possibilities to rural healthcare providers.

Terrence introduced us to World Health Partner’s telemedicine provision center concept, called Sky Health Center. Sky Health Centers work with rural healthcare providers, clinics, and shops to coordinate human resources and medical equipment.

UC Berkeley’s Technology and Infrastructure for Emerging Regions, or TIER, group is also focusing efforts in telemedicine. For more information on TIER’s work, visit the TIER website.