Know Context

Whats 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

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-1930s: 1948: Great Depression Begins World Health Association Progressive Era in 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.

1900s-1920

1920s-1940

1940s-1960

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

1981: New Plague Identified as AIDS 1981: PC Introduced by IBM 1987: DNA first used to convict criminals 1990s: Internet Becomes Popular 1996: Welfare Reform 1997: Scientists Clone Sheep 1998: Viagra on Market; Clinton Impeached

2000-Present

2000: Mapping Human Genome 2007: iPhone Released

Eras Map

1900s-1920

About 1920s: 1889: Households purchased sickness Opening of Johns Hopkins Hospital; insurance (similar to todays disability opening of nursing training program. insurance) to provide income replacement 1893: in the event of illness. Opening of Johns Hopkins University school of medicine: led a new era marked 1921: -Edward Mellauby discovers that lack of by rigid entrance requirements for medical students; upgraded curriculum; Vitamin D in the diet causes rickets. -Earle Dickson invented the Band-Aid incorporation of bed-side teaching and 1922: lab research. Insulin first used to treat diabetes. Early 1900s: 1929: -ZZ homeopathic medical schools. Precursor to Blue Cross-a group of Dallas -100 homeopathic hospitals. tea overs contracted baylor V. hospital to -Over 1000 homeopathic pharmacies. provide Z1 days of hospitalization for a 1901: fixed $600 payment. Karl Landsteiner introduces the system Early 1930s: to classify blood into A, B, AB and O Prepaid hospital service plans grew over groups. the course of the Great Depression. 1903: The American Medical Association invited 1932: Blue Cross established. homeopaths to join the association. 1934: 1900s: American Medical Association adopted Development of Preferred Prouder a set of 10 principles. Promoted for the Organizations (PPOS): Point of Service primary purpose of preventing hospital (POS) products. service plans from underwriting physician 1910: services and providing answer to Charles Wardell Stiles 1910 manual proponents of required medical insurance. on the sanitary privy: its purpose and 1935: construction. Percy Lavon Julian synthesized the 1912: Teddy Roosevelt ran for office pushing for medicines physostigmine for glaucoma and cortisone for rheumatoid arthritis. oversees health care for all Americans. 1935: Bull Moose party. Social Security FER signs the social 1912: security act into law to establish a system National convention of insurance of federal old-age benefits-fwds to build commissioner develops first model for state law, the standard provision law, for state local health departments. regulating health insurance. Revencee Act of 1930, establishes 1913: employee tax exclusion for compensation International Ladies Garment Union for injuries sickness, or both received begins 1st Union Medical Services. under workers compensation, accident, 1918: or health insurance. Flue pandemic killed at least 50 million 1939: people around the world. The Food Drug and Cosmetic Act of Before 1920s: 1930 in the USA allowed homeopathic Health insurance wasnt seen as medicines to be sold openly on the essential. It was the loss of work hours market. from sickness that was the issue.

1920s-1940

1964: 1939: The Economic Opportonity Act-war on Blue Cross Commission established. poverty 1940s: 1965: WWII advanced in medicine made a Prior to this year, nearly half of he elderly dramatic difference for Allied troops. had no health insurance and many other 1943: had inadequate coverage. Payments made by employer directly 1965: to commercial insurance companies Healthcare for retired, medicare and for group medical and hospitalization premiums of employees were not taxable medicaid. Medicare part A: hospital care. Medicare part B: general doctor care. as employee income Medicard: set up to help poor medical By 1944: Most casualties wee receiving treatment costs. within hours of wounding new medical 1966: On July 1, 1966, medicare, authorized technologies. DDT was used. by title of the social security act, offered 1946: health insurance to almost all Americans Truman signs the hospital survey and age 65+ construction act. 6 ave states access 1972: to groupB to help maintain health Nixon signs the Social Security technology. Required facilities to give Amendment extending medicare cov access to all patients regardless. to people under 65 with long term or 1946: terminal illness. Physician sponsored plans ultimately 1972: affiliated and became known as Blue The S.S. Amendments of 1972 granted Shield benefits to people under 65 the receive 1948: S.S. disability cash payment for at least McCarran Ferguson act fives states 24 months. It also added people with broad power to regulate insurance end-stage renal disease who receive 1949: maintenance dialysis or a kidney The national labour relations board ruled in a dispute that the term wages transplant. included pension and insurance benefits 1973: HMO Act of 1973 establishes benefit ad (union allowed to negotiate benefit ministrative and financial and contractual pacieases) regvivements for entities seeking 1950: Total health insurance enrolment about designation as federally qualified HMOs. 1974: 142,334,000 Employee retirement income security act 1951: of 1974 establishes uniform standards 41.5 million people were enrolled in that employee benefit plans must follow group or individual hospital insurance plans offered by commercial insurance to obtain and maintain their tax favoured companies. Only 40.9 million people werestatus. enrolled in blue cross blue shield plans 1953: The Department of health, education and welfare is established 1958: 75%Americans had private insurance.

1940s-1960

1960s-1980

Innovation Map

1983: Federal employees began paying the medicare payroll tax 1984: Alex Jeffreys devises a genetic fingerprinting method 1986: All newly hired state and local employees began paying the medicare payroll tax 1986: The consolidated Omnibos Budget Reconciliation Act allows health benefits to continue for a short time for those who lost jobs under certain circumstances 1995: Blue Card introduced streamlining benefits for members who are travelling living in another plans service area. 1996: Mental health purity act requires group plans that offer mental health benefits to provide the same level of coverage for such benefits. They provide for medical and surgical benefits. 1996: Americans spent 230 million dollars on homeopathic remedies.

1980s-2000

2000: Electronic signatures in global and nation commerce act of 2000, gives electronic signatures and records the same weight as written signatures and records, which should lead to easier administration of electronic benefit, compensation and human resources system. 2002: Estimated that the number of patients using homeopathic remedies had risen by 500% in the previous 7 years, mostly by purchasing over-the-counter remedies 2003: The Patient Protection And Affordable Care Act (PPACA) is signed into law. 2003: Medicare part D: provide prescription drug insurance coverage to those coho are enrolled in or entitled to medicare and administered by prime health. 2006: Mass. enacts Handatal health Insurance Law which requires all adults who can obtain insurance to do so. Also, nales program for low income. 2010: Obamacare Present: Blue Cross Blue Shield companies cover nearly one in three Americans Present. The 10 most common diseases treated by homeopaths are (older of frequency): asthma, depression, otitis media, hay fever, headache and migraine, neurotic disorders, nonspecific allergy, dermatitis, arthritis and hypertension.

2000-Present

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

Innovation Map

Pre-Existing Systems

Non-adherence: Not taking the drugs that have been prescribed by

physicians, or not taking them as per their recommended regimen.

Long Distance Caregiving: Not living a commutable distance from someone

you are trying to take care of.

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.

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.

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.

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 Adverse Drug Reaction (ADR): An expression that describes harm

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.

normal dosage and/or due to overdose) and any harm associated with the use of the drug (e.g. discontinuation of drug therapy). associated with the use of given medications at a normal dosage during normal use.

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 PDC (Proportion of days covered): The proportion of days in the

Medicare: In the United States, Medicare is a federal government social

patient has access to medication. This can be measured along two dimensions: by a patients refill count and by a patients pill count. measurement period covered by prescription claims for the same medication or another in its therapeutic category.

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.

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.

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.

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.

Social Worker: A professional and academic discipline that seeks to improve

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.

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