VITALS MONITORING KIT
2017 ; 4 months
Design Research, Product Design, Internet of Things, Systems Design
The Future of Health project was a part of Srishti Labs at Srishti Institute of Art, Design and Technology and was headed by
The healthcare space is in need of an upgrade to benefit from the technological advancements coming up not only in equipment based industries, but also grass-root level innovations in the spaces of remote monitoring, communication, data representation to name a few. In India, the healthcare system can make the most of these benefits due to the deteriorating environmental conditions and the already overburdened primary healthcare System.
Most health problems that we face as adults are consequences of habits and laxity in healthcare we develop as children.
The health screening kit is developed for Government Schools as they lack medical facilities and are completely dependent on government health camps or charity from NGOs.
The kit enables schools to record and maintain health reports of students with the aid of digital devices. The records allow administration to take informed healthcare decisions for their schools in collaboration with government and non-government organisations and also provides visiting doctors year round health records of the students. The intervention also looks at long term gain through decoding health trends in semi-urban and rural settings at the inception stage. I see the role of schools growing to embrace the advantages of an organised healthcare system, both for the students as well as Government or Private organisations.
THE SCREENING KIT
The Screening Kit facilitates a question-answer based screening that can be conducted by a teacher with the aid of a tablet. It also consists of essential medical devices to keep updated medical records of school children.
Screening Tablet- Interface for all screening devices, Questionnaires, a means to store, send and receive data.
Height and Temperature Scale- Performs the functions of a height scale and contact-free thermometer.
Weighing Scale- Weight is one of the most important criteria to keep check on in children.
Peak Flow Meter- To Keep track of the students’ respiratory health.
Blood Pressure Monitor- a wearable band that records blood pressure.
Oximeter- To monitor blood oxygen, respiratory rate and heart rate.
Camera- to facilitate remote checkups and maintain visual logs if needed.
UV Sanitizaiton- Sanitizes all devices when the kit’s lid is shut.
The data from this product and service is being generated at 3 levels.
First, at an individual level of the student that allows him to maintain his regularly updated health report for his reference should the need arise.
Second, with a cluster of students, you get school health reports that can be used by the school administration, government and non government organisations for the camps.
Third, with a cluster of schools, health trends of a district come into play. This kind of data is useful for civic and state bodies for policy and by corporates for possible interventions.
What follows is the detailed process that led me to the solution explained in the previous section. It mainly comprises of three phases- Immerse, Conceptualise and Refine. Each phase required a different mindset, approach and set of tools as described.
The first phase of the project that included a lot a site visits and research was undertaken as a group my project mates at the time- Jahnavi Jambolkar , a User Experience Designer, Priyanka Jain, an Experience Designer, Shreyans Baid, an extremely talented product designer, Tanvi Ranka, a "100% human centric Service Designer (You can find the output of her project here).
DECODING THE BRIEF
The first attempt to break down the brief to the most important elements brought out a narrative that Phillips as a client was looking for. They needed healthcare to become ACCESSIBLE through TELE-SOLUTIONS which could be used to address the lack of resources in the rural healthcare ecosystem currently through TASK SHIFTING as a methodology for execution. All of this was to come together as a SUSTAINABLE BUSINESS MODEL.
The initial research produced a lot of secondary data that needed to be effectively mapped. So, we decided to put together a generalised healthcare model across a patient's journey through a disease. It included 26 common respiratory ailments and how people generally respond to them.
Starting with preventive measures that people might take to avoid getting sick, then, to the part where you get symptoms that show signs of an approaching illness followed by different kinds of ways of getting rid of the ailment (Self-medication, homeopathy, allopathy, Ayurveda etc.) and finally, in some cases, rehabilitation. For people who fall sick, effective diagnosis becomes a deciding point at which the course of their treatment would be decided.
The newly formed sequence was much easier to navigate through and find patterns in. This would later help us have useful conversations with doctors and help identifying which part of the patients journey needs interventions.
The second hand information had to be now validated through some primary research. We prepared a questionnaire with a good mix of straightforward and open ended questions to get a balance of factual and opinion oriented data to work on.
