Putting Care in Context: Empowering Patients to Share Their Barriers to Good Health

Submission Deadline

Submissions are Closed


Jennifer David


  • First Place $5,000
  • Second Place $3,000
  • Honorable Mention $2,000

All Prizes Subject to Terms and Conditions

First Place


Healthify logo

Team Members

Eric Conner, Manik Bhat, JImmy Corines, Alex Villa and Dan Levenson

Healthify is a web-based screening tool used to assess patients’ social and behavioral health risks, identify and quantify immediate needs, and refer patients to government and community programs to meet those needs. The platform's dashboard lets providers and care teams make more informed decisions about their patients' needs to better coordinate care and offers a texting solution to facilitate follow-up with patients. Healthify allows healthcare providers to screen, connect, and communicate with all patients and not just a fraction as before. Download abstract.

Second Place


Share4Care logo

Team Members

Omar Shaker, Elizabeth Bojanini, Antoni Andruszkiewicz, Nagai Katsuyuki and Ashish Rohilla

Share4Care is a design prototype of an iPad app that would allow patients to document stress levels and issues in their life while in a clinical waiting room. The Share4Care app would then calculate a "Life Change Score" and assign a color (green, yellow, or red) that would be immediately available to the patient's physician, prompting them to ask about factors that could impact the patient's health. Download abstract.

Honorable Mention

MyDay Media Messaging Journal

MyDay Media Messaging Journal logo

Team Members

Laura Blumenthal

MyDay Media Messaging Journal is a web-based platform that patients use to document their barriers to health through photos and text messages. The MyDay website and mobile app allow providers to view patients' journal entries and follow-up to build patient-provider rapport, clarify journal entry content, and connect patients with resources. Download abstract.

Featured Finalist

Crowdhealth by Holistic

Team Members

Ryan Hansz

CrowdHealth uses the patient provider relationship as a stepping stone to connect people to the resources all around them in the community. The system is made up of a communication campaign, a web application connected to the Electronic Medical Record of the provider, and a patient facing application. Download abstract.

Featured Finalist

Snapshot of Healthy Living by Med Peds Bruins

Team Members

Jennifer Phung, Neha Agnihotri, Brian Lonquich and Matthew Stutz

This intervention uses photography to engage patients and physicians in discussions about barriers to health. Each patient enrolled in the program receives a disposable camera with instructions to take pictures of things that help them stay healthy and things that prevent them from being healthy. Patients attend a support group to share and discuss their photos and the issues they represent. Download abstract.

Featured Finalist

Context by Design Cures

Team Members

Raven Cunningham

Context uses the common waiting room magazine to help individuals discover and record barriers to their health through stories and interactive, reflective activities. Download abstract.


The California HealthCare Foundation is a nonprofit grantmaking philanthropy that acts as a catalyst to fulfill the promise of better health care for all Californians. CHCF has partnered with HxRefactored and Dr. Rishi Manchanda, author of “The Upstream Doctors: Medical Innovators Track Sickness to its Source” and founder of HealthBegins to present this design challenge.

Despite spending over two and a half times more per person on health than peer nations, the US suffers a major “health disadvantage” according to a recent report by the Institute of Medicine. [1] One reason for American’s poor health outcomes is the minimal attention paid to the “contextual” issues that contribute to the onset and progression of disease; issues like hunger, unstable housing, stress, and isolation.

There is growing consensus that the health care system must understand the hurdles in a patient’s life that impact their health in order to provide effective care, but there is not yet a good way to engage patients to proactively share this information. [2]

The Way It’s Done Now:
Today, health care providers do not routinely seek information about a patient’s social, environmental, and behavioral hurdles to health. When it does happen, the care provider initiates the conversation by asking a uniform set of questions which are typically only focused on one facet of a patient’s life. The process is often rushed, not coordinated with screening for other barriers or risks, and the information may not make its way to other members of the patient’s primary care team or specialists. Meanwhile, overcoming these hurdles can be a higher priority for patients than getting a medical procedure or medications.

A Better Way:
This design challenge aims to fix these problems by empowering patients to take an active role in recognizing, chronicling, and sharing information about hurdles in their life that impact their health.
To make this happen we need two things:

  1. better tools to support patients in chronicling and sharing their personal struggles with health care providers
  2. broader patient awareness that these factors are important to their health and should be shared

*Please note, we use the term “health care providers” to include: doctors, nurses, medical assistants, and other health care professionals, as well as clinic-based social workers, care managers, and health educators.


