Know Context
What’s Inside?
In this book we explore the context in which we are designing. We use tools such as the Eras Map and the Innovations Map to become more relevant in our context. It is important to do this to gain empathy for our stakeholder. It is also important to understand all of the surrounding events or circumstances that may have influenced or influence a behavior.
Sections Eras Map Innovation Map Pre-Existing Systems Glossary of Key Terms
Contents
Notes
1900s-1920
1920s-1940
1940s-1960
1920s: 1861-1865: 1941: Womens Sufferage American Civil War: Had Pearl Harbour dramatic long term impact 1920: US Declares Start Prohibition on American Medicine, War on Japan 1928: from surgical techniques 1945: Penicillin Discovered to hospitals to nursing to World War II Ends 1929: research facilities. Japan Surrenders Stock Market Crash 1890s-1930’s: 1948: Great Depression Begins Progressive Era in World Health Association 1931: Education (Part of was founded as a Unemployment Worst of United Nations agency Prograssive Movement) Depression 1906: to improve global health. Approved Meat Inspection 1935: 1950: Act Pure Food & Drug Act Alcoholic Anonymous Korean War Starts Founded 1909: 1955-1973: 1935: Plastic is invented. Vietnam War Social Security enacted in 1950s: 1913: US. Personal income tax Beginning of Civil Rights 1937: Introduced in US 1957: Social security pamphlet: Congress Passes 1914: “having a family is the levy Civil Rights Act Panama Canal Opens to survival“ “a young man 1914-1918: can hardly afford not to World War I marry“ 1917: Harlem Renaissance Begins 1939: World War II Begins 1918: The Depression: Flu Pandemic Unemployment, lower wages and the demands of needy relatives tug at the fabric of family life. Many Americans forced to share living quarters with relatives, delay marriage, and postpone having children.
1960s-1980
1960: Beginning of Civil Rights Movement in the South 1965: Congress Passes Cigarette Labelling and Advertising Act 1970: Clean Air Act of 1970 1978: First Test Tube Baby Born
1980s-2000
2000-Present
1981: 2000: New Plague Identified Mapping Human as AIDS Genome 1981: 2007: PC Introduced by IBM iPhone Released 1987: DNA first used to convict criminals 1990s: Internet Becomes Popular 1996: Welfare Reform 1997: Scientists Clone Sheep 1998: Viagra on Market; Clinton Impeached
Eras Map
1900s-1920
1889: Opening of Johns Hopkins Hospital; opening of nursing training program. 1893: Opening of Johns Hopkins University school of medicine: led a new era marked by rigid entrance requirements for medical students; upgraded curriculum; incorporation of bed-side teaching and lab research. Early 1900’s: -ZZ homeopathic medical schools. -100 homeopathic hospitals. -Over 1000 homeopathic pharmacies. 1901: Karl Landsteiner introduces the system to classify blood into A, B, AB and O groups. 1903: The American Medical Association invited homeopaths to join the association. 1900’s: Development of Preferred Prouder Organizations (PPOS): Point of Service (POS) products. 1910: Charles Wardell Stile’s 1910 manual on the sanitary privy: its purpose and construction. 1912: Teddy Roosevelt ran for office pushing for oversees health care for all Americans. Bull Moose party. 1912: National convention of insurance commissioner develops first model for state law, the standard provision law, for regulating health insurance. 1913: International Ladies Garment Union begins 1st Union Medical Services. 1918: Flu pandemic killed at least 50 million people around the world. Before 1920’s: Health insurance wasn’t seen as essential. It was the loss of work hours from sickness that was the issue.
