One Day Out 2017: "Contemporary Healthcare" by Dem Gerolemou

Thank you. Feel free to talk among yourselves. All good? Perfect. Good morning. It's a pleasure to be here. My name is Dan and I'm here to talk about contemporary healthcare from a product space. Contrary to Owen, I have the longest Twitter handle that you'll ever see because I've got a ridiculous name that isn't a real name. Before we get stuck in, a brief introduction. So, as I mentioned, I'm Dan. I'm a designer at Us2, a product designer. I've been there for about three years and I'm currently working on a healthcare product called Streams, which is in partnership with DeepMind. Who are Us2? So we're a digital product studio. We build businesses and services for clients and for ourselves. We're made up of around 300 people globally and that's spread across London, Malmo, New York and Sydney. And we're made up of people from all over the world, which is something we're quite proud of. You may recognize us from Monument Valley. That's the big thing that we made that goes around the world. We've got loads of traction. But we build products all the time. That's our bread and butter. Us2 is a principle-driven company. So we're on a mission to launch products and services and companies that have some kind of measurable, meaningful impact in the world, which is quite a bold statement to make. And that manifests in many different ways. But the one that I'm going to talk about today is through healthcare. Traditional agencies will have client services as their core offering. And we like to do things a bit differently where we try and divide our work over three different areas. Where we have traditional client services. We have own IP work, which is things like Monument Valley, stuff that we grow from start to launch ourselves. And then we have a happy medium, which is ventures, where we'll partner with industry experts to go in as a joint stakeholder as opposed to going in as a resource. One of those mood notes I'll talk about a bit later. So why am I here? It's not an experiment. And it's definitely not because my colleague was unable to attend today. It is because I want to talk about healthcare. So a few years ago we had, we have kind of like touch points in the studio to find out how people are doing. If they're happy with the work, what kind of thing they want to get out of their time at Us2. And recently we learned that about 50% of the studio really wants to work in healthcare. They want to work on products that touch in the healthcare space. So that over the past few years has seen us commit to being a studio that has a certain amount of healthcare work at any one time. And so that's an introduction to Us2. And what I want to talk about is how technology is healing healthcare. I'm going to break this down into three main parts. I'm going to start by very briefly touching upon a few commercial applications that are out there now, which illustrate how the technology we have accessible is extremely powerful. And then I'm going to talk about why there's a hurdle in that going to market in larger scales. Why healthcare providers don't offer all the services that we're able to use. Why is that and what are the obstacles we need to get past. And then lastly I'm going to talk about how we try and tackle that at Us2. How some of the projects we've done try and overcome those hurdles. So to start with, a quick temperature check. Everyone has a smartphone on them. Some people have smartwatches. We have all these incredible devices and they're getting more and more powerful. So just to very briefly, I won't go into too much detail, run through a few things that we're using at the moment to track our data and look after our health. You have services like MyFitnessPal which enables you to track things like your diet and set activity goals and work towards them. Which is quite amazing when you think of it because previously that would have been something a nutritionist and a personal trainer would have had to do. But now you can do it from something in your pocket. There's a fantastic app called Steps which the incredible Rekha will talk about later. I'm not going to go into too much detail of what it does because you'll see later. But it's essentially a tool that you can use to better yourself, to meet yourself. Help you overcome things that you want to and improve on yourself. Which is amazing for something in your pocket. You have things like Babylon Health which basically puts you in touch with clinicians. So you know what kind of care you need to get quicker. Which reduces the wait time that it takes to see a doctor. And then we have all these wearables and trackers where you can track anything from activity, calories burned, standing hours, sleep quality and heart rate without having to do anything. So it's all passive. So just by being here I'm having all this data recorded about me and I don't do anything with it but I could and that's quite amazing. You start to see things like this. You start to see articles like this where this kind of data is meaning that lives are saved. Because this passive data means that if you do need to see, if you do need to check up on it you have a nice resource that you can tap into and then share that with a professional. So I think this story is about someone who felt a bit funny and looked at his healthcare data for that day and saw that his heart rate had been completely erratic. Went to get professional help and found out that there was an imminent heart attack waiting for him and they were able to treat him quickly. So it's not too hard to believe that these applications are working. But the reality is that a lot of the applications of healthcare, healthcare in tech, have saved lives already. And