A large number of social, economic, environmental, and behavioral factors are known to impact health. For the purposes of this challenge, we would like to draw attention to just the following:

  • Food Insecurity - a lack of stable access to sufficient, safe, nutritious food to maintain a healthy and active lifestyle [3]. Food insecurity sits in the middle of a continuum, between food security and hunger. [4]
  • Housing Insecurity - “variably defined as having difficulty paying rent, spending more than 50% of household income on housing, having frequent moves, living in overcrowded conditions, or doubling up with friends and relatives” [4]. People experiencing housing insecurity are often at risk for homelessness.
  • Stress - the body’s response to change and other demands, particularly when an individual recognizes that dealing with a demand requires more resources than he or she has available [1].
  • Social Connection & Isolation - the degree to which people interact with other individuals, groups, or organizations and, the overall strength or weakness of social support they derive from these relationships. (Please note that isolation is different from loneliness [5]). The impact of social relationships on health often equal or exceed the impacts of major biomedical factors [1].

There are a growing number of questionnaires, some of which have been clinically validated, to screen for these factors. But while these tools meet the needs of researchers and physicians, they are often viewed by patients and caregivers as clunky, stilted, and lacking context. Furthermore, the questionnaires only measure whether barriers are present – they don’t help patients make connections between these factors’ impact on health, and often don’t help providers understand (and begin to address) the multitude of underlying causes. Additionally, asking these questions is generally triggered by a problem – presenting new symptoms, a worsening condition, frequent ER visits – that might have been prevented if the barriers were identified earlier.

How can patients, especially those with complex health problems, be engaged to proactively recognize, chronicle, and share information about hurdles in their life that impact their health with their providers?

Your challenge is to design a solution that:

  • Prompts patients to think about one or more of the factors listed above, and understand how it impacts their health.
  • Explains the reasons for discussing these barriers with providers, in a way that highlights how providers can help.
  • Helps patients feel comfortable sharing relevant social and financial problems with health care providers, and accomplish that sharing on their own terms.
  • Collects data to serve as a foundation for patients and providers to have the best possible conversations, either between visits or in the limited time they have together – whether it’s a first-time visit, an annual checkup with a physician, an outreach call, or home visit from a care manager or social worker.
  • Provides the opportunity to record, reflect, and possibly send a cry for help around the time a patient notices or experiences problems (e.g. an eviction notice, a loss of a loved one, or a job loss that results in not being able to afford enough food).
  • Creates a compelling, intuitive experience for the patient.

To get started, review the Resources section below for recommended assessment tools, a sample patient scenario, and additional background information. Solutions may use the recommended assessment tools or other evidence-based tools. All submissions must cite any pre-existing tools or question sets that have been leveraged in the design. We also encourage you to explore out-of-the-box ways of representing hurdles to health.

Eligibility Criteria

  • Must be a US resident, business, or non-profit entity to enter.
  • You may enter as an individual or small team (~5 people). Please only one submission per entrant.
  • Participants retain their rights in the designs they develop, giving the California HealthCare Foundation rights to publish, implement, use, and expand on submissions.
  • Employees of the California HealthCare Foundation, Mad*Pow, and Health 2.0 are not eligible to participate.


  • Challenge Launch: May 14, 2014
  • Submission Deadline: June 27, 2014 @ 11:59PM PDT
  • Judging Begins: June 30, 2014
  • Winners Announced: August 11, 2014

Review Panel

Evaluation Criteria

A panel of judges will evaluate each submission based on originality, how well it addresses the problem, consideration of patient needs, and overall quality. Participants are encouraged to incorporate user research into their design process and mention this in their submissions.

Core Criteria:

  • The solution clearly promotes awareness, understanding, and engagement related to a patient’s barriers to good health.
  • The solution collects useful data to aid providers in understanding the issues their patients face.
  • The solution targets low literacy users.
  • The solution can realistically be adopted by patients and staff at community health centers and clinics. For example, an idea solution would be low-cost and not too time consuming.
  • Extra Credit: The design is extensible and could be modified easily to include additional questions, or address different factors.

Submission Requirements

Proposed solutions may take a variety of forms – including but not limited to mobile apps, websites, and paper or other non-digital solutions. A number of provider-driven, single-domain questionnaire tools already exist; we are looking for creative approaches that could address a variety of domains using any medium to get people thinking about and communicating their social determinants of health. Submit whatever you need to convey your idea, within the following guidelines:

  • REQUIRED: Design brief of 500 words or less summarizing your solution and process, with a focus on the core evaluation criteria outlined above. Include citation of any pre-existing tools or question sets leveraged.
  • REQUIRED: PowerPoint slideshow or video (max. 15 min) that visually communicates your solution.
  • EXTRA CREDIT: A working prototype, or any other supplemental documentation that helps communicate your ideas or design process.

