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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 ( 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.

Just What the Doctor Ordered: Mobile Access to Your Kaiser EHR

Posted on January 26, 2012 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

Recent news that Kaiser Permanente has made its patients’ electronic health records available via mobile devices comes as no surprise. Kaiser often seems to be at the forefront of interoperability and coordinated care, in large part due to its integrated nature and sheer volume of patients. As the company’s press release mentions, it maintains the “largest electronic medical records system in the world.” Now, 9 million of its patients can view their EHRs via a mobile site or Android app, with an iPhone app expected to launch in the near future.

On a macro level, I think this is a great step towards further empowering patients to take control of their health. By giving 9 million folks instant access to their own health information, I’d like to think that this will in turn prompt their friends and relations to ask, “Why doesn’t my doctor do that? What benefits am I missing out on?” And perhaps these same folks will then have a conversation with their provider about adopting this type of mobile access.

I’d be interested to see six months to a year from now, statistics comparing use of the mobile app/site to use of the tools found on the traditional website. Will Kaiser see a tremendous increase in the amount of emails between doctors and patients via its mobile apps? Are its doctors prepared for the potential onslaught of correspondence? I wonder if a few have balked at the possibility of being overrun by emails from particularly communicative patients.

Will they be able to tie these usage statistics to a jump in quality outcomes? Will mobile access ultimately become a criteria measured within accountable care models or patient-centered medical homes? Will mobile health truly equal better health?

On a micro level, I would certainly appreciate the effectiveness of access like this, which includes the ability to view lab results, diagnostic information, order prescription refills and the aforementioned email access to doctors. I can’t tell you how many times I’ve been on the phone with a pediatric advice nurse and drawn a blank when asked what my child’s current weight might be. It would be nice to be able to quickly pull that data up on my cell phone, especially while we’re on the go or out of town. I could eventually see patient charting apps being layered on top of this, so that in the event of a high, overnight fever, I could log temperatures via the mobile app and review them with our pediatrician – possibly alerted every time a new temp or symptom is entered – the next morning.

The possibilities seem endless. I think the big goal for Kaiser now is to get folks engaged and using these new access points.