Transformation
Transforming Healthcare
Infrastructure
Dave Cronin
Cooper | dave@cooper.com
It seems likely that we find
ourselves at an inflection point
in the evolution of healthcare.
While the situation has cer-
tainly been brought to a boil
by recent U.S. political events,
the opportunities for change
fit into a much larger con-
text; they have the potential
to truly transform the deliv-
ery of healthcare globally.
Unlike some, I don’t believe
our current healthcare system
is totally broken. I’ve conducted
design research in quite a num-
ber of clinical settings and have
consulted for businesses repre-
senting many different aspects
of the healthcare industry,
including provider networks,
medical-device manufacturers,
and even health insurance com-
panies. I’ve seen magic worked
on regular basis, and from a
historical (and global) perspec-
tive, the standard of care in the
developed world is astoundingly
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high. I am in awe of the abilities
of doctors, nurses, techs, and
other clinicians to consistently
function at a very high level
despite the fact they are forced
to work with archaic infrastruc-
ture in less than ideal environ-
ments. (As for the insurance
companies, perhaps the best
thing to say is they function to
make money but could be dra-
matically more successful as
businesses if they changed their
approach to things.)
34
It is at this level—the level of
infrastructure—where these big
opportunities for transformation
exist. It is not that we do not
know what kinds of patient and
clinician behaviors and medical
interventions result in healthy
outcomes; it’s that at a systemic
level, we are not doing a good
job facilitating these behaviors
and driving appropriate inter-
ventions. The right changes
here will provide a conduit for
evolutionary change to cas-
cade throughout the system to
achieve dramatic improvements
in the quality and cost of health-
care. Which isn’t to say that it
also isn’t incredibly important
for medical knowledge to con-
tinue to evolve; it’s just that we
already know enough to dramat-
ically drive up quality and drive
down costs.
Many of the opportunities to
improve our healthcare system
can fit into three big categories:
proactively engaging individu-
als to take better care of them-
selves; providing better inter-
ventional care beyond the walls
of the hospital; and improving
care delivery inside hospitals
through standardization and
better collaboration between
clinicians, patients, and fami-
lies. All three of these strategies
require new infrastructure and
perhaps a shift in the definition,
role, and activities that charac-
terize the hospital.
The first two ideas are mostly
about what happens outside the
hospital. These are things that
architects would not traditionally
worry about when designing hos-
pitals. But that kind of thinking
has gotten us into our current
predicament, where the current
built “environment” for provid-
ing healthcare is sometimes an
impediment to necessary change.
If we step back and define a hos-
pital as the nexus for healthcare
in a community, we have a plat-
form on which we can imagine
the ideal infrastructure for keep-
ing people healthy as possible in
a cost-effective way.
In the May + June 2010 issue of
interactions, Hugh Dubberly sug-
gested designers ought to help
reframe what healthcare is and
how it is delivered, as well as to
reframe what it means for design
to help. I couldn’t agree more,
and in this spirit, propose recon-
sidering what healthcare infra-
structure is necessary to better
care for people, how design
should address this new notion
of infrastructure, and what this
all means for the institution of
the hospital.
Proactive Engagement
of Individuals
The first huge opportunity for
healthcare transformation is
around proactively engaging indi-
viduals with their own health.
In case anyone has missed this