then you have more specialized solutions. So there's Immersive Rehab for example which is an incredible platform using VR to help spinal trauma and stroke victims with their recovery. And essentially what it does is it puts you in a physical 3D environment in the VR headset which makes rehabilitation more engaging. And that's seen rehab rates improve which is incredible. The Microsoft HoloLens which is another headset, it's an AR1 alternative, alternate reality. That's another one, augmented reality where it places things in reality so you can see and interact with things that aren't really there. And that's been incredible in training surgeons and doctors, saving money, improving quality of care and saving time. And lastly there's a company called Acurex who are trying to tackle antimicrobial resistance which is essentially because antibiotics are prescribed so much, it's quite likely that in several years time, we will become immune to them. And what Acurex are doing is helping doctors prescribe more efficiently which is an incredible simple thing. But using contemporary technology they're able to do something like this which down the line will save us from one of the biggest threats to mankind which is AMR. So it's clear that technology is really empowering us in the healthcare space. There are so many amazing stories that have come out of all these products that we're able to use. Which is great but then what's the problem? Why have I got to talk about the obstacles and the hurdles that we have to get through? And why don't we see these things in practice? A little heads up, I'm from London, from the UK, so I'm going to talk about it from the perspective of the NHS and how things work there. But it's true of many healthcare bodies around the world. And for us, the NHS is great. It's fantastic that we have access to healthcare in the UK. It's something that we need. It's a fundamental human need. And we're able to generally be seen about something within a week or two and have the right care plan put together for us. Which again is quite a profound thing when you think about how many people there are on the planet. And not everyone's healthcare needs. But it definitely could be better. It's really struggling at the moment. There is just growing, growing needs. And healthcare needs are getting more and more intense. As populations age and as technology improves, people will be living longer which means more people to serve. Populations naturally grow. And we're at a stage now where some people think there's a humanitarian crisis in the NHS. And whatever you want to label it, it's clear that there's something wrong. There's double pressure on the service. Which will mean that by 2020 there's going to be 30 billion pounds of deficit. More than 23 hospitals will place on black alert in January. And that alone is quite a scary thing. So it's clear that something needs to be done. There's a nice meaty quote for you now. So there's a report from Nuffield Tech Health Report. Which is essentially saying that we have this amazing technology. Exemplified by the stuff that I shared earlier. Why is it that healthcare is so far behind everyone else? Why is it that it seems like around 10 years. I mean if you look at most other industries. Banking for example. You're seeing incredible applications on a massive scale. Where in healthcare there are startups trying to crack into the bubble. And really struggling because of the high barrier to entry. So it needs to be addressed essentially. And it's a great time for it as well. The global market for connected healthcare is expected to grow. It's expected to reach 37 billion by the year 2020. Which just goes to show how much space there is for us to... To make the right solutions now. An interesting argument is that digital transformation in healthcare. May happen to the NHS not within it. And again you can draw parallels to other healthcare providers. But because there are so many obstacles within the NHS. Perhaps it's going to be startups slowly cracking their way from the outside. And getting in to solve these problems. As opposed to the NHS doing it themselves. So we're already seeing it happen with companies like Accu-X and Babylon. Starting to eat the NHS's lunch in an attempt to support them. And something else we might be familiar with is this quote. Everyone that works in product is going to be familiar with the idea of... Of failing fast and learning quickly. Of moving fast and breaking things. And that's incredibly valuable as a mindset when building most products. But when it comes to healthcare you simply can't do that. When the quality of care or someone's life is at stake. You simply can't take risks like that. And that's quite a scary thing for product designers and people like us to face. Knowing that our process and the thing that we've grown our expertise around. Just doesn't really apply in the same way in this industry. So through direct work with people like DeepMind and Fresenius. And some healthcare startups we've worked with. We've learnt what it's really like to be a clinician working in a healthcare provider environment. And it's helped us to refine what we believe the solution to this giant obstacle is. And we think that's collaboration. So we're going to go on now to... To talk a bit about the process that we think is... The natural development from what we do in products in other industries. How we can apply our process and contemporary design thinking to healthcare. In an attempt to design and build solutions that are both safe and well designed and useful. So how can we adapt what we currently have? Clinicians are at the heart of what we do. Collaboration to us is the only way that we can make sure that we are doing