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The Voice of Healthcare - Episode 11

Co-hosts: Dr. Matt Cybulsky (Principal, Ionia) and Bradley Metrock (CEO, Score Publishing)

Guest: Lauren Janney, Principal Analyst at Lens Strategy.

Duration: 25 minutes, 47 seconds

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Bradley Metrock: [00:00:15] Hi and welcome back to The Voice of Healthcare, Episode 11 for May, 2018. My name is Bradley Metrock - I'm CEO of a company called Score Publishing based here in Nashville, Tennessee. My co-host for The Voice of Healthcare is Dr. Matt Cybulsky: Matt, say hello.


Matt Cybulsky: [00:00:33] Hello Bradley. Hello everyone - we've got a great treat today. I'm really excited about today's podcast, Brad.


Bradley Metrock: [00:00:41] It's going to be great. It's going to be really good. Before we get into it with our guest I want to mention a very special upcoming event, The Voice of Healthcare Summit taking place Tuesday August 7th on the campus of Harvard Medical School at the Martin Conference Center. We've got a phenomenal lineup for this thing. A lot of people are signing up already. It's really sort of taking on a life of its own. The purpose of the event is to examine the growing intersection between voice technology, more properly referred to as #VoiceFirst technology, and modern healthcare. And we've got keynotes from Rowena Track who will be joining us on The Voice of Healthcare in the coming weeks. She is Global Vice President of Cigna. We have Ilana Shalowitz of Wolters Kluwer and Devin Nadar of Boston Children's Hospital; it's a really strong lineup. Check it out by going to You'll find all the information there and you can get registered as well.


Bradley Metrock: [00:01:48] Our guest today is Lauren Janney, Lauren say hello.


Lauren Janney: [00:01:52] Hello and thank you for having me.


Bradley Metrock: [00:01:55] Thank you for joining us. So Lauren, you are Principal Strategist for Lens Strategy. Share with us a little bit about what you do within healthcare and what Lens Strategy does within healthcare.


Lauren Janney: [00:02:09] Yes, absolutely. Lens Strategy is a design consulting studio and we were actually born out of an architecture firm. We launched Lens because we found that sort of the creative methodology that we were applying to building design could also be applied to intangible solutions such as new business models, care delivery models, process improvements and organizational design. And a little bit about my background, I sort of always felt like the black sheep wherever I've been. I started undergrad in industrial design and where industrial design is typically thought of as product design, I was really focused on systems design. So my thesis there was an import and export system in sub-Saharan Africa, right. The only tangible part of my thesis was a shipping container, but the thing I actually designed was the economic system and I got criticized for that. After undergrad I moved into the architecture space but again found myself rather than designing buildings, designing new clinical schedules, or new care team roles that would help actually reduce the footprint of the building, or rather even make the building more affordable or affordable for the client.


Lauren Janney: [00:03:29] I think that this idea of design for me has really been the impetus for creating Lens and rather than subscribing to this notion that design is a singular type of solution like architecture, or branding, or service design, I really subscribe to the notion that design is a methodology that can be applied to various types of solutions and that methodology most closely follows sort of the concept of design thinking where we start by empathizing with the people we are designing for, defining the root problems that we're trying to address, exploring, iterating on a bunch of ideas, prototyping and testing those ideas, and then socializing those ideas as we roll them out.


Lauren Janney: [00:04:18] A lot of your practice and your experience centers around this concept of human-centered design that somebody who's not from that space, not a designer, no one's asking me to design anything. I'm always curious to hear designers and people such as you describe just the conceptual foundations that they work from. So I just want to ask you what is human-centered design and why does it matter?


Lauren Janney: [00:04:51] I'm glad you asked that question because I think that's the key to the design process that allows designers to design many different types of solutions rather than building expertise and just building design or toaster design. But to get at your question, human-centered design is the design that you can say products, services, space as business as anything you can think of, right. But the key is that it's not around the information that you as a designer know or even that the company that may be funding that design knows. It's not around a company or an organization's goals per se or their perspective or their requirements, but around the end users requirements, their goals, their perspectives, and what they're trying to achieve.