striking fact, many of the most
common chronic diseases, like
diabetes, heart disease, and
cancer, are not only a substan-
tial cause of death (70 percent
in 2006, according to the U.S.
Agency for Healthcare Research
and Quality), and a substantial
source of healthcare costs ($500
billion in the U.S.in 2006), but
they are largely preventable or
controllable by lifestyle choices
such as diet and exercise [1].
So not only is a person with
diabetes who is able to proactive-
ly keep their blood sugar under
control with diet and exercise
more likely to have a “positive
outcome” (i.e., live a long life,
avoid the nasty complications of
poorly controlled diabetes like
loss of vision or amputation),
but they are also likely to cost
their health insurance payer a lot
less than someone with poorly
controlled diabetes. Put another
way, you can buy an awful lot of
proactive engagement with the
cost of one ambulance trip to the
hospital followed by even a short
hospital stay.
But people without the symp-
toms of disease rarely encounter
the healthcare system, and by
the time someone faces Type 2
Diabetes or a first heart attack
he or she has probably devel-
oped some habits that are pretty
tough to break. So as obvious as
this opportunity is, it’s a tricky
challenge—how can we educate
and motivate pretty much every-
one to live in a healthy way as
early as possible, and then how
do we help people make radical
adjustments to their behavior if
either the first round of engage-
ment didn’t work, or they’re
genetically or otherwise predis-
posed to a chronic disease and
they’ve fallen ill?
FEATURE
While this all sounds good
in theory, people’s habits are
notoriously difficult to change,
and psychologists’ and econo-
mists’ substantial understand-
ing of human motivations can
seem meager in the face of
rampant unhealthy behavior in
our society. However, there are
instances in which these strate-
gies have been clearly shown to
be highly effective.
Like many large compa-
nies, Safeway’s health insur-
ance program is self-funded,
meaning the employer pays
all health insurance benefits
(and therefore incurs most of
the risk and benefits from all
cost savings). Starting in 2005,
Safeway has offered significantly
discounted premiums for people
with healthy behavior related
to tobacco usage, weight, blood
pressure, and cholesterol levels.
During the first four years of the
program, Safeway kept per capita
healthcare costs flat, while most
American companies’ costs
increased 38 percent over the
same period [2].
Safeway CEO Steven Burd
recently described the thinking
behind the Healthy Measures
program: “Safeway’s plan capi-
talizes on two key insights...
The first is that 70 percent of
all healthcare costs are the
direct result of behavior. The
second insight, which is well
understood by the providers of
healthcare, is that 74 percent
of all costs are confined to four
chronic conditions (cardiovascu-
lar disease, cancer, diabetes, and
obesity). Furthermore, 80 per-
cent of cardiovascular disease
and diabetes is preventable, 60
percent of cancers are prevent-
able, and more than 90 percent
of obesity is preventable” [2].
So it seems that with even the
most basic motivators (money),
it’s possible to both reduce costs
and improve health for a rela-
tively large and diverse popula-
tion. The next obvious question
is what infrastructure is required
to proactively engage individuals
to behave in healthier ways on a
broader basis. [1] Woolf, S. “Will
Prevention Save
Research by behavioral econo-
Money?” AHRQ 2009
mists has found that people tend Annual Conference,
Bethesda, Maryland
to make good decisions where 15 September 2009;
action and result are closely tied http://www.ahrq.gov/
about/annualconf09/
together (either through feedback woolf.htm/
or when consequences are obvi-
ous), when doing the right thing
isn’t too difficult, and when a
decision is made repeatedly (i.e.,
the individual is able to practice).
People also tend to be highly
motivated by making progress
toward achieving goals, and by
group social dynamics—fitting in
[2] Burd, S. “How
with and impressing (or not dis- Safeway Is Cutting
Health-Care Costs.”
appointing) their friends, family, Wall Street Journal,
colleagues, and neighbors [3]. 12 June 2009; http://
online.wsj.com/article/
It seems then that the start- SB1244768040 
26308603.html/
ing point for behavior change
is good information, and the
starting point for the supporting
infrastructure must be a robust
health record that includes
a wide range of information,
including data from clinical
systems (e.g., hospital electronic
medical records), as well as more
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personal information about [3] Thaler, R. H. and
Sunstein, C. R. Nudge:
things like diet, exercise, and Improving Decisions
health data collected at home About Health, Wealth,
and Happiness.
(weight, blood sugar, blood pres- New Haven, CT: Yale
University Press, 2008.
sure). Of course this data must
be accessible and easily main-
tainable for patients, their fami-
lies, and the clinicians (or insti-
tutions) whom they choose to
allow to create or consume data
from the personal health record.
While there is strong evidence
that just tracking personal data
can have a significant impact on
35
 Transformation