Maximum total size for all files uploaded is 25MB. If you are creating a video, we recommend uploading to YouTube, Vimeo, or similar. If you opt to set the video as private, please provide the password.

Please pre-register in order to access the submission form.

After judging, entries will be shared publicly to inspire continued work and conversation related to this important topic.

Terms & Conditions

California HealthCare Foundation Design Challenge
2014 HxRefactored Conference


1. Administrators: The Administrators of the Challenge are Health 2.0, LLC, 350 Townsend Street, #403, San Francisco, CA 94107 and Mad*Pow Media Solutions LLC, 27 Congress Street, Portsmouth, NH 03801 ("Administrators")

2. Challenge: The California HealthCare Foundation Design Challenge entitled Putting Care in Context: Empowering Patients to Share Their Barriers to Good Health (the “Challenge”) will occur from May 10 – June 27, 2014 as part of the 2014 HxRefactored Conference in accordance with the guidelines below. The California HealthCare Foundation, 1438 Webster Street #400, Oakland, CA 94612, (the “Sponsor”) is the Sponsor of this Challenge.

3. Eligibility: The Challenge is open only to (a) business and nonprofit entities formed and maintaining a principal place of business in the United States and (b) individuals and teams of no more than five individuals, who are (i) citizens or permanent residents of the United States and (ii) of the legal age of majority, at the time of entry, to form valid contracts in their respective jurisdiction of legal residence (each individual, each team, each individual member of a team, and each entity is referred to as an “Entrant” in these Rules). Affiliated Persons (as defined below) are ineligible to participate in the Challenge.

Special note to Entrants who are entering as part of a team: If an Entrant enters as part of a team, the Entrant understands and agrees that submission of an Entry constitutes a representation and warranty by Entrant that all of the members of the team have read and accepted the Rules. Furthermore, an Entrant that is part of a team understands and agrees that if his/her team is selected to receive an Award (as defined below), the team is responsible for ensuring the funds are appropriately distributed to each member of the team and each member of the team must agree upon the method of payment. In addition, once a team has registered, the team may not add, remove, or substitute members or otherwise change the composition of the team for the duration of the Challenge. Finally, the eligibility of the Entrant is tied to the team's eligibility; if one member of the team does not comply with these Rules or is disqualified, the team as a whole will be disqualified.

Special note to Entrants who are entering as an entity: If an Entrant is entering as part of an entity, the Entrant warrants that the appropriate officers, executives, managers, or other persons who have the authority to approve Entrant’s Entry into this Challenge have approved the Entrant’s Entry and the Entrant understands that these terms will be binding on both the Entrant and his/her entity. Furthermore, the Entrant understands that if the Entrant enters without obtaining the appropriate approval, the Sponsor may, in its sole discretion, disqualify the Entrant’s Entry. Finally, if an entity is selected to receive an Award, an officer or person entitled to bind the entity will be required to validate that the Entrant is entitled to receive the Award on the behalf of the entity and the officer or person entitled to bind the entity must provide the appropriate information for payment of the Award.

Entrants who are determined at any time to have violated the eligibility criteria will be disqualified from the Challenge.

As used herein, the term “Affiliated Persons” means (a) the trustees, directors, officers, shareholders, members, employees, clients (with respect to the Administrators only), contractors, agents, representatives and affiliates of the Sponsor, the Administrators and any entity associated with the funding, administration, or processing of the Challenge and (b) the members of the Immediate Family (as defined below) of any of the persons identified in the foregoing clause (a). The term “Immediate Family” includes a person’s spouse/domestic partner and the parents, siblings, children and grandchildren of the person and his or her spouse/domestic partner.

4. How to Enter: The entry period for the Challenge will begin at 12:01 a.m. Pacific Daylight Time on May 14, 2014 and end at 11:59 p.m. Pacific Daylight Time on June 27, 2014 (the “Entry Period”). Teams can enter the Challenge by visiting the Health 2.0 Developer Challenge website at http://legacy.health2con.com/devchallenge/chcf-design-challenge/, reviewing these Official Rules, and registering a submission by submitting the Official Entry Form according to the instructions posted on the Challenge Website. Each Submission entered into the Challenge must meet the "Submission Requirements" described by the challenge Sponsor (any Submission that, in Sponsor's sole discretion, violates the following criteria will be disqualified). Once a submission is made, a team is prohibited from making any changes or alterations to the product described in its submission until the evaluation of the entries is completed.

