Some thoughts about how disruptive technology: Artificial Intelligence, intersect with the future of Healthcare and Wellness
Healthcare in Indonesia is one of the biggest needs yet to be fulfilled. Indonesia spends only 1% of GDP (Gross Domestic Product) on healthcare, compare to 6–8% for OECD countries, and 16–17% for country like United States.
– John Riady — Director, Lippo Group
In 2014, government of Indonesia announced a universal healthcare coverage program, where Indonesian can get free-of-charge doctor consultation and medicines. As much as it is excellent offline, we would like to bring the experience online by creating an app that will not only support this program, but also facilitate every Indonesian to a much more simplified access to healthcare.
We did a qualitative research from several people about their current behavior when they feel sick/unfit, we got a lot of responses that they are just simply go to nearby drugstore, describe the symptom a little bit to the staff, and got a prescription-free drugs from them. If they still feel the same after 2–3 days, then they will go to the hospital.
We asked them whether they had healthcare app in their smartphone, 72% respondents didn’t use healthcare app, majority said that they need to see the doctor directly, and sometimes doctor also need to check their health status with tools that only possible if they meet face-to-face. Being said that, they still hate to go to visit doctor in Hospital because:
- Traffic on the road to go to hospital
- Long line waiting for doctor and medicines is such waste of time
- Unexpected price for the service and medicines
With these key-findings allowed us to seek an opportunity to create an app that not only allow people access to healthcare information, but also make them more aware of their health in general.
Why is it important?
Back to the statement cited from John Riady — Director of Lippo Group, we are all aware that healthcare in Indonesia is one of the biggest needs, and we are now in digital era, so combining the two, Indonesian people urgently need access to digital healthcare. Indonesia might not have all the infrastructure yet as developing country but with digital healthcare, we can have seamless and comprehensive healthcare experience, in and out of doctor’s office. That is where we are moving towards to.
These are the objectives that we need to answer:
- To create a one-stop online healthcare service in Indonesia
- To invent a personal health-coach for daily activity
- To digitise medical record for each person
- To facilitate government and private health insurance for everyone
One fundamental truth when we try to combine technology with healthcare is that healthcare is personal. Current situation indicate that there are many healthcare apps on the store yet they are inaccurate to verdict a disease, most of them don’t focus on user, but the commerce side. There even an app that violate patient’s privacy when consulting with doctor online.
Now we know that we should personalised healthcare, but the question is, how should we deliver it?
The principles of communication
Communication is a process of sharing meaningful messages. The messages, can be verbal (language) or non-verbal (gestures, facial expression, tone of voices, symbols). One of the most natural way to communicate is a conversation, when we exchange news ideas between two or more people in informal way. So is it possible to create an interface that would meet the communication principles above?
Conversational UI (CUI) as we can already look at Siri on Apple (ask weather, book a restaurant, order taxi, etc) or Google Duplex Assistant, that can even now help making reservation via phone call in the background, begins to show us what is possible.
In a new design paradigm, the conversational UI could add interactivity when people use technology to stay healthy. In building a healthcare app, whether it is for professionals such as doctor or patients, we need to think about the impact of what we are building, and to dig deeper on how this app can connects people to people, and people to informations. Therefore we need to address these elements:
- Compassion; Patients sometimes feel that they are at the worst situation and we need to understand their needs, fear, and goal compassionately.
- Education; Professional need tools to educate patient because healthcare itself is a vast knowledge.
- Adherence; It takes a lot of effort to integrate something new into your daily routine (e.g. taking medicine according to schedule). Thus we need to figure out what hooks to design into a system to encourage adherence-friendly behavioral changes.
- Reporting; So doctors, family, and community can contribute based on the information on the reporting.
In conversational UI, there are two types of answers as communication foundation:
- Defined; it is controlled, close-ended, users may not be allowed to speak what they want but instead choose from options (buttons) provided.
- Non-defined; it is not-controlled, open-ended, users are allowed to communicate more naturally.
There are hygiene factors that we want to build when it comes to conversational UI. At the first phase we planed to design a UX script for basic features, and the second phase were going to integrate AI to make the app more helpful and understand the people needs the more they use the app. So the app need basic functions as follow:
- Predictive nature; it’s fundamental to understanding the user, and predict what they will want based on daily habit.
- Social capabilities; giving recommendations, and share information just like talking to a friend.