Field visits included the Baptist hospital, Sapthigiri hospital, MS Ramaiah Hospital to meet with several pulmonologists, physiotherapists, lab assistants and check out various machines used for diagnosis. The result was a fairly decent set of insights regarding how the healthcare system works in hospitals, what procedures the patients usually had to go through etc.
Since respiratory healthcare requires diagnosis based on symptoms that overlap in many of the diseases from a common cold to COPD, proper diagnosis is lacking. In turn, patients receive a very symptom based treatment and usually are diagnosed when the symptoms become very serious or the disease is in no longer in a preventive stage. Some of these diseases are not reversible and affect the patient’s quality of life immensely. The scope for work in both awareness, data representation and diagnosis aspects of care is therefore immense.
Getting some of the tests done helped pick important details and hiccups in the process. One example would be our concern with the germs thriving inside a PFT machine after use by a sick patient.
The new insights from the visits called for some more secondary research. We used a similar healthcare sequence to organise the doctor’s side of the story with all the information we’d gathered. We further researched patient case studies and used our personal experience along with primary data from people in our circle with respiratory issues to fill in the patient’s side of the story.
RESPONSE TO BRIEF (EARLY)
Using research insights, I outlined the opportunity spaces. It was also time to shift to more focused research on topics that weren't a part of the initial blanket research that we did. These being-
1) Rural healthcare models
2) Task shifting
A healthcare solution that:
- Uses technology to build on an integrated ecosystem of services to make healthcare more accessible to marginalised people in order to improve their quality of life.
- Is User Centric but involve all Stakeholders at the same time.
- Can be placed within existing traditional healthcare delivery models.
- Can be aimed at bringing about a Behavioural Change.
Doctors, Caretakers, Patients, Hospital Administrators, Broadband Providers
Types of Interventions
- Systems and Service Design- Supplement existing delivery models
- Smart Devices- Standalone tele-monitoring/ mobile products
- Data Representation- Represent data in a way that is most relevant and comprehensible for the user
Areas of Intervention
Effective ways of highlighting the faults in current lifestyles that lead to diseases and/or how to deal with diseases.
Facilitate exercises to maintain a healthy lung or to deal with lung affecting diseases/smart products the inform the user of potential threats.
Devices/services to make diagnosis Easy, Accessible and Desirable.
Ensuring the patient remains motivated during the recovery process by monitoring progress so as to help with the
recovery process itself.
Enabling the patient to lead a “normal” life by using smart non-intrusive monitoring devices.
Data collection/ Representation
Devices/services to facilitate collection of relevant data and/or its representation for making personal health and the environments impact more transparent.
FIELD VISITS- PART 2- THE COMMUNITIES
After a relatively brief, but overwhelming exploration of the respiratory healthcare ecosystem, it was time to overlap the patient's needs over the opportunity spaces. We visited two low income settlements around Yelahanka, Bangalore.
After the interaction with communities I came to two conclusions.
1. They are not aware.
2. They do not care.
The semi urban population is struggling with the security of their basic needs, hence their priorities are focused towards earning money. For doing that, they look for immediate relief wherever there is a problem to get back to work at the earliest. This behavioural pattern is very hard to break, especially if you start with adults who have the responsibility of supporting a family.
Hospitals and medical services are so overburdened with people that they end up providing symptom based care due to lack of time for sensitising the patient and lack of infrastructure to back up proper diagnosis or long term treatment. On visiting one of the government hospitals we saw that the general physician was dealing with 80-100 patients a day. He complained about poor budgetary allocations and lack of awareness and compliance among patients.
Keeping both these points in mind, I started looking at models of diagnosis out of the healthcare model itself which are not even associated with disease in the first place. When we think of hospitals, we think of disease and not health. I wanted to promote routine check-ups for prevention as a healthy practice rather than something that only the sick get access to.
I imagined a system that would facilitate collection of data in a routine manner to initiate a routine cycle of data generation. This data could then be used to further drive the model by a) generating revenue b) bringing out more opportunity spaces.
Today, big data is playing a big part in product and systems design decisions as it provides more opportunities through large amount of data being produced through smart devices.
While researching, I noticed data from rural sectors is largely out of reach and only exists as siloed results surveys conducted by researchers. I decided to work towards a system that enables routine relay and organisation of information so as to enable intervention through collaboration of existing stakeholders or through making existing services more efficient. It could further lead to gains in the form of revenue or more opportunity spaces which would feed back into the model and make it sustainable.