5. Awards: The following awards are available to be awarded in this Challenge (each, an “Award”):

  • $5,000 – First Place
  • $3,000 – Second Place
  • $2,000 – Honorable Mention

Three (3) winning teams (the “Winning Teams”) will be determined by the judges, in the judges’ sole discretion. The Awards will be divided equally by the number of people on the Winning Team and distributed to each individual (a “Winner”) on the team. Neither the Administrators nor the Sponsor shall be responsible for mediating disputes that arise relating to prize distribution. EACH WINNER IS RESPONSIBLE FOR ALL TAXES AND FEES ASSOCIATED WITH RECEIPT AND/OR USE OF THE AWARD. All Award details are at Sponsor’s sole discretion. The Award is non-transferable. The Award will be fulfilled 4-6 weeks after the Winners are notified and each potential winner has been verified and complied with these Official Rules. Actual odds of winning depend on the number of eligible Teams.

6. Challenge Description: Each Team will be presented with the Challenge Description, which will be made available at the start of the Challenge or prior to the start of the Challenge, in Sponsor’s sole discretion. The Challenge Description will contain a more complete description of the project as well as the materials that will be available for participants, but will generally require participants to consider how to empower patients to take an active role in recognizing, chronicling, and sharing information about hurdles in their life that impact their health. During the Challenge, each Team must create and submit a product that responds to the Challenge Description in a way consistent with the Challenge Description (the “Design”). Such Design shall require the production of at least: (1) a brief visual presentation of the Team’s response to the Challenge Description; (2) a written description of the Team’s response to the Challenge Description; and (3) sketches, wireframes, visual compositions, working prototypes, or other user-interface designs that respond to the Challenge Description. Sponsor may, at its sole discretion, require the production of more elements to compose the Design, as described in the Challenge Description. At the end of the Challenge, six (6) qualified judges, determined by Sponsor in its sole discretion, will review the Designs of each Team, and will choose three (3) Winning Teams.

7. Copyright: Entrant warrants that the Entrant is the sole author and owner of the submission, and that the submission: a) completely originates with the Challenge; b) does not contain the intellectual property of another party; c) does not infringe upon any copyright or any other rights of any third party; e) does not contain material that is inappropriate, indecent, obscene, hateful, tortuous, defamatory, or offensive (as determined by Sponsor); and f) does not contain material that is unlawful, in violation of or contrary to any laws or regulations.

8. Intellectual Property Rights: Each participant of each Team, by submitting any Design, irrevocably grants to Sponsor a royalty-free, irrevocable, perpetual, non-exclusive, transferable license to use, reproduce, modify, edit, adapt, publish, create derivative works from, and display such Design in whole or in part, on a worldwide basis, and to incorporate it into other works, in any form, media or technology now known or later developed, including for promotional or marketing purposes, and without further compensation to you or any other person or entity. If requested, each participant of each Team will sign any documentation that may be required for Sponsor or its designees to exercise its rights under these Official Rules. For clarity, each Team’s Design and all rights, including intellectual property rights, title, and interest therein and thereto lie exclusively with each Team or its respective participants. This Agreement is not an agreement of sale, and no title, interest, or intellectual property rights or other ownership of the Design are transferred pursuant to these Rules, except as explicitly stated herein. Neither the Administrators nor the Sponsor shall be responsible for mediating disputes that arise relating to intellectual property ownership.

9. Judging: A panel of judges chosen by the Sponsor (collectively, the “Judges”) will select winning Entries from all eligible Entries based on the following judging criteria:

  • The solution clearly promotes awareness, understanding, and engagement related to a patient’s barriers to good health.
  • The solution collects useful data to aid providers in understanding the issues their patients face.
  • The solution targets low literacy users.
  • The solution can realistically be adopted by patients and staff at community health centers and clinics. For example, an ideal solution would be low-cost and not too time consuming.
  • Extra Credit: The design is extensible and could be modified easily to include additional questions, or address different factors.

By submitting a Design or participating in the Challenge, each Team acknowledges and agrees that such evaluations may differ from person to person and agrees to be bound by and not challenge the final decisions of Sponsor and the individual judges. The decisions of the judges are final and binding. In the event of a tie, the Team whose Design received the higher score for originality, as determined by the qualified judges, in their sole discretion, will be deemed the Winner. If a potential winner is disqualified for any reason, the Award may be awarded to a runner-up, if any, in Sponsor’s sole discretion.