1920s-1940
1
About 1920s: Households purchased 1 “sickness“ insurance (similar to todays e disability insurance) to provide income 1 replacement in the event of illness. m 1921: t -Edward Mellauby discovers that lack of 1 Vitamin D in the diet causes rickets. d -Earle Dickson invented the Band-Aid c 1922: Insulin first used to treat diabetes. h 1929: Precursor to Blue Cross-a w group of Dallas tea overs contracted B baylor V. hospital to provide Z1 days of t hospitalization for a fixed $600 payment. m Early 1930s: Prepaid hospital service 1 plans grew over the course of the Great a Depression. a 1932: Blue Cross established. t 1934: American Medical Association a adopted a set of 10 principles. Promoted 1 for the primary purpose of preventing u hospital service plans from underwriting a physician services and providing answer to 1 proponents of required medical insurance. s 1935: Percy Lavon Julian synthesized the 1 medicines physostigmine for glaucoma r and cortisone for rheumatoid arthritis. i 1935: Social Security FER signs the social ( security act into law to establish “a system p of federal old-age benefits“-fwds to build 1 state local health departments. a 1 Revencee Act of 1930, establishes i employee tax exclusion for compensation p for injuries sickness, or both received c under workers’ compensation, accident, w or health insurance. p 1939: The Food Drug and Cosmetic Act 1 of 1930 in the USA allowed homeopathic e medicines to be sold openly on the 1 market. i
1940s-1960
1960s-1980
1964: The Economic Opportonity 1939: Blue Cross Commission Act-”war on poverty” established. 1965: Prior to this year, nearly 1940s: WWII advanced in medicine half of he elderly had no health made a dramatic difference for Allied insurance and many other had troops. inadequate coverage. 1943: Payments made by employer 1965: Healthcare for retired, directly to commercial insurance medicare and medicaid. Medicare companies for group medical and hospitalization premiums of employees part A: hospital care. Medicare part B: general doctor care. were not taxable as employee income By 1944: Most casualties wee receiving Medicard: set up to help poor treatment within hours of wounding new medical costs. 1966: On July 1, 1966, medicare, medical technologies. DDT was used. 1946: Truman signs the hospital survey authorized by title of the social security act, offered health and construction act. 6 ave states access to groupB to help maintain health insurance to almost all Americans age 65+ technology. Required facilities to give 1972: Nixon signs the Social access to all patients regardless. Security Amendment extending 1946: Physician sponsored plans ultimately affiliated and became known medicare cov to people under 65 with long term or terminal illness. as Blue Shield 1972: The S.S. Amendments of 1948: McCarran Ferguson act fives states broad power to regulate insurance 1972 granted benefits to people 1949: The national labour relations board under 65 the receive S.S. disability ruled in a dispute that the term “wages“ cash payment for at least 24 included pension and insurance benefits months. It also added people with end-stage renal disease who (union allowed to negotiate benefit receive maintenance dialysis or a pacieases) 1950: Total health insurance enrolment kidney transplant. 1973: HMO Act of 1973 about 142,334,000 1951: 41.5 million people were enrolled establishes benefit ad ministrative in group or individual hospital insurance and financial and contractual plans offered by commercial insurance regvivements for entities seeking designation as federally qualified companies. Only 40.9 million people were enrolled in blue cross blue shield HMO’s. 1974: Employee retirement income plans security act of 1974 establishes 1953: The Department of health, uniform standards that employee education and welfare is established benefit plans must follow to obtain 1958: 75%Americans had private and maintain their tax favoured insurance. status.
Innovation Map
1980s-2000
2000-Present
1983: Federal employees began 2000: Electronic signatures in global paying the medicare payroll tax and nation commerce act of 2000, gives electronic signatures and records the same 1984: Alex Jeffreys devises a weight as written signatures and records, genetic fingerprinting method 1986: All newly hired state and which should lead to easier administration of electronic benefit, compensation and human local employees began paying resources system. the medicare payroll tax 2002: Estimated that the number of patients 1986: The consolidated Omnibos Budget Reconciliation using homeopathic remedies had risen by 500% in the previous 7 years, mostly by Act allows health benefits to purchasing over-the-counter remedies continue for a short time for 2003: The Patient Protection And Affordable those who lost jobs under Care Act (PPACA) is signed into law. certain circumstances 2003: Medicare part D: provide prescription 1995: Blue Card introduced drug insurance coverage to those coho streamlining benefits for are enrolled in or entitled to medicare and members who are travelling administered by prime health. living in another plans service 2006: Mass. enacts Handatal health area. Insurance Law which requires all adults who 1996: Mental health purity act can obtain insurance to do so. Also, nales requires group plans that offer mental health benefits to provide program for low income. 2010: Obamacare the same level of coverage for such benefits. They provide for Present: Blue Cross Blue Shield companies cover nearly one in three Americans medical and surgical benefits. Present. The 10 most common diseases 1996: Americans spent 230 treated by homeopaths are (older of million dollars on homeopathic frequency): asthma, depression, otitis media, remedies. hay fever, headache and migraine, neurotic disorders, nonspecific allergy, dermatitis, arthritis and hypertension.
Innovation Map
Housing/ Assisted Living
-Nursing Homes -Assisted Living Communities -Non-Assisted 55+ Communities -Personal Check Ins
Alert Devices/Reminder Systems
-Medical Alert Devices -Personal Emergency Response System (PERS) -Medication Reminders -Wellness Checks/Telehome Monitoring
In-Home Caregiving
-Personal In-Home Caregiving -Visiting Nurse Association (VNA) -Fall Prevention-In-Home Safety -In-Home Assistance
Housing/ Assisted Living
-Personal Caregiver/Companion/Mobility Assistance -Grocery Shopping/Meal Prep -Medication Reminders -Respite Relief for Family Caregiver
Transportation Assistance
-Transportation to and From Appointments -Volunteer and State Run Systems -Mobility Assistance -Errands
Pre-Existing Systems
Non-adherence: Not taking the drugs that have been prescribed by physicians, or not taking them as per their recommended regimen.