Lauren Janney: [00:05:40] And this is so important in healthcare because it means that we're designing for providers and for patients and often their families as well. I think that's a lot of a lot of times missed both in the design of spaces and the design of our healthcare processes and the design of our whole delivery system.


Lauren Janney: [00:06:01] But human-centered design requires that we get up from behind our desks, we get out from the walls of our offices and we conduct immersive research, and by immersive research I mean spending hours in clinics watching staff interact with each other or interact with patients. I'd even argue taking it a step further that we should be spending time out in the communities watching our end users, not as they're sort of wearing their patient hat, but as their people living their lives. I think the other important thing to note about human-centered design is it's also brought forward this concept of prototyping, right. So we've got sort of this rigorous research process that's immersive sort of in the communities to understand the values and the motivations of the people we're designing for. But on the testing and when you've come up with a design, that we're actually testing it with end users and gathering behavioral feedback to understand how usable the design is or the solution is.


Lauren Janney: [00:07:07] I think the last thing that I have to comment about human-centered design, and formally this isn't typically considered human-centered design, but is this idea of code creation. It's another jargon word but it essentially means a collaborative design process, and I think this is actually even a newer concept than human-centered design. But in the sense that you know this idea of going out and doing research and then coming back to the office or the design studio and crafting a solution and then going back out and testing it, that middle piece of the process now is starting to incorporate in healthcare specifically, providers in the room as we're coming up with solutions, and patients in the room is coming up with solutions. And that makes the role of the designer, the facilitator of great analysis tools, user research, brainstorming exercise, how to prototype something, and less of a requirement of having to be the expert in whatever the specific field is that you're designing for. And so it creates a great collaboration.


Bradley Metrock: [00:08:15] From your position as a designer and your background and given what you just explained about human-centered design, when you look at voice technology, or #VoiceFirst technology, the stuff going on with smart speakers, the stuff going on with voice assistants, you know the rise of voice user interface design, you know all these different fields are sort of springing up around this new technology, maybe share with us the one thing about voice technology that you really like from a design standpoint. And then share with us one challenge or something that you think maybe is getting overlooked from a human-centered design standpoint with these voice assistants or smart speakers or any aspect of voice technology.


Lauren Janney: [00:09:12] First let's start with one thing that I really like. I think voice technology brings with it the promise of, there's many ways to say it but I call it sort of the informalization of healthcare, right or the integration of healthcare into the lifestyle of patients or people. Sometimes they word as you know a switch from a continuum of care to continuum of wellness. And that's something that over and over again we find when we're doing user research that healthcare needs to shift from being centralized in these sorts of formal facilities environments to the point of use, and by the point of use I don't just mean out to urgent care as you know in communities or ambulatory care centers. I mean in the car with you as you're driving, going to bed with you at night, when you're having meals during the day. And I think the only way we can really achieve that is through technology, I think specifically voice technology, can be a great companion, a health companion, to people as they're going about their daily lives.


Matt Cybulsky: [00:10:37] Yeah I love the concept of companion when it comes to utilizing voice in healthcare tech. Now when it comes to human-centered design Lauren, it seems to me that voice is this integral piece of that. It's one of the many things that humans are innately born with, this universal ability to hear, to read emotions, to use tone, and put phonemes into morphemes, into sentences, into thought. There's no real - I mean once you have the ability to speak and communicate there are very few barriers it seems for someone to be able to use the technology. When you think about voice tech and you think about human-centered design and you think about the innate ability of humanities communication style through voice, what comes to mind for you as far as where this benefit ultimately lies?