health-related behavior [4], what can help individuals fine-tune which children should receive
is done with and in response to treatment of a disease or condi- a particular vaccine, or using a
the data is critically important. tion or better understand an chart that shows all childhood
The most basic motivator is a undiagnosed problem. While my vaccinations and the ages at
good understanding of the poten- assumption is that mobile- and which children should receive
tial consequences of individuals’ Web-based software interfaces them [5]. While interactive
actions, so interfaces into this will be invaluable in deliver- experiences can provide useful
personal health record must help ing these experiences, we assistance to people struggling
people understand what diseases shouldn’t at all discount the role to understand their medical and
and conditions they are at risk of clinicians—nurses in par- health situations, our overall
for based upon the clinical and ticular—in educating patients healthcare infrastructure must
personally tracked informa- about their diseases and help- better account for the education
[4] Hollis, J. F. et al.
“Weight Loss During the tion. From here various levers ing them establish and track of almost everyone, probably
Intensive Intervention
Phase of the Weight-
are used to help people reduce goals to improve their health. through integration into second-
Loss Maintenance Trial,”
American Journal of
Preventive Medicine 35,
2 (2008):118-126; http://
www.sciencedirect.
com/science/article/
B6VHT-4SXYB9Y-
5/2/475e530280f6bc0f0
29e29dbabb00287/

[5] Kutner, M.,

Greenberg, E., Jin,
Y. and Paulsen, C.
“The Health Literacy
of America’s Adults:
Results from the 2003
National Assessment
of Adult Literacy”
National Center for
Educational Statistics, the likelihood of these unhappy Sadly, for any of this to be ary-school curriculum. (Perhaps
September 2006;
i n t e r a c t i o n s    N o v e m b e r + D e c e m b e r 2 0 10

http://nces.ed.gov/ consequences with capabilities
pubsearch/pubsinfo.
for goal setting and progress
asp?pubid=2006483/
tracking, rewards for healthy
behavior, and education about
the potential ramifications of
effective, there is considerable
work to be done both in translat-
ing medical (and legal) informa-
tion for general consumption,
and in educating the public on
this would be an aspect of use-
fully reimagined “home econom-
ics” or “civics” classes.)
Personal-data acquisition is
also a huge field of need and
Photographs by Dan Simpson and Antonio Rosario

unhealthy behaviors tied in to
various social media to provide
community and support.
There are also huge oppor-
tunities to present data in such
a way as to help people under-
stand correlations between
their actions, environmental
factors, and their health. This
how to comprehend even basic
medical facts. According to the
2003 National Assessment of
Adult Literacy, fewer than half
of American adults were judged
to be proficient in health-literacy
skills to the extent that they
could accomplish tasks like find-
ing the correct age range during
opportunity. Current solutions
for tracking personal health
data tend to be extremely siloed.
While mobile devices provide a
great new way of delivering sens-
ing and monitoring capabilities,
and while there are some nicely
designed health-info trackers,
exercise logs, and food diaries in