everything we can for the patient. So there's a lot of digital health providers at the moment have a misunderstanding of the relationship between clinicians and patients. Which is born from an impatience to get to market and a fundamental lack of understanding of that relationship. And we believe the only way to address that is by collaborating. Collaborating with both the clinicians and the providers, the bodies and designers as well. To basically understand each other's fields better. And it's not a one way thing. It's not just that we need to understand the clinicians. Like day to day work. It's that they need to understand what we're trying to do as designers and developers. And support each other in doing that. So we still have a build, measure, learn approach. It's just in a slightly different context. Where there's a relationship that we need to keep at the forefront of our minds. So another thing we believe is that private needs to go public. What do I mean by that? I don't mean that the NHS needs to be privatized. That's not the way forward. It's essentially we need to see some of the design thinking and the solutions that all these startups are using. Applied in healthcare to large bodies like the NHS. We need to see that the disruptive technology and all those buzz wordy things that are doing so well in startup culture. And apply that to big entities. And it's not an easy thing to do. We can explore what's revolutionizing these other service providers and try and learn from their journeys. And understand how we can use that to support bodies like the NHS in trying to do the same on a larger scale. So we think that that looks like building bridges. It's building bridges between institutions, businesses, clinicians, designers, everyone involved. To ensure that there's no strict divide of responsibility. It's a very much shared understanding. So it means that we're working directly with everyone involved. To fulfill the richest understanding we can of the problem area. At the end of the day. The end user is always going to be the patient. So we need to make sure that we understand everything along the way. And that's everything from the marketing of a product all the way down to the design of it. So collaboration is far more than being joint stakeholders. It's a mindset shift. We're not working for each other. We're working with each other. There's a partnership of trust and compromise. In that we understand the constraints of both. You know within tech there are technical constraints for what we can build and what we can't. There are constraints for clinicians within. And the healthcare industry. It's a big thing that we have to address. So how does this look in practice? There are some big obstacles that I've highlighted. And I mentioned at the beginning that we wanted to work on more healthcare products. So that sounds like a recipe for disaster. And that we have to change our process entirely in order to cater to this new thing. But we tried it anyway because why not. And in the past few years we've had the opportunity to work on quite a broad range of different products. Within healthcare. And I'm going to go into a little bit of detail about one and slightly more about two others after. As I mentioned I'm working on a product called Streams. Which is a partnership with DeepMind. DeepMind Health. I'm just going to pull out a few very high level points about this. I won't go into too much depth about the actual product. Essentially what Streams is, is an alerting platform for clinicians. It streams the right information to the right person at the right time. And it can track the patient's recent data and stop it from being fatal data. So currently or before product like Streams came along. A clinician would have all these tests done about a patient. Delivered to them on a paper chart. Or on a big giant old school white case PC. Which lives in the corner of the hospital that no one really has access to. So if you imagine that there's a patient and their test results come back. And they could be critical. Then the difference between having to go to that machine or go and look at a chart. And having it alerting you on a device that you have on you. Provided by the healthcare provider. Then you can completely escalate things much, much more quickly. And much more efficiently. Which is an amazing thing to be able to do. So it's more about context. We're contextualizing what already exists. Which is patient tests. This is a great example of design in healthcare. Because it's clinician led and patient centered. We're partnering very closely. We have a few clinical leads who are helping to guide us. In understanding what this looks like in practice. So what it's actually like to be in a hospital providing care for a patient. And what the difference between having something done early or done late really looks like. So it's an interesting dynamic. And what's more is that because we're built in close partnership with NHS clinicians. Not only are they able to help steer us within understanding healthcare. They're also able to support us. And hold us to the highest standards of security and oversight. Which is something that's incredibly important within healthcare. Because obviously it's a very sensitive area. And being held accountable by people working in that space is absolutely paramount. Something I found really interesting when I joined the project. Was we have a team room for streams. And it's lovely. There's a load of post-its and whiteboards. Exactly what all of you designers love. And I walked in there and it was a complete mess. Just stuff scribbled everywhere. Good kind of mess. Organized mess. And it was productive. And on one of the whiteboard walls at the very top of