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LifeTime

Data flow in medicine is broken

We have no easy access to our own medical data

Medical practices are some of the last workplaces in Germany where a lot of communication with clients (patients) and colleagues (other doctors) is still done paper-based or verbally. Important information, is written down illegibly by hand, is only briefly mentioned - or in the worst case - not handed out to patients at all.

Historically, the fact that people are not granted direct access to their own health data can be explained by the role of doctors as "gods in white". Patients weren't considered as wise and educated enough to have a say and diagnostic details were only seen as an overwhelming burden to them. This attitude can still be found among older doctors today.

In fact, I believe only in the field of psychiatry/psychotherapy, it sometimes is better if doctors are able to make diagnoses and take notes without patients having direct access to everything. In all other medical fields, transparency should be an absolute prerequisite for medical treatment.

It should be clear to everyone that medicine is not an exact science and that it holds many uncertainties. Decisions are often based on probabilities or experience. In no other domain with equivalent consequences for one's own life would one give up complete control to outsiders so readily and "hope for the best" without trying to understand the basis on which decisions are made.

Doctors need access to the medical history of patients

People - especially chronically ill - who actually try to keep track of past treatments and diagnoses usually do so in form of a folder in which documents are filed. This folder is then carried from doctor to doctor and placed on the counter at the reception before the appointment.

The handling of these folders varies from place to place. In some facilities, the documents are all scanned in. In others, the doctor leafs through them briefly just before the treatment, hoping that something accidentally strikes her or his eye. In other facilities, the paper stacks are simply ignored.

It's not the doctors' fault. On average, they only have 8 minutes for one treatment and have no chance to process big stacks of files during this time.

In the current state of affairs people own only part of their medical data themselves – mostly on paper. Most of it is scattered over various computers of doctor's offices and hospitals they have visited in the past.

If a patient or doctor needs access to certain information, the patient must first remember that the information exists and where the data was collected. Then the current standard process is a phone call followed by a direct transmission of the file from doctor to doctor by fax. A technology from the 1970ies that almost no one else uses anymore.

Computers can not help to take medical decisions.

If previous findings are not digital, structured and do not contain any meta-information, the data is not very useful to computers. There are efforts to make medical documents understandable for machines through OCR software. However, the road to meaningful results on this path is still long.

For your diagnoses, doctors therefore rely to a large extent on the data they collect themselves during an appointment or on the few pieces of information that are collected through questionaires, handed out to patients before the appointement.

This is tiresome repetitive work for both doctors and patients and let's be honest: Who can reliably remember details of diseases of his relatives and his own medical past?

But: This information could be very valuable for a better diagnosis.

What if there was a system in which patients could fully own, control and, if necessary, share their data with doctors? On the medical side, software would then aggregate this data and help with the diagnostic work.

Our approach

Secure infrastructure for medical data

The path to computer-assisted medical treatment begins with structured collection and aggregation of the patient's medical context. This data is then supplemented by new information that is created during an appointment or an hospital stay and ends with all newly acquired information and treatment instructions being structured and fully returned into the hands of the patient.

Patients should be considered intelligent enough to have a say. They should be allowed to ask questions and to question decisions. Interfaces are needed to give them insights into their treatment processes and enable them to browse through their medical history and draw conclusions from it.

Doctors should be supported in their difficult work by the best possible data basis and clear and just as helpful interfaces, which aggregate this data base in a meaningful and understandable way and thus enable raw computing power to be used for medical purposes.

Decentral & mobile first

In the past several companies have tried to solve the problems with centralized cloud platforms where both doctors and patients can log in.

The difficulty always lies in building a link between the two sides and a way for the encryption keys to be exchanged and stored. In some systems, the patients have to authenticate themselves by calling their doctor's offices. In others doctors have to hand over one-time-passwords on paper.

All solutions have in common that as a doctor you have to open a web app to send a file. In most apps you have to log in every time. Next the patient has to log in to the patient portal to retrieve the file.

The biggest flaw: The company that operates the system has a complete list of all patients, including their insurance and insurance numbers, and all health data flows through the company's server. And another problem: if the platform provider decides to discontinue the service, all data will disappear instantly.

LifeTime follows another path. It is decentral and mobile first. Encryption keys are stored on the doctor's computer and medical data is stored on the patient's smartphone and can from there be pushed to cloud storage or sent to other doctors at the patient's will.

Doctors can send files to a patient's smartphone via an end-to-end encrypted connection without the patient having to set up a user account in a web app beforehand. The patient does not even need to have heard of LifeTime before.

The assignment between doctor and patient is created using the insurance number and the mobile phone number. Normally, doctors' offices already have both numbers stored in their systems.

With LifeTime the patient is in full possession of his data and the only one being able to decrypt it. The app runs natively and if it is being discontinued in the future, the user has enough time to export the data to another system.

The components of LifeTime

LifeTime for Patients: The Android and iOS Apps

On the patient side, LifeTime provides an Android and an iOS app that serve as electronic medical records and have elaborated features for managing, scanning, receiving and sending files. It is also equipped with sophisticated medication reminder features.

Originally, I had designed two relatively different apps for both platforms to meet the platform-specific requirements. Gradually, I brought the apps closer together as the general design differences between Android and iOS became smaller in time. A fact that also saves a lot of design effort and enhances the branding efforts with a uniform look and feel.

Creating trust in the product has been the biggest challenge for LifeTime from the very beginning. That's why we gradually eliminated patterns that people were not already familar with from other apps. Custom iconography is only used to add delight, not in places where the meaning of icons and symobls is critical.

People are already using apps with similar features every day (e. g. chat apps, scan apps or cloud storage apps). We noticed over time that the LifeTime app is more likely to be accepted when familiar patterns are predominantly used and new patterns are only taught in bite-sized form.

LifeTime for Doctors: The best interface is no interface

On the doctor's side LifeTime provides an Electron app for asynchronous, encrypted transmission of files to patients or, as of late, also directly to colleagues.

Here I had fewer comparable applications and fewer known patterns to start from. Doctors and medical teams already use many different applications in their daily work, all with their own interfaces: appointment management apps, practice information systems, image viewers, etc. These programs are often large legacy systems with unintuitive design.

In the beginning, I created an elaborated interface for sending reports and documents to patients. In the next step I began to eliminate and hide uncritical parts of the UI in order to only show elements really necessary for the task at hand. At the end there was nothing left. The LifeTime Desktop Interface became mostly invisible and only appeared when needed.

Doctors only need to log in once. From this moment on, they just have to click on print or alternatively put a file in a designated folder on their desktop.

The minimalistic dispatch window pops up and stays in the foreground of the screen to avoid getting lost when the user copies a mobile phone number from the practice management system into the window. As soon as the user clicks on send, the interface disappears again.

The challenge in this case was not the visual design of the buttons, but the brainstorming and mockup process to achieve an optimal experience for the practice team.

Over time a more visible interface was added back carefully as new features like an inbox were introduced. There too the design is based on known chat apps to have the least onboarding friction possible.

Outlook

We live in exciting times for digital health. Apps are maturing slowly and the acceptance of tools that really help doctors and patients in their daily communication and interaction is increasing from day to day.

Digital health has long been synonymous with fitness and nutrition apps or quantified self tools.

I believe that the real potential will only unfold when software not only helps young, healthy people to stay healthy, but actually supports chronically sick, elderly people or others really in need of care, when it helps doctors in their daily work and creates transparency for all sides.