36

the iPhone App store, almost all
require a user to actively launch
the application or interact with a
reminder in order capture data.
These all tend to be plagued with
the same problem as paper track-
ers—the people who remember
to use them regularly tend to be
people who are already in good
control of their health.
The real opportunity lies in
figuring out how to integrate
data tracking and education
with experiences that people
already find engaging—whether
it’s social networking, televi-
sion, games, or reading news.
The tricky part is figuring out
how to present these capabili-
ties so that they provide enough
friction to capture people’s
attention, but not so much fric-
tion that they detract from
the overall experience. And
of course, they should be as
lightweight to interact with as
possible. I could even imagine
insurers paying to advertise in
media and software—behavior
FEATURE
placements instead of product
placements and even setting up
incentive programs where media
providers are rewarded for driv-
ing healthcare engagement (like
paying for clicks in online adver-
tising). This would seem to be a
small expense in the face of the
cost savings shown by Safeway.
Changing the Boundaries
of the Hospital
Clearly, as healthcare institu-
tions continue to reach out
into the community to concern
themselves with proactively
motivating healthy behaviors,
the boundary of the hospital will
increasingly no longer be defined
by physical walls. This trend also
extends to interventional and
nursing care.
Home healthcare is noth-
ing new, and millions of people
in the U.S. alone receive some
form of home care [6], but it is
very expensive for patients and
payers alike to get an in-person
visit for basic healthcare moni-
toring for patients with chronic
conditions like congestive heart
failure. A number of products
exist that walk patients through
the process of collecting vital
signs (in the case of conges-
tive heart failure: blood pres-
sure and weight), reminding
them about their care regimen
and uploading the vitals to a
central nursing station where
software tools can help nurses
spot trends that may require
in-person intervention. [6] National Center
for Health Statistics,
“National Home and
Hospice Study,”
February 2004.
[7] “Home Health
Monitoring May
Significantly Improve
Blood Pressure Control,
Kaiser Permanente
Study Finds.” PR
Newswire, 21 May 2010;
http://www.prnewswire.
com/news-releases/
home-health-monitor-
ing-may-significantly-
improve-blood-
pressure-control-kaiser-
A recent study by Kaiser permanente-study-
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Permanente and the American finds-94576164.html/
Heart Association has shown that
patients with high blood pressure
using home healthcare monitor-
ing were 50 percent more likely to
have their blood pressure under
control [7]. This alone represents
a dramatic opportunity—hyper-
tension is a leading predictor for
heart attacks and strokes, both
of which are highly deadly and
expensive to our healthcare sys-
tem as a whole (and therefore
expensive to every one of us).
37
 Transformation

So it seems that
with even the most
basic motivators The Mayo Center for
Innovation (CFI) has been work-
great opportunities to mitigate
these problems by allowing
ing on a program to design a patients to access the expertise
(money), it’s possible “patient-centered medical home” at specialized facilities from
that provides a better connec- far away. And not only ought

to both reduce costs tion between patients and their

and improve health for
a relatively large and
diverse population.
Another recent study conducted
by Kauffman Foundation and
Brookings Institution economist
Robert E. Litan predicts the U.S.
could save $197 million from
implementing telehealth systems
to help treat chronic ailments like
[8] LaRusso, N.
“Imagine Solutions: diabetes, congestive heart failure,
Transforming health
care through a patient- chronic obstructive pulmonary
focused delivery disease, and chronic skin ulcers.
system.” Naples Daily
News, 20 February Current home health moni-
2010; http://www.naple-
snews.com/news/2010/
toring products are mostly dis-
feb/20/imagine- mally designed. For example,
solutions-transforming-
health-care/ the Health Buddy, a popular
telehealth device, communicates
to its (mostly elderly, sight-
impaired, arthritic) users entirely
with small, center-aligned text,
which is clearly not as readable,
let alone as engaging, as it could
[9] Auchincloss, A. H.
i n t e r a c t i o n s    N o v e m b e r + D e c e m b e r 2 0 10
healthcare providers beyond
the in-person visit. According
to the CFI, it is “exploring ways
to implement unobtrusive sys-
tems into a patient’s daily rou-
tine—perhaps a coffeemaker or
refrigerator that records blood
pressure or glucose levels—with-
out disrupting their busy lives”
[8]. While this certainly points
in the right direction, it is the tip
of the iceberg. Whether it’s in a
coffeemaker, the television, or
PC-based social media, there is
a huge opportunity for designers
to imagine how home healthcare
monitoring and telehealth can
more seamlessly fit into people’s
daily lives.
Using technology to provide
better care beyond the walls of
hospitals and doctors’ offices
need not be limited to monitor-
ing chronic-disease patients.
Many routine trips to a doctor’s
office might easily be replaced
by a videoconference or even an
email exchange. This, of course,
would be especially beneficial to
patients in rural settings.
Centralization of specialized
our new healthcare infrastruc-
ture better support remote
clinician-patient interactions,
but because of this trend to cen-
tralize specialization, healthcare
providers will also increasingly
need information systems to
support non-collocated col-
laboration between clinicians.
A common concern about an
increased reliance on telehealth
is that the lack of face time will
result in a reduction in quality of
care. This thinking goes that it
will be even easier for doctors to
be less thorough, and they won’t
benefit from their well-developed
senses of observation. The
counter-argument to this is that
by reducing the amount of time
spent on very routine visits, doc-
tors will actually free up time to
spend with patients whose condi-
tions require their full attention.
Current payer policies are
perhaps the biggest infra-
structure challenge when it
comes to telehealth. As often
is the case with many kinds
of preventive care, currently
telemedicine and remote con-
sultation and treatment are

