Stanford Medicine X Talk: Interactive Experience Design For Health

On September 27th, I participated as a speaker at Stanford Medicine X conference in a session called Designing (and redesigning) For Health. Medicine X conference is a catalyst for new ideas about the future of medicine and health care. The initiative explores how emerging technologies that will advance the practice of medicine, improve health, and empower patients to be active participants in their own care.

Designing (And Redesigning) For Health

My fellow panelists were:

• Geri Lynn Baumblatt, Executive Director of Patient Engagement at Emmi Solutions.
• Julie Wheelan, Vice President of Marketing & Brand Strategy at Edison Nation Medical.
• Daniel Penn, CEO/Co-Founder at Shift Health.

‍Immersive, Interactive Experiences for Healthy Behavior

In this talk titled Designing Immersive, Interactive Experiences to Prevent Sedentary Habits of Pediatric Patients, I discussed our challenges and accomplishments in designing for young patients, explored other examples of health care environments that combine and art and technology with the goal of providing the audience with the understanding of the benefits of this new paradigm in healing spaces. Click here or check out below, for my slides from the talk.

Hello, I’m from OUVA.

OUVA is a newly established healthcare design service, with focus on combining technology and design research to create better healthcare environments.

Day to day I help explore research areas and bring our ideas into products that will improve the quality of patients and staff.

‍The premise of this talk is:

By combining, an engaging experience and interactive technology, we can create a better environment that helps the wellbeing of the people that occupy the space.

I believe that this field we are going to explore today, will have significant clinical applications in the very near future. My goal today is to raise awareness to this platform, and fire up a discussion that will continue beyond this talk.

Today I’ll talk about:

• Why we need better healing environments.
• I’ll talk a bit about where the technology is today.
• My previous work at Kinesis Studio, especially in physical therapy and pediatrics.
• And what the future holds for this field

The interactive visual technologies have wide range of applications. I’ve worked anywhere between entertainment and scientific visualization.

Most recently, I’ve created public interactive experiences, starting with museums, trade shows and finally healthcare spaces.

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One common theme between these fields is my obsession to visual comprehension and interaction that creates an engaging experience. 

The difference of this form from a, say, game, is that it is an open-ended social experience. It is always on.

This allows us to present it as part of the architecture.

It also means how you engage with it is highly dependent on you, making it a great platform for us to engage people in public spaces.

Before we continue, I’ll share a story with you from my childhood.

I grew up in Turkey, surrounded by ruins of ancient cities. 

I once visited one of the oldest known hospitals, named Asklepion. It has stuck with me for more than 20 years.

This was a popular treatment center where famed people of the time like Marcus Aurelius would line up to be cared in.

It was designed like a modern day spa. One example of it is these large tunnels you see in this photo, where they had patient beds underneath the openings on the ceilings, and therapists would whisper wishes and tunes to the patients inside, to create a positive environment for healing. 

Now, Turkish hospitals were not popular for their quality. I remember being mesmerized, dreaming of how it would be like to be in this magical healing environment thousands years ago.

So, when I first stepped into a hospital to deliver one of my projects last year...

…I was perplexed by the visual complexity where patients are, such as Emergency Rooms, ICU units, patient hallways.

However, I had completed beautiful projects for hospitals. But the hospitals only had budget for waiting rooms, lobbies, either with funds supported by a donor or a hospital renovation budget.

Although we are surrounded by design and architecture all the time, it is as if seen as an attractor, not as participant.

As Kristen McConnell puts it in her NY Times article from August:

“The eerie dehumanization of both the patient and the caregiver.”

An ER doctor we’re working with said, some patients never see daylight during a 24-hour stay. 

So we began surveying the extent that an environment would have an effect on patient’s healing. We interviewed nurses, child life specialists and doctors who are working with patients every day

From our research, what we have found is that hospital environments rid patients of motivation, morale and engagement, and the costs are staggering.

• In 2011, the cost of Delirium was $164b/year to Medicare.
• When patients are depressed, the length of stay nearly doubles.
• When elderly patients lose physical strength, the additional cost was estimated at $26b/yr.

Let’s take a closer look at Delirium.

Reasons:

• Unfamiliar setting, unable to personalize your environment,
• Not having sense of time, lack of windows,
• Confusion, not having sense of control.

Suggested solutions:

• Motivate to exercise,
• Manage patient’s mood,
• Orienting them, putting up a clock on the wall,
• Bringing familiar items from home.

Thus the quality of the environment is a large indicator how well the patient will receive a treatment.

Granted, there is a major shift in building better patient care environments and engagement systems.

Designers of healthcare spaces use evidence-based methods to create calming, relaxing environments.

In addition, data gathering technology combined with next generation of interfaces starting to offer a glimpse of what future of health engagement might be like.

• Wearables have become mainstream providing body metrics.
• There are countless physical fitness apps that motivate people as they spend more time gazing at their smartphones.
• Gesture technology, is already adopted by various physical therapy startups as a way to guide patients. There are already studies that provide validation for this technology to be used in healthcare.

Hospitals have adopted patient engagement systems for a while as an information network within a patient’s healthcare journey.

The challenge, I believe, is where, when and how this technology is used to present the information to the patient.

This is a snapshot of a standard physical therapy guide. Some clinics started using apps for better engagement but this is pretty typical still in a lot of cases. The motivation is left up to the patient, their level of engagement and whether they have an environment that is conducive to healing or not.

