Konstell is a speculative service for the New North Zealand Hospital in Denmark. It unites different constellations of data with people to better organise support for patients living with a chronic condition.
Today there is a crisis in healthcare across the Western world. The system has to strive to deal with the impact of rising healthcare costs, a growing number of elderly people and changes in disease patterns due to people's lifestyles. The resources in healthcare are concentrated in centralised large institutions, and although many governments are attempting to move to preventive care in the community, this is not progressing fast enough.
For the past year I have worked as a service designer for Cupris, a healthtech start-up and have become increasingly fascinated by the potential that technology has to offer. We are witnessing an incredible moment in time, where technology is evolving faster than ever, transforming the way we engage with with own health. Wearables, sensors and a large numbers of new apps are increasingly being adopted by citizens and medical practitioners, showing different ways of how healthcare is delivered.
My project partner, Mariepi Manolis (NHS medical practitioner) and I decided to use our backgrounds of medicine and design to research the idea of distributed and decentralised healthcare services. We partnered with the innovation unit of the New North Zealand hospital in Denmark, a new hospital expected to launch in 2021.
The experience of COPD patients in Denmark
As a result of a workshop we decided to focus on the experience of patients with COPD, as it affects one in ten Danes and is the most frequent cause of hospitalisation in their current hospital.
430,000 Danes suffer from COPD which is the most frequent cause of hospitalisation in medical wards accounting for 150,000 Hospital bed days and 30,000 outpatient visits.
What is COPD?
COPD describes a group of lung conditions that make it difficult to breathe because of the airway narrowing. It is a chronic progressive disease, it worsens with age and is most commonly diagnosed in smokers. The severity of the disease is linked to socioeconomic factors and there is a stigma attached to the condition, leaving many patients isolated. As a nurse told us, “these people are invisible to society”.
Living with COPD
If we compare COPD to cancer, living with COPD is more complex. As you can see on the graph, patients deteriorate over time and suffer from severe fluctuations in their condition, making it hard for them to cope, and increasing the chances of hospital admissions.
During the 6 months of the research, we have carried out 3 research trips to Denmark. This involved interviews with COPD patients, clinicians, nurses, Tele-care partners, and the innovation team. We also held 5 co-design workshops and undertook extensive desk research.
Since we worked with the Innovation Unit, we aligned our approach to their “innovation funnel” which starts with ideas, moves to what they call “prejects” (what happens before a project is defined), then are the projects, and finally the process of scaling. In their process space, we the double diamond approach from the general ideal of distributed healthcare, and our project outcome will be followed up by more concrete service projects that we are currently planning with them.
What are the reasons behind so many COPD (re)hospitalisations? Our research highlighted the experience of COPD patients and the main causes of hospitalization. Understanding these factors generated 4 main insights:
Our research highlighted the experience of COPD patients and the main causes of hospitalization. Understanding these factors generated 4 main insights.
- Many COPD patients do not adequately manage their condition causing them to feel they are not in control of their health. This is due to a lack of knowledge of what the disease is and how to manage everyday life.
- There is a delay before patients ask for help. This is for two reasons: Psychologically, they feel like a burden and don’t want to “bother” anyone, and secondly, because of how different the disease can be from one day, to the next.
- Discharge transitions are not adequately coordinated and integrated because of systemic issues between primary and secondary care.
- There is not always a clear follow up for patients after discharge. This causes anxiety for patients, and a third of them are readmitted to hospital within 30 days.
These challenges helped us to understand which elements would be critical when creating future services. With these in mind, the goals were:
- To distribute knowledge to patients to enhance self-management
- To design communication channels for patients to connect with medical practitioners
- To improve ways transitions are organised, increasing safety for patients and efficiency for practitioners
- To support patients after discharge, enhancing safety and recovery.
We had to consider what would be a realistic context in which they could be achieved. These goals shift the way current practices are being delivered and we understand that hospitals need time to plan. In addition, artificial intelligence and other technologies, when widely developed adopted, will provide a springboard for more radical innovation.
Given these two reason, we are imagining our future service being in place
How might we create a personalised and integrated distributed healthcare service for COPD citizens in 2030 in Denmark, by leveraging technology to improve their experience and reduce hospital admissions?
Our solution is Konstell, a service platform that assists COPD patients and healthcare providers. Konstell supports COPD citizens to understand and easily manage their condition in everyday life. By capturing data from various devices and wearables, Konstell detects early changes and triggers a prompt response to avoid hospitalisations wherever possible. It also supports healthcare providers to quickly access relevant information from other databases, coordinate interdisciplinary care and arrange appropriate follow up such as virtual ward rounds.