After intensive research and collecting data, it was time to translate the insights into possible ideas. I did quick rough sketches of different directions I could take. I got interesting leads from public kiosks to all kinds of toys for kids. The ideas started to cluster under categories such as, rehabilitation, prevention, screening under the themes of interactive installations operating on the principles of fun and play to portable healthcare devices.
The new service model is to be facilitated by value addition to the data that is collected so as to generate revenue or gains in terms of either further product development or identifying new opportunity spaces.
One constraint with respect to intervening in rural healthcare is lack of real time update of information, coupled with lack of infrastructure, manpower and awareness.
Option 1- An installation/ interactive Kiosk which is placed in a public space of interaction (Markets, schools etc.). This is to maximise data input which will further help to drive the system.
Option 2- A smart product which is a part of a larger kit that facilitates routine, door to door check-ups.
For this to work, the Installation or the Smart Product will have to:
1) Incorporate existing diagnosis tools
2) Integrate diagnostics with existing technology
3) Have networking and Computing Capabilities
4) Be in constant relay with a database in the back-end
FIELD VISITS- PART 3- THE SCHOOLS
Schools seemed like the perfect fit for my intervention model due to a few important reasons-
a) Students/kids are more open to new things than adults, so compliance could be dealt with.
b) Routine check-ups could be clubbed with existing routines of physical education classes.
c) Schools hold a high ground in the hierarchical structure in both urban and rural areas. So, if teachers promoted something like this, it had more chances of having an impact on the local people.
d) Schools had basic infrastructure in place, so they could be used as centres for weekend health-camps for not only the students but also the parents.
Schools seemed to be a good fit considering the challenges I was looking at around that time. Challenge 1,2,3,4.
The product was to be placed in schools as a screening device to maintain student and school health records.
Main sources for my information and validation were my field visits and secondary research online.
I visited- 4 KV schools, The taluka office (Did not get to meet him), spoke to Dr. Gupta from the School Health Scheme and Mr. Sahai, Insights manager from IMRB International (Mkt. Research).
The schools were surprisingly well organised. I got to know about existing health services available to the school. The school lacked a medical room but had a first aid box that was to be operated by the teachers. They received yearly supply of supplements etc. from the government. An annual camp was organised by the government in which the vitals of the students were checked and a health card was maintained.
At this point, I was fairly sure that I wanted to work on a ‘kit’ or medical facility that could be provided to the school as their own medical room that could facilitate routine check-ups.
This would provide corporates and government with real time data that they could use to intervene with new products and service in these otherwise out of reach areas.
For validation of my concept, I spoke with Dr. Mriganka Juneja, post graduate student, MD Pulmonary medicine, who suggested I integrate questionnaires into the service as they would be more helpful in such a context as compared to devices. I researched the questionnaires online and found that there were standardised questionnaires for diseases that existed for lung health and they were widely used and accepted by researchers who worked in the field in a lot of rural areas. It would help create statistical data by segregating the people into different categories.
Now, I needed to validate if the data aspect of this could play out and sustain the product as a business model. I spoke to Mr. Varun Sahai, data analyst at IMRB, who’s first feedback was that my intervention was disruptive in nature and would take years to implement in a government scenario. He said I should look at a more supplementary service rather than a solution that does everything and replaces existing practices. He also told me that the data collected from young kids (1st-6th std.) would not be credible and I should shift the scope to a more mature age group if I wanted to implement the questionnaires through the service.
I started looking more into what services were already being provided and how could they be made better. I visited the Taluka office several times but couldn’t get a chance to speak with him. I wrote to the Addl. Director of the School Health Scheme and got a chance to speak on the phone with Dr. Anil Kumar Gupta, who explained to me what was the service was supposed to be and how it actually funtioned. He specified a problem with the available manpower which forced them to take 2 years to complete a 1 year job. Also, he specifically mentioned a need for a data solution in the back end where their hand written records needed to be digitised. The current process took him months to execute and was extremely hard to coordinate.
This reinforced my belief that digitisation of student records could help various stakeholders at once.