the room. In giant writing in Sharpie. It said, first we do no harm. And I found that really profound. Because I figured that DeepMind are a company where they have to move at a pace. Where there are so many things they have to balance and juggle. But to walk into the team room and see that this is the top priority. Made me feel really good. It made me feel, I really started to understand how we were trying to solve the problem. And it's essentially meant that as a designer you kind of understand your place a bit better on the team. And you have to take a step back and put ego aside. Because design is functional. And it can do amazing things. But at the same time you have to make sure that you're always going back to the end user. To the patient. And that's by doing no harm. So whenever there's something we're discussing and we're not sure which direction to go with a feature or something like that. We'll always go back to this. Whether it's a clinician arguing for something or it will be a designer trying to put something forward. We'll question which does the least harm. Is there any risk of this doing any bad? Or is it only going to be supplementary? And so that's been a guiding light for me on that project. And something I really respect the team for. So that's a bit about DeepMind Health. I'm now going to talk about Keepsake. Which is something that us two built in collaboration with Nightingale Care Home and City University London. Which is a product to help. Caregivers of those who suffer dementia take notes more easily and take better notes. Which again goes back to the end patient because it means better quality of care. If notes are good then the end user will have a better care plan put together for them. So we started this by asking the question. How can we improve documentation for carers? It's a huge part of what they do. And no one actually really likes doing documentation. So how can we try and lift the burden a bit but also improve the quality? We had eight weeks. And a two week trial to validate what we thought we could do. And I'm going to show you a quick video. Briefly explaining kind of setting the scene of what the project was set out to do and how we approached it. Haven't tested sounds so fingers crossed. There are around 800,000 people. Diagnosed as living with dementia in the UK. A third of whom are living in residential care homes. Staff do their best in a work environment that is typically chronically short staffed. Underpaid and under trained. As a result the phrase incredibly clean terminally bored. Can often describe the bleak reality of growing old in a care home. Which most of us avoid contemplating. A huge part of working in care services is about documenting what is going on on a daily basis. Yet. Yet ate well and had a good day. Are as descriptive as we can expect. Considering the clumsy folders and quantity of work demanded of this job. Because most of the time we have so many paperwork. Writing and documenting and filing all those things. What was their experience during the day? How they spent this day? If there was anything significant. That time can be allocated to looking after the residents. Providing the one to one care that we need for the residents. In response to this. City University London and us too. Have prototyped a digital care note system. That mixes qualitative and quantitative data capture. Along with communication with family and friends. Our system uses natural language processing algorithms. Developed over the last few years at City University. To draw inference from the notes carers are making. Carers benefited from being instinctive and natural. And describing how residents are experiencing their day. Taking pressure off professional language skills. And allowing staff to describe people as people. With all the quirks of personality and behaviour that comes with. So here's an example of how our prototype currently works. Carers can first view a list of all the residents they are looking after. They can review specific information about each resident. Both from that day's shift. But also as a summary of activity over the last few days or weeks. For instance by selecting an activity. They can see all the notes taken for that resident. And add new notes. Forms are specifically designed to capture data entry. In a simple concise way. Furthermore the system can analyse carers notes. To then prompt the carer to reflect on the possible reasons behind. For example distress or low engagement. This provides a safety net to catch any potential issues for the future. In the next few years a system like this could replace paper. With software that works on any smart device. As domiciliary care becomes more prevalent. Tools like this will become essential. So now you have some background on Keepsake. I'd like to talk a little bit about how we got from A to B. From the start to the finish of that. And the way that we always start our projects. Or when we build products. Is by really understanding our users. And in this case that was understanding how things worked. Within Nightingale Care Home. So we spent time in the home. Building relationships and understanding what work looks like. And what care looks like for both the people there and the carers. And we were able to start building empathy. With both parties. And empathy for us is a really important design tool. Because it helps you to understand what it's really like in context. In situ when you're using a product. It's easy enough to build something. Having interviewed all your users. And really understanding their needs. But until you actually empathise with them. And what task they're trying to complete with your product. It's really hard to actually make something that feels human. And