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Berlin, April 8, 2021 – A clinical trial at Charité – Universitätsmedizin Berlin has used design methods to redesign clinical workflows. The research project, funded by the Berlin Institute of Health (BIH), investigated whether and how telemedicine can improve health care for children with type 1 diabetes. The study was conducted in cooperation with the strategic design agency Designit Germany, who used human centred design methods throughout the trial. The results have now been published in the Journal of Medical Internet Research, the world’s leading journal for digital health and medical informatics. They demonstrate the added value of design to study success and of digital tools for treating children with diabetes.
The research team, led by Katarina Braune, MD, studied what technical and organizational changes could benefit the care of children with diabetes over a 6-month period. This study is the first to report on remote care and treatment success during the COVID-19 pandemic in children with type 1 diabetes. It describes how service design methods were used to engage stakeholders and improve clinical care workflows. In addition, the study evaluated the feasibility of implementing an interoperable open source platform in a university hospital, and the success factors and barriers to transitioning from conventional to digital care were analyzed.
All 28 participants successfully completed the study and wish to continue receiving telemedicine care in the future. After 3 months of remote consultations, the participants experienced significant improvements in the management of their glucose levels. Specifically, they were within the optimal range for more time and experienced fewer hypoglycemic and hyperglycemic episodes. These improvements were maintained throughout the first COVID-19–related lockdown. Their parents and caregivers reported that diabetes management was more challenging during the pandemic and that they felt supported by the telemedicine care they received. The reduced time commitment for the patients and their families, and the combination of regular check-ins with on-demand appointments, were also viewed positively. Following completion of the study, the children’s psychosocial health was also improved.
“We are very proud to have been part of this pioneering research project,” says Lilian Schulze, Research & Service Designer at Designit. “The positive effects of our user-centered approach on patients and medical staff prove the value of design in the clinical setting. We also confirmed the importance of involving other organizational stakeholders, such as IT, data protection, ethics committee, and communication, during the design process.” Designit supported the research team throughout the clinical trial. The added value through design came especially from actively listening to and managing the multiple stakeholders. Using interactive workshops and other research formats, the designers explored the perspectives of patients and their families, as well as those of all the professional groups involved, and incorporated their respective needs into the new processes. In this way, the design agency was instrumental in making the study more inclusive and transparent for all involved.
Design Explores Complexity and Broadens Horizons
The Digital Diabetes Clinic study started before the COVID-19 pandemic and continued into the lockdown. The pandemic context further demonstrated the power of telemedicine, as design thinking had resulted in a simplified approach when compared with the existing hospital process. “Despite sophisticated diabetes technology, the continuous self-management of diabetes is a real challenge for our young patients and their families. This is further exacerbated by the pandemic,” explains Dr Katarina Braune, the BIH Junior Clinician Scientist who led the project. “Designit supported us from the beginning to the end of the project, demonstrating how design methods can help us navigate the complexities of health care and optimize operations. Taking into account the social dimension, for example communication and cooperation, new processes and interfaces were created that provide a positive experience for all stakeholders—the most important criteria for acceptance of new clinical processes.”
The study concludes that remote consultations and transparent data access for both therapists and patients can improve clinical outcomes and quality of life for children with type 1 diabetes, even under challenging conditions. “But for digital to be truly meaningful, the context must also be considered,” adds Barbara Posern, Strategic Design Lead at Designit. “This is where design methods drive innovation so that it is relevant to users, creates differentiation in the marketplace, and fits with the philosophy and competencies of an organization. And most importantly, design can help create essential value for people—the most important thing in medicine.”
The strategic innovation consultancy and design agency is grounded in the Scandinavian design culture that puts people at the center of its design. Designit developed the networked value model “Value Experience” and accompanies companies from strategic consulting to the implementation of products, services, and experiences. With 18 offices worldwide, international teams collaborate to design products and services for the future. In Germany, Designit works from Munich and Berlin for clients such as BMW, Roche, Novartis, Lufthansa, and Bosch. The company uses its expertise as a key to social change and drives forward future-relevant topics such as telemedicine. Designit was founded in 1991 in Aarhus, Denmark, and has been an independent brand of Wipro Limited since 2015.
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Braune K, Boss K, Schmidt-Herzel J, Gajewska KA, Thieffry A, Schulze L, Posern B, Raile K. Shaping Workflows in Digital and Remote Diabetes Care During the COVID-19 Pandemic via Service Design: Prospective, Longitudinal, Open-label Feasibility Trial JMIR mHealth uHealth 2021;9(4):e24374.