This is the third of a series of blog pieces I am doing to sum up my experience as a judge for the Ensuring Safe Transitions from Hospital to Home Challenge. Developers were asked to come up with a mobile app that would empower patients and reduce preventable hospital readmissions. Each of my blog pieces will look at one or two design issues that were not explicitly covered in the evaluation materials, but which struck me as important.
It was a mobile challenge, folks.
One of the judging criteria was "Demonstrate creative and innovative uses of mobile technologies", but many of the apps made no use of mobile technology at all. I guess those developers felt that if they had an existing system that ran well on a desktop computer or terminal it was worth a shot to just submit the entry and hope no one noticed that it would miss the mark on this dimension. In fact, in looking at all 29 applications side by side I noticed that many of the apps fell into two contrasting design categories:
- "Big system trying to scale down". There are several mature discharge planning systems out there that were built to run in hospital settings. These systems are well-integrated with other hospital data systems and assume that the user is a nurse or other care provider who is sitting at a desk in a medical facility. Unfortunately for those developers, that was not the type of user the challenge was trying to target. But can't you just run your fancy hospital app on a tablet? Wouldn't that meet the criteria? Sorry, but no.
- "Little app trying to scale up". These teams obviously designed first on a mobile device, and sometimes showed good grasp of mobile design principles. But some seemed unaware that the mobile device could communicate with a mothership somewhere. These teams never showed me where the data they were collecting was going or who would make use of it once it arrived. They failed to see that at some point in the food chain a more complex dashboard experience could add value. That dashboard probably should be designed for a larger form factor.
If you could just slap a desktop application on a smartphone or tablet and have it work well, we would all be clamoring for Windows 7 tablets. This means that if legacy vendors want to win in this new mobile world they need to develop specialized user-focused versions of their apps that are optimized for mobile delivery. Most legacy apps do not play well on mobile devices. The reduced form factor and need for touch control mean that apps must be optimized for specific types of mobile devices. Mobile interfaces must be device-appropriate and simplified, reducing the amount of information shown at any point in time. It must be possible to access features with just one or two taps.
In some ways, the legacy vendors are at a disadvantage. They may be too set in their old design paradigms to see what is going on in the new mobile world. Companies that built strong web apps were seduced by the ample real estate of a desktop monitor. They crammed more and more features onto their displays. But deploying a web app to a mobile device is not just a matter of trimming off some pieces of the web version. That method of simply cutting a complex app down to size misses the point that on a small form factor device you must focus on what mobile users really want and how they interact with their device. To my eye, the best mobile solutions have an elegant minimalism. A Zen garden may have just a few rocks arranged in a mindful way, but the visual effect can be compelling.
How people work on their device is also affected by size. Desktop users can easily multitask between complex interfaces. Smartphone users are often more transaction-oriented. The tablet users are often seeing a more immersive entertainment experience. Does your app run on the Kindle Fire, by the way?
Mobile users have come to expect apps to be location-aware, but the apps seemed location-unaware. None demonstrated use of GPS to show me a list of support services near my current position. If quitting smoking is part of my treatment plan for COPD, why can't I use my GPS to find the nearest smoking cessation resources? If I need to lose weight as part of my diabetes control plan, can the app help me find a nearby gym, or connect me with a hiking club so I can increase my social interaction at the same time I exercise? Developers, do you use Foursquare? Can you see some ways that paradigm could be integrated to support care transitions? Your goal is to help your users not be the Mayor of the local emergency room.
Last but not least, a few vendors showed specialized hardware devices that were intended for use as home-monitoring devices. This is an interesting category of equipment, but doesn't fall into the mobile category we were asked to evaluate. But they did jog my thinking a bit. If you are a hardware vendor who is still trying to sell a set-top device to put on mom's kitchen counter, consider redesigning your offering to run on a tablet. Just do it. Get over the idea that someone is going to buy a dedicated device that looks like a toaster. On the other hand, why did no one show me how their mobile app could directly pick up weight data from a scale or blood pressure cuff? Is this coming?
Coming Next: Part 4: Telephony: Yesterday's Technology Today!
Also see: Part 1: The ONC Care Transitions Tech Challenge: Thoughts from a Judge
Also see: Part 2: My rant on patient education