What we have here is a great information network between the nurse, the doctor and patient. But the points of engagement, that is, when the patient decides to take part in their own health is disconnected.

Scott Adams, creator of Dilbert cartoons, in a post said “Everything we create becomes a brain accessory. We manipulate the environment to reprogram our brains as needed". It is a short post titled ‘Exobrain’ – you should read it.

So many health problems stem from us not being in charge of our environment. On the other hand we have been pretty good at customizing our own spaces.

So if we can achieve a space that is an extension of our bodies, and reacts to our needs, it would be a great leap towards a healing environment. We need to extend our ability to manipulate our environment.

So let’s start with a premise.

Can the environment be an active participant in its occupant’s wellbeing?

For it to work, we need to understand, and our software needs to understand, at a fundamental level:

• What does a person need to be motivated any given time? Joy, privacy, care...
• What would be an interface to fire up those emotions?
• How to create a feedback loop where we collect data and improve the experience?

This is a field where healthcare, architecture, psychology and engineering needs to intersect.

In the second half, I’m going to define immersion and talk about what we have learned from building interactive spaces at hospitals that begins to answer some of these questions.

Immersion is your own impression that you are participating in a realistic experience.

Interactive media now enable various degrees of digital immersion.

The more a virtual immersive experience is based on design strategies that combine actional, symbolic, and sensory factors, the participant’s engagement will be that much greater.

Studies have shown that, immersion provides a great way to enhance a process.

In his Science Magazine article, Chris Dede stresses that:

"Immersion allows the ability to change one’s perspective."

In one study, digital immersion allowed students to build up confidence by stepping out of their real-world identity of a poor academic performer. And they actually did better.

And lesser degrees of immersion can even still provide this experience.

Applications of immersive technologies can vary:

• By medium (projection systems, TV displays, virtual reality environments etc.).
• Content/purpose (entertainment, calming, physical therapy etc.).

Usually you get an immersive experience by being surrounded by the medium. Which means, large scale, or engaging more than one sense to get as close to removing sense of disbelief.

Formally, an interactive technology can generate data about the environment: Everything from people, ambulation, range of motion to heartbeat and respiration.

This allows the application to deliver targeted content. In a pediatric environment, program may adapt to the kid’s therapy by making them reach higher to reach the birds.

Or in a patient room, it fine tune the environment, the colors, imagery and sound to motivate patients to get out of the bed.

We developed an example of this work at Nemours Children’s Hospital’s Pediatric ward in Delaware.

We created an immersive 50-foot fantasy landscape that records on average more than 1200 interactions a day. 30 people can interact at once.

The experience promotes movement, creativity. It allows young patients that are otherwise uncomfortable in a hospital setting to feel in control through interactions such as planting new flowers, taking care of their plants and other nurturing elements. But most importantly, all of this is done through gesture interactions that can adapt to the user.

We developed the gestures by working with physical and occupational therapists. The resulting experience is accessible to all patients.

This work was the culmination of many different collaborative and engaging interactions that have been individually part of different installations at various hospitals.

A strong advantage of this technique is that it allows us to create a storytelling experience for the kids in a public space, while having them move their bodies in ways that are beneficial for their treatment.

Most of our work might look like art pieces.

Welcome Wall at UCSF Benioff Children’s Hospital certainly looks like one. It allows kids to contribute to their hospital environment by using their bodies to form their own bubbles of different shapes.

But we have collected data.

We were able to get as fine as this one example:

More than 60% of people who play with the wall raised their left arm more than 135 degrees (180 being all the way up).

This is one of the default exercises in many post-operation physical therapy scenarios. Now imagine what you can have the software do at that point when the patient feels most engaged in exercise.

Moreover, we were able to track up to 83% of BOT, the Standard Motor Proficiency assessment test.

For Kaiser Hospital, we created a smart room system that tracks patient’s ambulation, gently reminding them of their goals, as well as interaction with physical objects.

These experiences create a stress-free environment, especially in pediatric spaces, where the encouragement for motion, exercise and social play is much needed.

A staff member from one of the clinics in Miami said they use it to assess motor skills. There’s a lot of movement that needs to be checked with children with oncology and blood disorders, that they just observe and not even have to ask.

We have been getting requests about adult spaces too. Especially in labor and delivery rooms, the right lighting, distraction and appropriate sense of time of day is a big need.

We created several proof-of-concept devices that can transform a room, allowing a patient to personalize how it looks, motivate them and inform them in a more engaged manner.

We demonstrated some of this work this summer with great feedback.

I went and saw the patients interact with these environments. This is a photo of the installation at Nemours Children’s Hospital.

I believe we are ready to redefine what it means to be in a healing environment. Not just lobbies for visitors but in spaces where patients exist. ER, patient rooms, MRI rooms.

We can create new devices that will engage all senses (not just goggles :)) and allow us to customize the environment based on the needs of the people that occupy the space.

Through validated work, we can start generating data and meaningful responses based on how people interact with that environment.

Technology can adapt based on the input to motivate, personalize, boost morale and educate people to relieve them of mental challenges due to hospitalization like depression and stress.

We started Ouva, to develop projects that rethink everyday spaces as a generator of data and an interface for health and wellness.

I am always looking out for new healthcare challenges that can benefit from this combination of technology and design.