Lauren Janney: [00:11:43] I think with voice technology and healthcare we're often thinking about its role, that the role that it plays with patients or consumers and I think that there's like I just said probably the single most important promise that it can deliver. I see on a daily basis the role it can play in helping remove the burden of work, and I think this might even be a more immediate feature of voice technology, but removing the burden of work for our healthcare providers. So you know it's pretty commonly known we've got a workforce issue right, a demand supply issue in our provider workforce where we're short on primary care physicians, and we're short on sort of many preventative health providers out there. And you know I think in addition to that, all the administrative work that providers these days are required to do, sort of the pressure on increasing through-put through their daily schedule has led to this level of burnout. And I think that voice technology when you bring it to the hospital or even the current places that our providers are working, can work as a sort of administrative companion to those providers.


Lauren Janney: [00:13:09] I read an article the other day talking about you know the value of voice technology in that industry and healthcare and sort of cited at the top was this idea that virtual nursing assistants, things like administrative work flow assistants, add up to about 40 billion dollars' worth of revenue available sort of in that realm and I think that voice technology in the hospital. And so for example during a surgery, surgeons kind of looking up a code or asking a question and voice technology being able to answer it right there during the surgery. Patients as they are in the in-patient room can give real time feedback and request when their meal should be delivered and that can then send a code or send a message to the kitchen and maybe someday a robot will deliver it that can reduce food waste. But I think there's so much value to it today and sort of removing that administrative burden of work that we might even see or that we have the potential to capitalize on before even really taking advantage of it out sort of in the world as that patient companion.


Matt Cybulsky: [00:14:37] I love that perspective. A few things, when you mention labor and voice tech and healthcare especially, it's hard to describe how many practitioners and providers I speak to regularly that talk about the burden of their administrative duties, especially in the EMR, after clinic, after procedures. There's even some great work that NEJN has done gathering data on how much time physicians and providers, not just physicians, are spending over their own weekends filling in information into that EMR. One thing I'm really excited about is an advent of using these voice tools in the patient provider experience to return emotional connectivity and emotional healing in that moment. Whereas there are key words that the physician provider says through a visit or consult that the voice tools can automatically record and then transmute into texts and put it into the EMR record without the physician having to do that work. That's a masterful thing if we can get there quickly.


Matt Cybulsky: [00:15:46] A moment ago you mentioned a positive thing about the voice tech world and I think you were headed towards giving us maybe some of the negative. Now you pointed to labor, but perhaps there was another negative that you had in mind that you wanted to share with us and also how human-centered design could modify that.


Lauren Janney: [00:16:07] Absolutely. This is a term that actually comes from the tech world, but the concept of human in the loop. I'm not sure if you guys have heard of this or are familiar with it. It's a negative in the sense that I think it hasn't expanded; the concept hasn't expanded as widely as it needs to. We're talking about artificial intelligence, machine learning etc., but the concept is that even when designing systems that sort of take the burden of work or replace the interaction between a person and another person, there still needs to be that, and in the healthcare realm, there still needs to be that provider or that physician that's integrated into that feedback loop. And I think oftentimes these technologies are looked at as sort of a replacement for the provider rather than as a co-pilot or an assistant to that provider. And I'll give you a great example of it. And I think this is sort of that human-centered perspective of designing for the capabilities and limitations that we have as people. So we know that machine and robots can more effectively sort of outpace our cognitive skills, for example there is a robot that can more effectively administer anesthesia. And because we don't understand how that robot is achieving that success rate, even if we've seen only 100 percent accuracy or improvement over an actual anesthesiologists or a person doing the same task, we won't trust that machine. And so we have to look at how the anesthesiologist can work as a co-pilot and have some level or some role in that loop between the machine or the system and the user. It gets a little bit sort of west worldly on us in the sense that the unknown I think prevents us from accepting. I think a lot of that unknown comes when the cognitive capacity of a machine is exceeding our own.


Matt Cybulsky: [00:18:42] I love that comment you just made, west worldly. I think it's a good metaphor for some of the fear you speak to.


Bradley Metrock: [00:18:52] Matt, don't go spoiling my episodes, I'm only through part of Season 2.