et al “Neighborhood
be. These products also suffer
Resources for Physical from the same issues that plague
Activity and Healthy
Foods and Incidence many existing solutions around
of Type 2 Diabetes
proactive engagement: They are
Mellitus.” Archives of
Intern Medicine 169, not already integrated into a per-
18 (2009):1698-1704;
http://archinte.ama- son’s daily routine. For example,
assn.org/cgi/content/ given the prevalence of television
abstract/169/18/1698/
watching among the chronically
ill, it seems that the cable-TV
box would be a much more use-
ful platform than a standalone
“medical device,” which is as easy
to ignore as the blood pressure
pump itself.
resources seems to generally be
a good thing in the organiza-
tion of a healthcare system. It’s
more cost-effective and easier
to standardize care (and thereby
improve quality) to deliver car-
diac care in a single large facil-
ity in a metropolitan area than
in a number of small facilities
spread around. However, a huge
downside to this approach is
the increase of travel time—
and decrease in access—for
patients. Telehealth provides
not well-covered by Medicare
or private health insurance
plans. Remote consultations
between doctor and patient are
reimbursable only if conducted
over video, and preventative
examination of remote moni-
toring data is not reimburs-
able. It’s clear that both public
and private payers could reap
significant cost savings (and
care improvements) by better
compensating physicians and
hospitals for using telemedicine