The following video, illustrates the future experience of Konstell for a COPD patient, from the moment they are diagnosed, to the moment they are discharged from a hospital admission.The story behind the video has been iterated with COPD patients, innovation team staff and medical practitioners throughout the project.
Konstell is made up of 3 key principles.
It is predictive, as it uses AI to interpret contextual data and trigger early alerts
It is personalised, because it encourages patient autonomy. We believe the design should address each person's needs and behaviours.
Finally, it is decentralised. Care is delivered outside hospital settings, ensuring any kind of transition is efficient and safe.
Konstell system overview
How would Konstell work? We are expecting that in the future, a COPD citizen such as Marianne will be surrounded by multiple wearables and pieces of technology, which creates contextual data.
Konstell will capture the relevant parts of Marianne’s data. For example, how many steps she’s taken, her eating trends, her vital signs and among other interpretive data. Her profile will create a constellation algorithm that can be viewed by her medical practitioners who can access only the data that is relevant to them. If her condition flares up, it will not only notify her medical practitioner immediately, but family members if desired.
Marianne’s support network consists of both formal and informal support team, each collecting only the necessary data depending on the role they play. For example Marianne can see an overview of her condition. She also receives digital support from “konstance” an intelligent assistant, but is able to contact her wellness nurse for support if this is not enough. They have decided that her daughter, Karen, is contacted anytime her wellness nurse is contacted, which happens only when her condition looks unusual. Hospital employees on the other hand, play more of a distant role and only intervene when things are severe.
We believe that what is really powerful about this system, is that it is proactive. Instead of Marianne having to wait weeks or even months to get help, those who matter will immediately respond. This also relieves Marianne from the burden of having to ask for help.
Who owns the data
A big question that has arisen throughout this project is, who owns the data? In the future, we expect a personal information management system will be available to users. People will also have access to blockchain technology which is a decentralized and distributed system. This ensures the encryption of personal data, providing privacy to people.
In other words, primary and secondary care won't be able to keep the data, unless patients decide so. Ultimately it will be up to patients to decide how their data is used.
As a network-based service, we believe that konstell will get continuously smarter and more efficient the more it is used. The more patient data gets liberated from isolated systems and added to Konstell, the more knowledge and value can be generated for the Danish healthcare system and the citizens it serves.
The following video to includes some of the prototypes, which is narrated by some of its users in 2030.
Impact and reactions
To summarize, we have designed a service that supports patients from an earlier stage. As the journey of a COPD patient isn’t linear but a spiral we have sought to decrease the frequency and severity of exacerbations, enhancing prevention as well as the speed of deterioration.
Konstell supports patients to cope in everyday life, increasing their autonomy and helping them to recover faster after a flare-up in their condition. This also has an associated cost benefit for the hospital.
1. Project reactions in Denmark:
2. Feedback gathered during the RCA Show 2017:
“It is amazing how you’ve managed to explain something so complex with so much simplicity, that it is easily understood. It’s complex because it involves behavioural aspects, economical aspects and policy. I can tell that there’s a huge amount of work that has gone in to make it understandable.''
Director Growth & Innovation, Design Council UK
“I think this is amazing, it’s really really cool. Basically this is the incubation phase for future treatment patterns. It’s pragmatic but inspiring. I love that it’s predictive and event driven. I think that’s the big shift. What I like about Service Design as a concept is that you use customer empathy to find the big shifts, then you design around it. And for me a good shift is event driven at the intervention points."
Senior Partner at McKinsey UK
“This is fascinating stuff, as there’s so much work been done currently about disrupting healthcare."
Managing Director, Healthcare Strategy at Accenture UK
“This is impressive. We are doing a project in Devon with the Design Council about transforming ageing and we are trying to use design methods just like that to start a conversation and create a shared vision in the community, in serial workshops”
Senior designer, Policy Lab UK
“This is really great and I think one very important thing out of this, is that someone who isn’t comfortable with their disease could get information orally or through an avatar, saying that these would be the symptoms of anxiety etc. That’s already hugely helpful.”
Head of innovation lab CERN
The future of konstell is today being discussed as a collaboration between the Royal College of Art and the Innovation Unit @nythospital Hospital, Denmark.
We strongly believe that a platform like Konstell can transform care delivery by redefining who, how and when decision making takes place, and we are currently working to continue its legacy.
Date: January to July 2017
Area: Service design
Members: Estefanía Trisotti, Mariepi Manolis.
Client: Innovation Unit, @nythospital Hospital, Denmark.
Extent of the project: 6 months, full-time
More information: konstell.dk / https://firstname.lastname@example.org