Matt Cybulsky: [00:18:55] Throughout time, throughout human advances, and I think I've mentioned this on the show before, it's a concept that I really like when people bring up you know these false concepts about the slippery slope and this technology is going to be the end all. Humans have created amazing innovations over time. I mean molecular biology, IVF, nuclear energy, cloning and CRISPR now. There are all kinds of electrical and physics advances that people have thrown their hands up in the air and said "This is the big one; we no longer can connect anymore." Even famously in a macabre sense, Ted Kaczynski in his famous manuscript describes the risks of advances in technology and believe it or not Tolkien in his books even talks about, in a metaphorical sense, of good versus evil and evil being those who are seeking high tech and power. I think the counter argument to that fear, and the counterargument to the examples of these narratives I've mentioned, are humans have been very good at creating systems to protect ourselves and to guide these technologies so that we don't cause mass death or mass hysteria or chaos.


Matt Cybulsky: [00:20:19] So I think that's something that comes to mind immediately when you talk about those fears is something that's on everyone's mind right now, which is something you mentioned which is trust, but also can be distilled down to privacy. I think more than ever we're very much aware of the pitfalls of our online lives and the lack of privacy that we seem to get sometimes in the slips that are made in security. So that being the case, what are your thoughts on this technology as it relates to privacy?


Lauren Janney: [00:20:54] Well that's a timely question. I just heard on the news this morning there's a couple in outrage with Amazon because Alexa had recorded a private conversation and then sent it to you know someone on their contact list. Something that's probably a difficult set of circumstances to repeat, but is absolutely possible. So you know I agree, I think privacy is sort of one of the greatest challenges that we're going to have to overcome. The one thing I will say as sort of an early millennial and certainly from the sort of philosophical perspective, I identify with millennials quite a bit and it causes some heated discussions with my husband, who is certainly not a millennial like myself. But I think millennials are a lot more comfortable with the level of privacy that you know ensures that their information won't be taken advantage of, but otherwise sharing everything else.


Lauren Janney: [00:22:04] And so as you look at social media and look at millennials and their broadcasting you know where they are, what they're doing, what they like, what they don't like, and I think from that perspective privacy is a little bit of a cultural issue or a generational issue that I think is naturally just going to evolve and I think from that trust or the perception of privacy will change. You know that said at the end of the day you know there's a certain level of privacy that will have to be addressed. But I think there's a good chunk of it that's generational and as millennials start to become greater users of healthcare, which is a whole other conversation, then we know that some of those concerns will phase out a little bit.


Bradley Metrock: [00:23:01] Thank you for sharing with us all of your insight on this and some of your background and just giving us this time. I saw you know December last year you joined the Emergency Medicine Advisory Board at Brigham and Women's Hospital which I think is really interesting and cool. Share with us a little bit here at the end of the show about that and why that matters to you.


Lauren Janney: [00:23:28] Yeah. So I think at the end of the day what I'm passionate about is helping people creatively solve problems and teaching everyone that they are creative. And I think in the healthcare industry there's a whole ton of creativity from the sort of advancement of medicine and science. But in care delivery, I think it's something that oftentimes we lack. And I think a lot of that's just the burden of the daily work. Being that expert in the room that can teach people sort of methods for connecting with patients, connecting with their communities, and finding more creative solutions I think are going to be essential to advancements in health delivery and care delivery.


Bradley Metrock: [00:24:27] Thank you for sharing that with us. Thank you for sharing all of this with us, your time and your insight. We greatly appreciate having you on the show, Lauren.


Bradley Metrock: [00:24:36] Thank you very much and I look forward to seeing you guys in Boston in August.


Matt Cybulsky: [00:24:40] Yeah I'll echo Bradley on that, a really special talk today, Lauren. We're really impressed and motivated by the kind of work you're doing and we appreciate you sharing with us today.


Lauren Janney: [00:24:50] Thank you.


Bradley Metrock: [00:24:51] If you've been listening to this episode, we're going to include all the information to where you can reach out to Lauren or check out Lens Strategy and learn more about what she and they are doing. Also don't forget, head over to to learn more about the Voice of Healthcare Summit coming up this fall.


Bradley Metrock: [00:25:14] For The Voice of Healthcare, episode 11, thank you for listening and until next time.

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