38

effectively, but are too bogged
down in bureaucracy to make
the necessary policy changes.
While telehealth is largely
about extending the impact
of the healthcare system into
people’s homes, when we talk
about redefining the boundaries
of the hospital it is also impor-
tant to consider how healthcare
institutions can have a bigger
impact in communities, perhaps
even by bringing these commu-
nities into the hospital. While
it may be common sense to
many of us, a 2009 paper in the
Archives of Internal Medicine
showed a 38 percent lower inci-
dence of Type 2 Diabetes among
people who lived in neighbor-
hoods with better resources
for food and exercise [9].
Determining exactly what
should be done as a result of
this data is certainly a ripe
opportunity for design think-
ing, and some would reasonably
argue that access to healthy
food and exercise is a civic
good that is best handled at the
municipal level. That said, if we
truly want to orient our health-
care infrastructure in such a
way as to result in better health
at a lower cost, perhaps there is
an opportunity for healthcare
institutions to have a hand in
providing these essentials to a
community. It’s clearly outside
their core expertise now, but
as these institutions move in
the direction of encouraging
healthy behavior, is it really too
much of a stretch to imagine
that hospitals could have a hand
in providing exercise facilities
and farmers markets full of
fresh veggies (one of the biggest
drivers of diabetes reduction
on the food side of the above-
mentioned study)?
FEATURE
Changing Care Delivery
Even if we are successfully and
proactively engaging people to
live more healthily and we are
better able to use telemedicine
to avoid expensive trips to the
hospital, a significant portion of
medical care will still be deliv-
ered in hospitals and doctor’s
offices. One of the most signifi-
cant recent changes in health-
care is a move to standardize
treatment upon what has been
scientifically shown to produce
the best outcomes. It turns out
that this incredibly reasonable
(and surprisingly new) approach
does in fact tend to improve
patient outcomes while reducing
cost of care.
For example, at Intermountain
Healthcare, a Salt Lake City–
based system of hospitals and
clinics, clinicians adopted prac-
tices to more tightly control
the glucose level of patients in
intensive care units (ICUs), which
“led to a statistically significant
reduction in the rates of mortal-
ity in this patient group.” And by
standardizing care for patients on
ventilators, they ended up reduc-
ing the average time each patient
was on a ventilator by more
than a day. These adjustments
reduced the rate of ventilator-
associated pneumonia by 10 per-
cent over two years, shortened
the overall length of stay in the
ICU, and reduced costs by more
than $3,000 per ICU patient [10].
(In the name of full disclosure,
I’ve should say I’ve worked with
IHC for the past couple years.)
As obvious as it might sound,
on a practical level, actually prac-
ticing evidence-based medicine
is harder than it might appear.
The rate of new findings in
medical science continues to
increase, and for all but the sub-
sub-specialists it is nearly impos-
sible for a physician to read and
retain all the research relevant
to the patients that they see. For
evidence-based medicine to be
a reality, it requires that medi-
cal decisions be made in light of
appropriate patient data, which
is viewed in the context of up-
to-date medical research (it also
requires that substantial data
be captured about the treatment
and progress of each patient to
feed back into research). Further,
while all this data is absolutely
critical to the endeavor, informa-
tion systems must also be smart
and help make people smart.
Human bodies and diseases
are incredibly complex, and
research findings are rarely
[10] Baker, G.R. et
black and white (and are always al. High Performing
changing). In top form, human Healthcare Systems:
Delivering qual-
judgment (for example, as por- ity by design. Toronto:
Longwoods Publishing,
trayed in Gary Klein’s Sources 2008. For more on
of Power or Malcolm Gladwell’s ICH, see Leonhardt, D.
“Making Health Care
Blink) is capable of things well Better.” New York Times,
3 November 2009;
beyond any AI or decision engine
http://www.nytimes.
(or at least one that’s ready for com/2009/11/08/
Magazine/08Health 
prime time on a hospital floor). care-t.html/
But the one thing that comput-
ers do have on even the smartest
clinicians is consistency. This
means that information systems
must aid in filtering through the
increasingly voluminous data
captured about each patient;
i n t e r a c t i o n s    N o v e m b e r + D e c e m b e r 2 0 10
help clinicians understand
relationships between data,
observations and protocols, care
guidelines, and other standard-
ized approaches to care; and
ultimately assist in making good
judgments about patient care.
Rapidly increasing medical
knowledge has resulted in an
increase in specialization. This
means that most patients with
a chronic disease or comor-
bidities are treated by teams
of clinicians rather than one
39
 Transformation
or two individuals, and our
healthcare infrastructure must
also support communication,
collaboration, and workflow
coordination between clini-