feels like a good fit. So by building those relationships. And starting to build empathy. We wanted to set ourselves up well to do the right thing by them. So there are a lot of really incredible stories at the home. And it's really moving to see caregivers have such a personal relationship. And understanding with the people they're caring for. And that's a big part of what makes Nightingale special. They really believe that it's important to build a relationship. And truly understand a person's past. And what makes them who they are. What their interests were. Understand how they were with their family. So they can start to build up an understanding firstly. Of things like why they may behave in a certain way. But also put together a personal care plan for them. And that's incredibly important. So for example there was someone who used to be an art critic. And the fact that they knew that. Meant that they were able to start putting together a care plan. Where they were sensitive to that. And started to learn things that worked with this patient. Which were things like painting with her. Then there's understanding the carers needs. Documentation is a huge part of what they do. They need to do documentation. Because firstly it helps them do their work. And put together a suitable care plan. But it's also for assessment purposes. They're held at a really high standard. And they need to do things to a certain degree of accuracy. And that's a big ask of them. They need time as well. Because there are so many things for them to do. Their attention is constantly being pulled at. By things like the actual patient they're caring for. By the documentation they have to do. And just by the day to day parts of their job. And then there's the family. So understanding the family as I mentioned. Can help you to understand the patient better. It can help you to start to put together an understanding. Of why they may be behaving a certain way. But it also is the responsibility of the caregiver. To support the family. Because it can be an incredibly hard thing to deal with. And what we learnt here is that the quality of data is really key. So as I mentioned. There are compliance standards that have to be met with care notes. When they're taken. With all the documentation they have to do. And that's one reason why quality of data is important. But the real reason is the end user. It always goes back to that. If the quality of data is as good as it can be. Then the quality of care that the patient is going to receive. Is going to be best. So this is a really interesting case. Where we know that data is going to be a really important part of this. So we can start to build solutions around that. In a human way. So we had an assumption. Which was that digitizing data collection. Can drastically improve quality of care. And that's what we used the eight weeks to try and validate. We wanted to understand if this was true. Or if this was an assumption. Which comes from a lack of understanding the problem. So the way we tackled this. Was by sketching low fidelity screens. And continuously testing with them. And iterating on them. With the users in the home. So we spent a lot of time based in the care home. Which was. It was a real luxury for building a product for these users. And being able to be there with them. Considering we had such a short amount of time. Meant that we were able to get a lot out of those eight weeks. And really learn quickly. And use the feedback to refine the product. Before we started the two week trial. So we really. We had to do whatever it took. And there's like an interesting spread of the team here. Where Alex spent his time in the care home. With the users during the trial. And then we had Axel who was in Malmo. Who was making changes to the software. And then we had Arnau who was based in London. Who was pushing things live to the device. And it was a really, really incredible collaborative effort. Because we partnered with the university. Who did the research. Putting training. Building the software. Natural word processing. We were able to build that into the product. With a team that was remote. And then test it on site with the care home. And then we started to gather feedback. So. As I mentioned a few slides back. We started with an assumption. And we wanted to validate that assumption. We learnt that. It's not that successful at that in all cases. This one user was saying that it's probably not quicker. But there are benefits from it. And they weren't necessarily in line with our assumption. But it does go back to the whole quality of care thing. So for example. Precision became a lot better. And notes became more accessible for people. Which is a great benefit. It's not what we initially assumed. But that's still a good thing to learn. Some people did find that it was really good. Some people saying that it was quicker. And they could write on a platform that they were comfortable with. Which again. It assumes a level of technical literacy. Which not everyone will have. But for those that don't know. It's a great tool. And there were other people as well. Who were saying similar things. Where because their time is so precious. And pulled in so many different directions. You have to store a lot of information in your head. And adding it to a phone. A product that we built on a smartphone. While it didn't solve the problem that we assumed it would. Or hoped it would. We learnt again. That they were able to add more information. More detail to it. So that's another example of how we think collaboration is the solution to some of these problems. And hurdles that we face. So that was Keepsake. And then the last product I want to talk about is Mood Notes. So Mood Notes is a