Viviana Geron

Designing tools and protocols for the healthcare setting requires intersectional consideration of how that tool fits into different teams in versatile settings. An example of a tool that worked well in my clinical experience is Tegaderm, a transparent bandage produced by 3M. In my experience working in a surgical oncology clinic, Tegaderm was a reliable, simple, and durable tool to prevent infection in recent incision sites.

AEIOU for Tegaderm:

Activities: Tegaderm is easily applied by providers, can be changed at home, and allows for greater flexibility than standard bandaging.

Environment: Tegaderm was often initially applied in OR settings but was used in clinic and at home for patients.

Interactions: The bandage required minimal interaction after application, making it safer and more reliable for patients.

Objects: This bandage required less additional materials and was more compatible with clothing.

Users: Users included both medical professionals and patients.

Failure to consider these aspects can lead to design flaws and lack of consumer interface. A memory of a failed design is the 2001 Pontiac Aztec, widely regarded as one of the most unattractive vehicles ever manufactured. While the car was functional for the necessary activities and equivalent to other vehicles in utility in versatile environments and object components, users did not want to drive the car based on the aesthetics and how others might interact and perceive the vehicle. Holistic user goals are integral to the foundation of innovation.

Peer Reviewed Paper

Title: Cost-effectiveness of full and partial opioid agonists for opioid use disorder in outpatient settings: United States healthcare sector perspective

Authors: Sun A. Choi, Connie H. Yan, Nicole M. Gastala, Daniel R. Touchette, Paul M. Stranges

Summary: This paper was a measure of cost-effectiveness of medications proven to be beneficial in the treatment of opioid use disorder (OUD). The study used total costs, quality adjusted life years, and incremental cost-effectiveness ratios to evaluate cost and provided value of three different treatments, including two forms of buprenorphine and one form of methadone. The study found that sublingual buprenorphine and methadone were cost-effective, while long term injectable buprenorphine was not cost-effective. Despite variance in ICERs, all three of these treatments have been proven to be efficacious in the treatment of OUD. Treatments that are not considered cost-effective may still be highly indicated for certain patients. I found this to be relevant to the patient population we are serving, particularly given that insurance coverage for these medications is highly variable and often based on analysis of cost-effectiveness. Maximizing the return on investment for out of pocket patient costs is essential in a population of patients with over 50% living below the poverty line and must be considered when determining course of treatment.

Commercial Solution

TaperMD is a tool created by Dr. Dee Mangin to manage tapering of medications, initially in older dults but now more broadly applicable to other populations. The tool integrates recommended tapering guidelines and dosing information into a tool that can be integrated in an EHR to optimize the discussion and teaching of a taper protocol to safely remove a patient from a medication that can have adverse effects if stopped abruptly, such as opioids or antidepressants. The tool is designed to limit information and display it visually to promote patient comprehension. Tapering both prescribed and illicit drugs is a common, but confusing process in the US and particularly in the population at MSHC.

Upon reviewing the clinical needs based on last week’s observations, the following needs and observations were noticed.

Need Statement: Clinical sites require a standardized method of scheduling patients with substance use disorder for follow-up appointments in line with their treatment protocol in order to increase patient retention and health.

Primary Observation: In clinic, social workers are spending significant time and energy trying to connect with patients after their visits in order to schedule follow ups. Contact can be difficult to establish given the high percentage of patients who lack secure access to a phone.

Secondary Observation: it is estimated that greater than 9 million Americans struggle with a opioid use disorder, with only about 50% receiving any treatment and 25% receiving medication. Black and brown people are also at higher risk for overdose¹. Many patients are lost to follow-up, but the quantification of this population is difficult given the limited data.

Business Observation: While many EMRs offer scheduling protocols (Epic, Tebra, PtEverywhere), they are not being utilized in the setting of our clinic in an efficient manner for all patients. Given the unique needs of the population, either an entirely separate platform or a tool designed to be integrated into the current EMR (Epic) would be competitive against existing technology.

Sources:

1. Centers for Disease Control and Prevention. (2024, June 27). Receipt of medications for opioid use disorder among adults — United States, 2022. Morbidity and Mortality Weekly Report, 73(25), 577–584. https://www.cdc.gov/mmwr/volumes/73/wr/mm7325a1.htm

After feedback on a shared idea, our group updated and designed the following needs breakdown.

To better illustrate our need from the patient perspective, this story board was designed based on our data collection.