- Ability to reach out into real world; let the machine learn about the user need and what they are looking for, then connect them with a “real” help (doctors)
- Have a personality; It is engaging how we can interact with bot that somehow, know how to express itself (using emojis or gifs reactions)
- Vast medical information; This is the core function that will predict the symptoms based on information that user gave, and the follow-up action to specific condition.
- Deep understanding of user; Learn the user’s habit and past in the background, and make them as a backdrop of conversation.
Our vision is not designing an app to create a personal doctor bot that you will only need by time you feel sick, but a lifestyle app that you continuously use in daily activity, like a health coach, but at the same time also like your mother, who knows you well and care about you.
AVA is an avatar of health coach that we are going to build. Later on, this avatar can be customized based on user preferences, because of course anything customizable make things more personalized.
Departing from objective to create a one-stop health service in Indonesia, we design a three core features for AVA app for consumer, they are:
- Find/book a doctor
- Pharmacy delivery
- Voice/video call consultation
- Pay in/out (e-wallet integration)
There are also AVA app for professional with core features:
- Pay in/out (e-wallet integration)
We later had findings that appointment system is still not working in Indonesia for all type of business (especially healthcare industry), some still prioritise people that direct-visit so it’s a challenge for us to change the mindset of people to have a more structured booking system.
On our roadmap plan, we are aiming to develop an app that facilitate not only healthcare but also to encourage healthy lifestyle, elevate fitness level, wellness, and of course happiness in life. These features are as follow:
- Wellness buddy
- Medical Library
- Fitness Tracker
- Fertility and Pregnancy
- Sleep Pattern
- Healthy Food Intakes
AVA is not just an app, but a system. It will be integrated to many sectors to ensure seamlessness of digital healthcare experience offline to online. The roadmap of AVA from phase one including these portals:
- Corporate; Helping corporate HR to help supporting their employees’ health. Setup video call with doctors for employees who called in sick and set up medical checkup for new employees.
- Hospital; Integrating the system to hospitals and provide reliable information of services and enable patient’s booking system through consumer app.
- Doctor; Connecting doctors with patients through AVA app for professional or web back-office.
- Insurance; AVA integration with insurance will make it easy for people to access the insurance information & services, also channeling the insurance coverage system.
We did a quantitative research from 550 people with quite a balance ratio of 49% married and 51% single in Indonesia about their views toward healthcare app and its features to begin prioritisation in phase one. We want to do so much within so little time to produce an MVP so with a very short time research, we succeeded to gather insight about most demanded features in healthcare app. The respondents vote as follow:
- 48% for doctor database and book a doctor
- 41% for pharmacy database and delivery
- 11% for virtual health assistance
We encountered difficulties with quantitative approach because some terminologies are quite advance and some people didn’t understand and actually these terminologies needed visual look and elaboration. So in the next phase we were planning to do qualitative research to interview people and have a casual discussion so both parties were on the same page.
Developing visual design
This conversational UI design adapting Material Design system. Why? Because we want to save times from developing our own visual language while instead we should focus more on our core app functionality. By using Material Design, our targeted user subconsciously attribute a level of trust and security to our app (the most important thing in healthcare app) beyond its station because they will associate our app with Google. This will be a rewarding strategy for our growth-stage app development.
When it comes to wireframe for healthcare app, we did a lot of exploration about a conversational UI, how it should look like, and to make it as natural as typing an SMS. The whole design system must support a combination of buttons and card interface elements.
In developing visual design system in Material Design, we implement basic color theory of blue as primary color. Blue is used extensively to represent calmness and responsibility. Light blue here should appear more refreshing and also friendly as we use conversational approach to the interaction. As much as blue is often associated with hospital and surgery that have a little bit of tense aura, instead we want to make it more relaxing and approachable, also more sophisticated.
There are three basic principle to the color system:
- Hierarchical; The blue color indicate interactive elements. This resulting important elements stand out most of the others.
- Legible; Blue text and icons meet legibility standards when appearing on white or colored backgrounds.
- Expressive; Reinforce blue brand colors at memorable moments.
Context is really important in conversational UI and it makes the difference compare to chat with a real person. For some topics, it’s faster to give option button rather than a non-defined answer that open to many unrelated possibilities. It’s indeed a complex system in the background to appear as simple as possible to the user and this will be a differentiator to other healthcare app.
“The aim of medicine is to prevent disease and prolong life, the ideal of medicine is to eliminate the need of a physician.”— William J. Mayo (American physician and surgeon)