cians. This means not only more
team-oriented physical environ-
ments, but also better tools for
remote collaboration: a way of
[11] Weber, J. “A SPARC conducting remote “rounds”—
for Medical Innovation.”
BusinessWeek, 27 complete with videoconferenc-
October 2005; http://
www.businessweek.
ing, patient video feeds, shared
com/innovate/ viewing of imaging, and medi-
content/oct2005/
id20051027_614500. cal data, all with next-to-zero
htm/
fussing with technology.
And as we consider how
infrastructure should support
communication and collabora-
tion, we must not forget patients
and their families. Recently,
there has been a drive to bet-
ter involve patients and their
families in care decisions. At the
[12] Beck, M. “The
Mayo Clinic, the SPARC innova-
Family Plan.” Wall Street
Journal, 27 October tion group has been experiment-
2009; http://online.wsj.
com/article/SB10001424 ing with consulting spaces that
05274870447150457444 move the doctor out from behind
9572778372770.html/
the big desk, onto equal footing
with the patient in an attempt to
engage the patient as a partici-
pant in care rather than a pas-
sive invalid [11].
Similarly, at the St. Louis
Children’s Hospital newborn
intensive care unit, parents
are encouraged to contribute
[13] Duffy, B. “Improving
Patient Experience.” observations during rounds, be
Video November 8
i n t e r a c t i o n s    N o v e m b e r + D e c e m b e r 2 0 10
2007 Cleveland Clinic;
involved in treatment decisions,
http://www.icyou.com/ and participate in routine care
events/3rd-annual-con-
sumer-centric-health- activities so they’re prepared
care-congress/bridget-
before taking an infant home.
duffy-md-improving-
patient-experience/ Not only does this type of family
involvement reduce emotional
stress, and in fact help coordi-
nate communication between
clinicians, but the American
Academy of Pediatrics has also
found that pediatric care that
actively involves parents gener-
ally results in shorter hospital
stays, fewer readmissions,
40
improved staff satisfaction, and
fewer lawsuits [12].
The infrastructure required
here is actually quite similar to
what we have already discussed
with regard to changing care
delivery. Hospital architecture
and information systems must
not only account for communica-
tion and collaboration between
clinicians, but must also include
patients and families. They
should be able to monitor and
enter data, to review and discuss
care plans and specific orders, to
ask questions and provide sug-
gestions to clinicians, and to be
reminded and encouraged about
things like medications and
physical therapy.
Conclusion
There is no way that healthcare
transformation can be achieved
solely by legislation. While the
necessary changes absolutely
do require new policies to be
put in place that better align the
interests of healthcare providers
(doctors and hospitals) and pay-
ers (insurance companies and
government) with the health
of people, this alone will not
achieve the cost reductions and
quality improvements we seek.
What must be changed is the
way individuals interact with the
healthcare system, and I believe
this change must be driven by
healthcare institutions.
The institution of the hospital
is ripe for reinvention. By tak-
ing a step back and considering
what infrastructure best sup-
ports a healthy community,
we can reframe the idea of the
hospital in a way that makes it
more effective, both in terms of
medicine and economics. What
if instead of limiting our notion
of a hospital to the building
where clinicians physically act
upon patients, we expanded that
definition to include the physi-
cal and virtual environment that
provides all kinds of interactions
and experiences that result in
healthier people.
Of course there is no shortage
of challenges in achieving this
vision. Medicine is very com-
plex, and transitioning to the
digital age has been slow and not
universally successful. As with
everything built on a foundation
of modern information technol-
ogy, there is a huge potential
for difficulty for the people
involved—patients and clinicians
alike. There are legacy systems,
policies, and attitudes that
threaten to unnecessarily slow
the pace of progress. And at the
end of it all, while digital infra-
structure will be invaluable to
the productive transformation of
healthcare, the most important
interactions will between people.
As former Cleveland Clinic
Chief Experience Officer, and
patient-centered design pioneer
Dr. Bridget Duffy put it, “I think
there’s an understanding that as
the higher tech we get, the more
high touch we need to get” [13].
About the Author 
Dave Cronin is a managing
director at Cooper, where
he works with design teams
and clients to research,
understand, imagine, strat-
egize, design, and create all sorts of digital
products, services, and experiences. He’s
enjoyed working on everything from the
kiosks and handheld guides at the Getty
Center to computer-assisted surgery, and
has a particular passion for medical- and
health-related projects. Cronin cowrote
About Face 3: The Essentials of Interaction
Design, and writes, speaks and teaches on
the subject of interaction design and strate-
gy. Find him on twitter at @davcron.
DOI: 10.1145/1865245.1865254
© 2010 ACM 1072-5220/10/1100 $10.00