Non-Compliance: In medicine, compliance (also adherence) describes the
degree to which a patient correctly follows medical advice. Most commonly, it refers to medication or drug compliance, but it can also apply to other situations such as medical device use, self-care, self-directed exercises, and therapy sessions.
Cohort: A group of people with a common statistical characteristic. Stakeholder: Includes all of the people and organizations that have a real or perceived “stake” in the project or its outcomes.
Primary Stakeholders: The people or groups that stand to be directly
affected, either positively or negatively, by an effort or the actions of an agency, institution, or organization.
Secondary Stakeholders: The people or groups who have a role in the decision-making process without being directly affected by the outcome.
MPR (medication possession ratio): Measures the percentage of time a
patient has access to medication. This can be measured along two dimensions: by a patient’s refill count and by a patient’s pill count.
PDC (Proportion of days covered): The proportion of days in the
measurement period “covered” by prescription claims for the same medication or another in its therapeutic category.
NHATS (The National Health and Aging Trends Study): Is a new resource
for the scientific study of functioning in later life. In design and content, NHATS is intended to foster research that will guide efforts to reduce disability, maximize health and independent functioning, and enhance quality of life at older ages. The NHATS will gather information on a nationally representative sample of Medicare beneficiaries’ ages 65 and older.
PRI (Patient Review Instrument): Is an assessment tool developed by the
New York State Department of Health to assess selected physical, medical, and cognitive characteristics of nursing home residents, as well as to document selected services they may receive.
Respite Care: The provision of short-term, temporary relief to those who are
caring for family members who might otherwise require permanent placement in a facility outside the home. Respite programs provide planned short-term and time-limited breaks for families and other unpaid caregivers of children with a developmental delay and adults with an intellectual disability in order to support and maintain the primary care giving relationship.
Long Distance Caregiving: Not living a commutable distance from someone you are trying to take care of.
Support Group: In a support group, members provide each other with various types of help, usually nonprofessional and nonmaterial. Members with similar issues can share coping strategies, providing a sense of empowerment and a sense of community.
Preventive Care/Preventive Medication: Consists of measures taken to prevent diseases, (or injuries) rather than curing them or treating their symptoms.
Adverse Drug Event (ADE): Refers to any injury caused by the drug (at
normal dosage and/or due to overdose) and any harm associated with the use of the drug (e.g. discontinuation of drug therapy).
Adverse Drug Reaction (ADR): An expression that describes harm
associated with the use of given medications at a normal dosage during normal use.
Medicare: In the United States, Medicare is a federal government social
insurance program that guarantees access to health insurance for certain Americans and legal residents aged 65 and older, younger people with disabilities, people with end stage renal disease and persons with Amyotrophic lateral sclerosis.
Medicaid: A United States health insurance program for persons of all ages whose income and resources are insufficient to pay for health care.
DNR (do not resuscitate): A “DNR� is a legal order written either in the
hospital or on a legal form to respect the wishes of a patient not to undergo CPR or advanced cardiac life support (ACLS) if their heart were to stop or they were to stop breathing.
Medical Ethics: A system of moral principles that apply values and judgments to the practice of medicine.
Social Worker: A professional and academic discipline that seeks to improve
the quality of life and well-being of individuals, groups, and communities through research, policy, crisis intervention, community organizing, direct practice, and teaching on behalf of those affected by social disadvantages such as poverty, mental and physical illness or disability, and social injustices or violations of their civil liberties and human rights.
Glossary
Medical Social Worker: A sub-discipline of social work. Medical social
workers assess the psychosocial functioning of patients and families and intervene as necessary. Medical social workers typically work on an interdisciplinary team with professionals of other disciplines (such as medicine, nursing, physical, occupational, speech and recreational therapy, etc.).
Snowball Cases: Patients that continue to return with the same symptoms. Side Effects: An undesired harmful effect resulting from a medication or other intervention such as surgery.
Pharmacy: The science and technique of preparing as well as dispensing
drugs and medicines. It is a health profession that links health sciences with chemical sciences and aims to ensure the safe and effective use of pharmaceutical drugs. Pharmacy is practiced in a wide range of settings: community pharmacies, hospitals, long term care facilities, the pharmaceutical industry, mail service, managed care, and government (Department of Defense, Department of Veterans Affairs, Indian Health Service, Public Health Service).
Caregiver: A paid or unpaid person that provides physical, emotional, spiritual, financial, or logistical support to another with a chronic, disabling or lifethreatening illness.
Glossary