cognitive behavioural therapy app. This is a joint venture built by us two. In partnership with Thriveport. Who are two LA based psychologists. And the aim here was to help users improve their mental well being. So once again our assumption. We started with the question. Is it possible? Can we help people to look after their mental well being through a product? And there were a few reasons why we wanted to focus on this. One is because we had an interest in healthcare. But secondly because it is a really serious, serious problem. It's a hugely important area. By the year 2030. Depression is predicted to be the top cause of global disability. Which is profound to think about. In the UK. One in four of us will experience a mental health crisis. Mental health problems each year. And while that's based in the UK. If you think about how many people are in this room. Then a quarter of those people will be suffering. And struggling with things. 400 million people alone suffered with depression in 2016. And on top of that there are business reasons as well. So stress, anxiety and depression. Are estimated to cost. The UK employs 26 billion pounds annually. And the US employs 80 to 100 billion pounds annually. So from all areas. It makes complete sense to try and address this. Thank you. So back to the process. And the people we partnered with. This was a collaborative effort. As I mentioned. The psychologists live and work in LA. And us do London. The London studio based in London. Spoilers. And it's incredibly hard to make this work. Because they are such busy people. So it was Edric and Drew. Their full time jobs. One of them is a forensic scientist. And the other is a lecturer in cognitive behavioural therapy. They make an incredible crowd. But they essentially do this in their free time. Thriveport for them. Their company that partnered with us two. Is kind of like an evening project. Which is incredible to think. So aside from the 8 hours of time difference. There was. And the. Restrictions on working days. There were a lot of hurdles in the way in working together. So again I've got a short video to show you. To give you some understanding of how that worked. The world health organization. Projects. Just as an example. Of the scope of the problem. That by 2030. Depression is going to be. The number one cause of global disability. So the need for services. Is tremendous. And unfortunately. So in late October of 2014. We received an email from us two. Expressing interest in. Potentially collaborating with us. On a new app. We'd received. A number of similar emails over the years. But there's something different about. Us two's approach with their message. Very early on. We recognized that there was a mutual goal. That we wanted to help individuals. Take control of their health and well being. And we thought that. In a very short time frame. We could actually create something. That would make a measurable impact. And difference to people's lives. What's really wonderful about an app like this. Is it's essentially a journal. And it's a practice. That can really help somebody. Reflect on. Not only their daily experiences. But to understand themselves better. So the biggest challenge. Of any health app. Is to hide the vegetables in the meal. So to speak. We developed some very complex principles. Into understandable and actionable. Suggestions or antidotes. That users would find engaging. And intuitive. And that's where us two. Was able to bring in their expertise. And really help us bring that content to life. We start the experience. With a simple question. Something that you hear every day. Which is how are you. And through a kind of conversational interface. We start to get the user into the habit. Of journaling. In a way. And we try to get something out quickly. Test it. Learn from it. And then reiterate. Each time we test it with users. That's when we get the validation of what's working. And what's not working. But really the co-designing with health experts. Has really helped. And through that iterative process. With us providing feedback predominantly on content. And then certainly bringing their design expertise. To the table. It ultimately resulted in an app. And we're believers that when we feel better. We do better. And to offer a tool. That's accessible to people. Even when professional services are not. Is engaging and is intuitive. And it gives them a deeper appreciation. For what else they might be able to do. To improve their well-being. Or the well-being of their loved ones. It's an incredibly gratifying endeavor for us. So at the beginning of this process. As I mentioned. There were some obstacles with the time difference. But we still thought that we could make it work. And do collaboration well essentially. And one of the ways that we wanted to try doing that. At the beginning. Was by getting a shared understanding of the problem space. And how we're going to tackle it. And what we did was. We put together a fake. This is fake. I know it's not real. We put together a fake article. A headline of what the press might say. When we release this product. And we asked the question. Is it possible that doctors can prescribe mobile apps. Instead of pills. It's an ambitious thing. But essentially we wanted to try and empower people. To get better using cognitive behavioral therapy. As opposed to medicine in that case. So the timeline for the project. We started in October 2014. We had some time. We figured out how things would work. And then we got started quite quickly. We spent two weeks of concept work. And then we did eight weeks of iterative builds. Going straight into a four week trial. With beta testing. Before launching to the app store. And the team was small. Which was kind of a benefit in moving at such pace. So we were made up of the two clinical psychologists. Based in LA. And then the four person product team in London. At us two. And this process was essentially informed by this. We put out surveys. We gathered 160 survey results from people. To help us. To help frame the understanding of the problem. We conducted 15 user interviews. And we had a six person. 