10. Release: Acceptance of the Award shall constitute and signify the Winner’s agreement and consent that Sponsor and its designees may use the Winner’s name, city, state, biographical information, likeness, Design (including any related video presentations), and/or Award information in connection with the Challenge for promotional, advertising or other purposes, worldwide, in any and all media now known or hereafter devised, including the Internet, without limitation and without further payment, notification, permission or other consideration, except where prohibited by law. Potential winners may be required to complete an Affidavit of Eligibility/Release of Liability and related tax forms, including a 1099 form, and, if legally permissible, a publicity release within ten (10) days of attempted notification. Each Team hereby releases and holds harmless, the Sponsor and its subsidiaries, affiliates, suppliers, distributors, advertising/promotion agencies, and Award suppliers, and its officers, directors, employees and agents (collectively, the “Released Parties”) from and against any claims, damages, liabilities, cost and expenses (including reasonable counsel fees and legal expenses), losses and judgments arising out of or incurred in connection with (a) any breach of these Official Rules; (b) the Design, or use thereof; (c) the acceptance, possession, use or misuse of the Award; or (d) participation in this Challenge or any Challenge related activity. By participating in this Challenge, each Team agrees that the Design conforms to these Official Rules. For clarity, although Sponsor may explore future use of the Design, or future partnerships with any winner, Sponsor shall not be obligated to promote, endorse or otherwise use any Design. Sponsor is not responsible for lost, late, stolen, damaged, incomplete, invalid, un-intelligible, garbled, delayed or misdirected Designs, or any other obstacle complicating submission of any Design during the Challenge. Any Design not submitted by the end of the Challenge shall be void.

11. Liability: Entrant agrees that the Sponsor and Administrators (a) shall not be responsible or liable for any losses, damages, or injuries of any kind (including death) resulting from participation in the Challenge or any Challenge-related activity, or from Entrant’s acceptance, receipt, possession, use, or misuse of any Award, and (b) has not made any warranty, representation, or guarantee, express or implied, in fact or in law, with respect to any Award, including, without limitation, regarding such Award's merchantability or fitness for a particular purpose. The Sponsor assumes no responsibility for any damage to an Entrant’s computer system which is occasioned by accessing the Challenge website or other Challenge-related websites or participating in the Challenge, or for any computer system, phone line, hardware, software, or program malfunctions, or other errors, failures, delayed computer transmissions, or network connections that are human or technical in nature.

12. General Conditions: Sponsor reserves the right to cancel, suspend and/or modify the Challenge, or any part of it, if any fraud, technical failures or any other factor impairs the integrity or proper functioning of the Challenge, as determined by Sponsor at its sole discretion. If the Challenge is terminated, the judges may, in their sole discretion, determine the winners from all non-suspect, eligible Designs received up to the time of such action using the judging procedure outlined above. Sponsor, in its sole discretion, reserves the right to disqualify any Team it finds may be tampering with the process or the operation of the Challenge or to be acting in violation of the Official Rules of this or any other promotion or in an unsportsmanlike or disruptive manner and void all associated Designs. Any attempt by any person to deliberately undermine the legitimate operation of the Challenge may be a violation of criminal and civil law, and, should such attempt be made, Sponsor reserves the right to seek damages and other remedies (including attorneys’ fees) from any such person to the fullest extent permitted by law. Sponsor’s failure to enforce any term of these Official Rules shall not constitute a waiver of that provision. When used herein, the words “includes” and “including” and their syntactical variations shall be deemed followed by the words “without limitation.”

13. Governing Law/Jurisdiction: All issues and questions concerning construction, validity, interpretation and enforceability of these Official Rules, or the rights and obligations of the Entrant, Sponsor, and/or Administrators in connection with the Challenge, shall be governed by, and construed in accordance with, the laws of the State of California without giving effect to any choice of law or conflict of laws, rules, or provisions. Any legal claims arising from or relating to the Challenge or these official rules must be brought in the federal or state courts located in Alameda County, California, and each Entrant hereby consents and waives any objection to jurisdiction of such courts for such disputes.

14. WINNERS LIST/OFFICIAL RULES: To obtain any legally-required winners list (after the conclusion of the Challenge) or a copy of these Official Rules, send a self-addressed envelope with the proper postage affixed to: Health 2.0, LLC, Attn: Health 2.0 Developer Challenges, 350 Townsend Street, San Francisco, CA 94107. Please specify "winners list" or "Official Rules" and the name of the specific Challenge in your request.