[Paper Review] Design research, eHealth, and the convergence revolution

Valeria Pannunzio, Maaike Kleinsmann+1 more|arXiv (Cornell University)|Sep 13, 2019

Global Public Health Policies and Epidemiology16 references4 citations

TL;DR

This paper reviews design research in eHealth over the past five years using the Quadruple Aim framework, finding strong contributions to patient and clinician experience, moderate impact on population health, and limited focus on cost reduction. It identifies design research as a strategic enabler in the convergence revolution, advocating for sensory and self-monitored data as boundary objects to integrate multidisciplinary stakeholders and advance eHealth innovation.

ABSTRACT

The Quadruple Aim is a framework which prioritizes four aims, or dimensions of performance, for innovating in the healthcare domain, respectively: 1) enhancing the individual experience of care; 2) improving the work life of health care clinicians and staff; 3) improving the health of populations; and 4) reducing the per capita cost of care. In this contribution, recent literature providing examples of design research in the eHealth domain is reviewed to answer the research question: in which measure has design research contributed to each of the four aims of eHealth innovation in the past five years?. The results of the review are presented and employed to draw three main observations: 1) design researchers in eHealth seem to be largely focused on improving experiences of care, either patients' or health professionals; 2) design researchers' contribution on reducing per capita costs of care appears to be less pronounced, which is outlined as a point for improvement; and 3) in a considerable amount of reviewed contributions, design researchers appear to be contributing to multiple aims at once. In this sub-group of reviewed contributions, several disciplinary areas and types of stakeholders interact and integrate through design research activities. The latter observation leads to a reflection on the strategic role of design research in the contexts of the convergence revolution and of the non-communicable disease crisis. Implications of this reflection for design researchers are recognized in the opportunity and timeliness to develop eHealth-specific ways to orchestrate design integration. A direction for further research in this sense is identified in the use of sensory and self-monitored data as a boundary object for eHealth innovation. The prospective value of this direction is finally exemplified through the case of blood pressure.

Motivation & Objective

• To assess the extent to which design research in eHealth has contributed to the four dimensions of the Quadruple Aim over the past five years.
• To identify gaps in design research contributions, particularly in reducing per capita care costs.
• To explore the role of design research in facilitating integration across disciplines and stakeholders amid the convergence revolution.
• To examine the strategic potential of sensory and self-monitored data as boundary objects in eHealth innovation.
• To propose a research direction for orchestrating design integration in eHealth through data-driven, multidisciplinary collaboration.

Proposed method

• Systematic review of recent literature on design research in the eHealth domain.
• Application of the Quadruple Aim framework (patient experience, clinician well-being, population health, cost reduction) as an analytical lens.
• Thematic analysis of reviewed contributions to identify patterns in focus areas and stakeholder integration.
• Identification of recurring design research practices that support multi-aim contributions.
• Reflection on the role of sensory and self-monitored data as boundary objects to bridge disciplines and stakeholders.
• Illustration of the proposed direction using blood pressure monitoring as a case example.

Experimental results

Research questions

• RQ1 To what extent has design research in eHealth contributed to improving the individual experience of care over the past five years?
• RQ2 How has design research influenced the work life of healthcare clinicians and staff in eHealth contexts?
• RQ3 What is the level of design research engagement in improving population health outcomes through eHealth innovation?
• RQ4 Why is the contribution of design research to reducing per capita care costs relatively limited in recent literature?
• RQ5 How can sensory and self-monitored data serve as boundary objects to integrate diverse stakeholders in eHealth design research?

Key findings

• Design researchers have made the most significant contributions to enhancing the individual experience of care, both for patients and healthcare professionals.
• Contributions to improving the health of populations through eHealth innovation are present but less prominent compared to experience-focused work.
• Design research has had a limited impact on reducing per capita healthcare costs, indicating a notable gap in current research priorities.
• A substantial proportion of reviewed studies demonstrate simultaneous contributions to multiple Quadruple Aim dimensions, suggesting synergistic design outcomes.
• In multi-aim contributions, diverse disciplinary backgrounds and stakeholder groups actively collaborate through design research processes.
• Sensory and self-monitored data, such as blood pressure readings, show strong potential as boundary objects to integrate stakeholders and advance eHealth innovation.