How might we design patient-centered digital health in South Africa?


Vanessa Carter
15 Nov 2017
20:30 SAST | 14:30 ET
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Start your answers with T1, T2, T3, T4 or CT for transcript purposes after the moderator prompts.
Both panel experts and attendees are encouraged to participate.
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T1: Why do you think including all health stakeholders is important to patient-centered design?
T2: What protocols/steps/tools can be used to implement a patient-centered design research framework?
T3: Are there areas of the real-world we should consider first while re-designing solutions for e-Health?
T4: How can we encourage a culture of creativity among healthcare leaders, patients and employees to advance innovation?

CT: Closing Thoughts – Is there anything you feel is important to add to this conversation?


What is Human-Centered Design and why is it important to e-Health?
Digital health, such as wearable technology and mobile phone applications (“apps”), is increasingly promoted as a means of facilitating patient engagement. Digital health may, for instance, help patients self-monitor; encourage behaviour change; improve comprehension of diagnoses and discharge plans; and permit dynamic interchanges between patients, their healthcare data, and clinicians. Digital health tools have been hailed as easily disseminated, low-resource solutions to help patients take ownership of their healthcare journey.

Despite the rhetoric and hope for digital health, however, patients are not using the tools as much as they could. Typical medical or fitness apps have a 90-day user retention rate of only 27–30%, and 50% of apps are downloaded less than 500 times. The low usage of current digital health tools is not, interestingly, due to a lack of demand. Research in the emergency department (ED) shows that 90% of patients are interested in a technology-based intervention for their health. Recent national surveys show that up to 66% of Americans are interested in specifically using apps and wearable monitors (like FitBit and the AppleWatch) to improve their healthcare.

If not due to lack of interest, then what explains the low use of digital health by patients? There are multiple competing explanations, including lack of evidence of effectiveness, concerns about privacy and security, and resistance from physicians. Ultimately, many experts feel that the lack of uptake may be explained by a lack of attention to users’ perspectives during the design of digital health tools. [1]

Human-Centered Design vs User-Centered Design
It can be supposed that Human-Centered Design (HCD) is the process of creating things deeply based on general natural characteristics and peculiarities of human psychology and perception. It doesn’t matter if you design furniture, cars, stationery, TVs, websites or anything else — any object of design can be made human-centered on the ground of psychology, physiology, sociology and other sciences analysing human life and interaction with the environment. It means that human-centered product will be not only nice but also functional according to psychological traits and features typical for big groups of users.

User-Centered Design (UCD) is more focused and concise version of Human-Centered Design (HCD) with deeper analysis of target audience. It is concentrated on not only human characteristics and perception in general but also specific traits and features of target users to make the problem-solving potential of the designed product as high as possible in perspective of its users.

This is the stage when details about the target user of design object start playing their role: defining target audience, the designer takes into account age, gender and social status, potential education level and professional background, influential social factors and typical environments of product usage etc. On this basis, the designer makes deeper research on preferences and peculiarities, special aspects of interactions, specifying general human-centered ideas with important details of target audience’s preferenсes, emotional and physical perception traits as well as levels of technology awareness and tons of other factors. [2]

Fundamentals of Patient-Centered Care Models in Healthcare
In 1988, the Picker/Commonwealth Program for Patient-Centered Care (now the Picker Institute) coined the term “patient-centered care” to call attention to the need for clinicians, staff, and health care systems to shift their focus away from diseases and back to the patient and family. The term was meant to stress the importance of better understanding the experience of illness and of addressing patients’ needs within an increasingly complex and fragmented health care delivery system.

The Picker Institute, in partnership with patients and families, conducted a multiyear research project and ultimately identified eight characteristics of care as the most important indicators of quality and safety, from the perspective of patients: respect for the patient’s values, preferences, and expressed needs; coordinated and integrated care; clear, high-quality information and education for the patient and family; physical comfort, including pain management; emotional support and alleviation of fear and anxiety; involvement of family members and friends, as appropriate; continuity, including through care-site transitions; and access to care. Successfully addressing these dimensions requires enlisting patients and families as allies in designing, implementing, and evaluating care systems.

This concept was introduced in the landmark Institute of Medicine (IOM) report Crossing the Quality Chasm as one of the fundamental approaches to improving the quality of U.S. health care. The IOM defined patient-centered care as “care that is respectful of and responsive to individual patient preferences, needs, and values” and that ensures “that patient values guide all clinical decisions.” This definition highlights the importance of clinicians and patients working together to produce the best outcomes possible. [3]


  1. What’s the difference between human-centered design and user-centered design? – Tubik Studio
  2. Faith Birnbaum, BSc,1Dana M. Lewis, BA,2 Rochelle Rosen, PhD,3 and Megan L. Ranney, MD MPHPatient engagement and the design of digital health – US National Library of Medicine National Institutes of Health
  3. Principles of Patient-centered Care – Picker Institute


Nick Dawson

Nick is the Executive Director of the Johns Hopkins Sibley Innovation Hub.
Nick is a proponent of human-centered design in healthcare as a way to create a health system which is more desirable, compassionate and advanced.
In the Innovation Hub, he helps lead an innovation team charged with tackling both simple and complex challenges for patients, staff and providers.

Nick is the Chair of the Executive Board for Stanford’s Medicine X program. Medicine X is a catalyst for innovation, patient empowerment and advances in academic medicine. He is the past president of the Society for Participatory Medicine. His past roles include hospital leadership of departments including strategy, finance and operations.

He skis in the winter, runs most days and is forever restoring his antique Land Rover.

Nick has participated in a variety of national-level health care discussions. Examples include facilitating the White House and USAID’s Ebola Grand Challenge, the White House Stanford Precision Medicine Summit, President Obama’s Healthcare Champions of Change, and Vice President Biden’s Cancer Moonshot. He has also participated in design events led by the Office of the National Coordinator of Health Information Technology.

Contact Nick for speaking engagements, innovation events, patient or advocacy work.