Complex Technologies Lurk Within Simple Interfaces – A Lesson for Health Care

Posted on November 13, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Technologists are justly proud of the complex problems they solve. What’s hardest is hiding that complexity from the end-user. When a great magician performs, the audience is not aware of the excruciating practice he put into the Disappearing Coin trick (I have tried to learn it). In the same, complex analytics and personalization may have to hide behind a simple one-button device.

The demands placed by health consumers on health technology were laid out persuasively by David Inns, CEO of GreatCall, at the recent Connected Health Conference. His reasoning could be proposed as a kind of classic syllogism:

  • Major premise: technologies continually advance, whereas people are most comfortable with the technologies they learned when young;

  • Minor premise: health needs are concentrated among the elderly or middle-aged;

  • Conclusion: the people most in need of health technology will not be comfortable with the latest technology.

Translated into practical advice, this means that any personal health technology must adapt to multiple interfaces. If an individual has the latest iPhone, that’s great. If she prefers a simple flip phone, let her use that. And if she has nothing and is willing to tolerate only a device she wears around the neck with a button, let her have it.

Let’s shift gears for a moment (for those readers who remember manual transmissions). What does GreatCall offer its clients?

GreatCall is a typical–though technologically advanced–component of a a wellness program or patient-centered health medical home. It allows older adults or disabled people to keep in touch with caregivers, both family members and professional caregivers. The individual obtains from GreatCall a device with 5 Star Service that he or she keeps close at hand. GreatCall learns the individual’s habits: it knows what a visit to the doctor looks like, a Sunday in church, etc. The software that powers the GreatCall Link app notices when something worrisome happens, such as a person staying in bed very late, not getting out of the house regularly, or leaving the house at odd times. It starts by notifying the family caregiver.

If a change has been flagged as urgent and a family caregiver fails to respond, GreatCall can escalate the issue to a 5 Star operator who can assist with such situations on a 24/7 basis. Everyday behaviors, such as medication adherence, can also be monitored.

The GreatCall Link app can also give individuals and their caregivers summaries of the individual’s status. These summaries are not presented as numerical lists or even two-dimensional charts, which would be hard for non-techies to understand. Instead, GreatCall creates a written paragraph that summarizes whether the older adult has engaged in more activity or less, and similar information.

What technologies are necessary for GreatCall to carry out its mission? First, there must be ways for the individual to communicate easily with his or her device. Even a flip phone can be enhanced with secure apps to accept messages from users.

GPS is also a critical component, but GreatCall adds another layer of positioning–A-GPS or assisted GPS. First, it enhances satellite-based GPS with the precision provided by cell towers when someone is indoors and satellites can’t provide location information. Second, GreatCall tracks changes in location over time to account for errors. A GPS system may report that a patient is two blocks from her apartment at 2:00 in the morning when actually she is safe in bed. Data collection and analytics allows GreatCall to avoid a panic call–but all of this sophistication lies behind a simple interface.

In the cloud, GreatCall stores the necessary information to match a user’s location with her favorite haunts and to contact caregivers or family members when necessary. Data is carefully protected and not shared with anyone outside GreatCall.

I’ve been intrigued by the GreatCall service because it combines fancy analytical technology with an interface that adapts to the needs of the user, whether a tech-savvy active ager or a 90-year old with more serious cognitive or health issues. They represent an inspiring story of investigating their users, understanding them empathetically, and offering their advanced technologies in a service that is likely to win adoption. Every app developer should carry out research like this.