The Standard Health Record

Prototyping and envisioning future applications of a national health data standard in order to drive its development

Health IT | Interoperability | Mobile Design

Role

I produced designs and prototypes exploring the future vision and use of the Standard Health Record (SHR). This drove development of the SHR, as well as enabled dissemination and buy-in of the SHR at the local and state level through multiple hospital partnerships.

I was a designer in a core 20+ person team of 1 designer, 1 creative director, 1 SME, 1 project lead, and more than a dozen engineers.

I executed on ideation and creation of all storyboards, UI designs, information visualizations, and mobile prototypes shown below.

Time

7 months | 5/2016 - 12/2016

Client

MITRE Corporation

Background

$80 billion

The yearly cost in the US of not having a standard health data language. 1

3rd cause of death is medical errors

The lack of accurate data leads to costly mistakes. 2, 3

The Standard Health Record (SHR) is a federally funded MITRE project for developing the data elements for an open source standardized health record for the United States.4

Goals

The design goal was to elucidate the structure and use of the SHR.

The business goal was to push adoption of the SHR and its data model and elements.

Insights

Through communication with the MITRE team of 20 engineers and clinicians, it was clear that the SHR model and elements which were primarily living in code, were difficult to communicate to those outside the core development team.

MITRE needed human-readable representations to show the structure of the SHR to stakeholders

Visual representations like the system map below, allowed stakeholders to see the SHR data model and its value to the health IT infrastructure within the US.

The future of interoperability had to be envisioned.

I created design concepts on top of the SHR data model. These concepts, like the mobile personal health record below, were used to to communicate the long term vision for the applications of the SHR, leading to buy-in and partnerships of key health stakeholders at the state and national level.

Principles

The following principles drove the SHR representations.

Design

Visualizing the SHR structure

I conducted several rounds of sketching and design validation cycles with a team of 20 engineers and clinicians at MITRE.

A treemap representation continued to emerge as a reflection of the SHR that many on the team felt high engagement towards.

A treemap continued to emerge as a human-readable representation of the SHR.

Health information could be organized into smaller elements, such as medication dose amount being a subelement of a component of medication dosage, which in turn is a component of medications.

Applying the SHR visual language to real world scenarios

Applying the visual language to real world use-cases allowed the engineering team to understand how the SHR could be used in a variety of health situations.

One use-case was the flow of data for an outpatient journey. This allowed providers to relate to the clinical connections of the SHR.

Designs were validated by several primary care physicians and system engineers at MITRE.

Envisioning the future of interoperability, made possible through SHR

It was important to show the future services that would live on top of the SHR, in order to drive support and partnerships at the state and national level.

I created storyboards for different scenarios of care, which were presented to Governor Baker of Massachusetts in 2017 to drive support at the state level.

Initiating a personal health record that values patient data ownership.

A remote emergency care setting.

Envisioning the personal health interface that incorporates all social determinants of health, to provide a full and holistic view of health.

Impact

The design goal was to elucidate the structure and use of the SHR.

The business goal was to push adoption of the SHR and its data model and elements.

Next steps

The SHR is currently being used to develop an oncology data curation interface (Flux Notes) using real patient data in order to demonstrate its use and efficacy.

References

  1. Girosi, Federico, Robin Meili, and Richard Scoville, Extrapolating Evidence of Health Information Technology Savings and Costs. Santa Monica, CA: RAND Corporation, 2005. https://www.rand.org/pubs/monographs/MG410.html. Also available in print form.
  2. Stetson PD, McKnight LK, Bakken S, Curran C, Kubose TT, Cimino JJ. Development of an Ontology to Model Medical Errors, Information Needs, and the Clinical Communication Space. J Am Med Inform Assoc. 2002;9(6 Suppl 1):s86–s91.
  3. Makary Martin A, Daniel Michael. Medical error—the third leading cause of death in the US BMJ2016; 353 :i2139
  4. The Standard Health Record Collaborative. (n.d.). Retrieved from http://standardhealthrecord.org/