600 person beta trial. At the end of the iterative build stage. And this continuous feedback. Helped us to really understand. Really understand. What it's really like to be dealing with something like this. And help us to refine the product. Based on. Based on that essentially. There are some obstacles. Working in healthcare. With healthcare professionals. So the solution that we believe. Is working with these people that are hands on. In the trench so to speak. But there are also obstacles that that brings. So while a clinician might offer you insight. Into what it's really like to operate with a customer. To work with a customer. That's awful. There are challenges in things like. Brand attributes. When you're building a product. You have to brand it. Unless there's an existing brand already in place. And for a clinician or for some psychologist. That isn't necessarily something they would have done before. So we had to help them through this process. And make sure that it was very much a collaborative effort. And not just something that we protected and did ourselves. But we did it together as a team. So we put together some attributes. We wanted it to be supportive without being hand holding. We wanted it to seem intelligent without being academic in tone. And we wanted it to be engaging. And then. The really meaty stuff. The faces. So this might seem like a relatively trivial thing. But this is. This is a core interaction of mood notes. If any of you haven't used it. It's essentially when you're logging your feeling. How you're doing. The initial thing that you do is select how. You look at a face and you adjust it accordingly. And we spent a lot of time on this. There are a lot of things you can derive from faces. And we wanted to get this right. So. There was a lot of back and forth about this. From color for example. Does red mean anger or does it mean love? Are the faces too light hearted? Are they too serious? Are they too personal? Too impersonal? Is it meant to be my face? Is it everyone's face? What does it mean? So it took us a long time. And a lot of refinement and testing. To settle on the final mood notes palette. But it essentially resulted in a tool. That allows you to progress over time. So you can look back and see how you've done. And what's more is that it is credible content. Provided by clinical professionals. And that's something that's a really important part of this. If we did this on our own. We could have made a great product. That looked beautiful and had great utility. But partnering with clinical professionals. Made sure that we were doing right by the end user. We do no harm. It's all about doing things right for them. And that's resulted in some incredible feedback that we've got. Which is incredibly validating. So there was a review on the app store in December. Where this user was talking about how. Looking back over past entries. Serves as a beacon of light. Because it helps to remind them that. I might be struggling now. But I've got through this before. And I can see that. And I can see how many times I've done that. And how it's worked. And that is a very empowering thing. So briefly what's next for mood notes. We're looking to offer deeper insight. To offer health kit integration. So you can start to contextualize your data outside of it. And localization. And just to continue building on feedback. We're continually learning from how it's doing. On the app store. And taking the feedback into account for future builds. So finally. A few quick slides on what we've learned about collaboration. And where it's come from. So we said we want to make a measurable difference in the world. Measurable outcomes take time. They take a lot of time. And that's to be expected I guess. But especially in healthcare. And especially in mental health as well. We're still understanding the product. And the problem space better each day. With the feedback that we're gathering. And that's just the way it is. In order to gather quality. Quality feedback. You need to make sure that you are continually monitoring it. It also requires a significant investment. So us too is a for profit company. We're not a non profit. And that means that we don't have access to a lot of grants. So we lose out there. But because we're committed to healthcare. We're willing to invest. We put our own profit at stake here. To do this stuff. Because it is important to us. Anyone who sees a problem can arguably research it. Prototype it. And try and test the solution. But actually taking it to market is a difficult thing. And focusing on efficacy. And outcomes from the very beginning. So as I keep banging on about. You're probably bored of it by now. Patients are at the heart of what we do. When looking at design in healthcare. Everything you do must go back to doing good for the patient. Last point. This is amazing. This stuff is incredible and empowering. But is it fair? Are we being exclusive by creating solutions on platforms like smartphones and things? Because not everyone is technically literate. Not everyone can afford these devices. And not everyone wants to use them as well. So by offering digital healthcare solutions. Are we denying healthcare from people who really need it? And is that something that will change over time? Or is that something we just need to address as quickly as possible?