I focused further on a kit that I could develop for schools that could further be used by teachers to operate a medical room of sorts in these schools. At the end of it, it would create student reports, school reports and district reports. The plan then needed to be detailed out at various stages with different stakeholders in mind.
At this point, another important stakeholder came into the picture- The NGOs.
I spoke to Mr. Sathish from Rotary Club Yelahanka who had first-hand experience conducting several camps in government schools. He highlighted the problem of absence of infrastructure and no support from the government. But from his experience, he was quite happy with the response from the schools. Also, he had all kinds of collaboration with corporates, hospitals etc. who were willing to help him with equipment, funding and manpower as CSR initiatives. The camps he spoke about were mostly general camps like eye and ear check-ups. He also stated that he did not have any reports from the school before the camp itself.
This rotary club in Yelahanka is active with schools around Bangalore. They recently organised Eye checkup camps in collaboration with hospitals that offered free treatment for children within 7 days of the checkup. They were also looking for schools that required spectacle donations as a few donors had gotten in touch with them.
This insight helped make my intervention useful in an already functioning model. The NGOs have the means to execute the solution, all they needed to know was about the problem
In conclusion, I could see two well defined existing systems here-
1) Government supplements and camps every year
2) NGO networks and collaborations
The current flow of the system was linear and the school accepted whatever was given to them as charity and the camps organised by the Govt and the NGOs were generalised to all schools. I saw this as an opportunity space to change the schools’ role to make the current system more efficient.
What if the school could be made independent to maintain their own health records? This would enable them to-
1) Share the useful health records with the taluka officer before a camp was organised to enable them provide customised care if needed and to make their annual visit more fruitful.
2) Approach the NGO networks with their needs to facilitate the right kind of collaborations that are useful for all.
3) Speed up the process of information flow between Government Departments.
4) Gives government platform to start yojnas.
5) Open up opportunities for the individual to become a part of schemes like RSBY, that make healthcare more accessible and affordable for people who are economically weak.
There is a precious cluster of resources that exists in isolation. It consists of trusts, donors and social welfare organisations that have access to everything. They just needed to be connected to the schools.
SYSTEMS AND STAKEHOLDERS
With an overview of the possible stakeholders, I started mapping out relations and flow of value in the larger
system I was to place my product in.
FIELD VISIT - PART 4- CONCEPT TESTING
To test this concept, I made a brochure of a hypothetical product that would serve all these issues. I went to 2 schools with the Mr. Sathish Shetty and he introduced me to the principal of a Kendriya Vidyalaya in Yelahanka and the school coordinator for Kendriya Vidyalayas in North Bangalore. I presented the concept and got a positive response from them.
I presented the kit as a product which would include devices for recording the vitals of students regularly with ease. All of this would be facilitated through a tablet which would be running an application which can take inputs and upload them to a secure database over the internet. They were most interested in maintaining their schools records and having a device on campus that could allow them to do so as a routine practice. They were both willing to help and implement this idea. The rotary club also offered to fund it partially, if needed.
To further reinforce my ideas, I did a research specifically on different parts of my intervention.I looked at statistics of the health conditions of school going children, existing products and services in sync with my ideologies and different kinds of technologies that could be integrated with the product.
After deciding upon what all was required in the screening kit, I started to sketch out the form to chalk out the approximate dimensions, usability etc.
It gave me a better idea about how big the whole kit was going to be and how I could merge multiple devices to make the kit more user friendly.
My project mate Shreyans and I tried to replicate the flow of a spirometer through a (a) flow sensor and a (b) flex sensor.
THE KIT- ELECTRONIC BLUEPRINT
The initial design plan included 3 important elements.
- The sensors (S1-4)- Different types of sensors to perform different kinds of functions such as calculate height, weight, temperature etc.
- The Hub (D1)- One common hand-held device to connect individual sensors to. The device would power the sensors, store the information and transmit it to a tablet over bluetooth.
-The Tablet- This is mainly used as a screen to display the data of the sensors and run the application that allows for data input. The data can then be uploaded securely to cloud storage and made accessible to relevant stakeholders.
I laid out several scenarios, a few of which are illustrated in the following pages.It helped me define the scope and further possibilities of the kit.