Better user engagement enabled by the Internet of Things.

The following is the narrative from a speech made by Gus Desbarats, Chairman, Alloy at a recent Technology Strategy Board conference.

The intersection of ICT and the health care sector isn’t a very happy place these days. Talk of ‘huge national failure’ tends to dominate the media, and for many innovative technology companies the sector is impossibly complex and resistant to change.

The obvious need for progress in this area is an opportunity for the Creative Industries which is why CI KTN sponsored the event and my participation as Keynote speaker. 

The reality is that there is plenty of innovation in health care, it just tends to be focused on what clinical professionals, quite rightly, consider to be ‘job1’: keeping people alive longer. A good example is keyhole surgery which has transformed the vast majority of surgical procedures in over the last few decades. 

ICT in Healthcare has tended to sit in the ‘job2’ camp: administrative information, where paper based processes still bear a remarkable resemblance to those in use 50 years ago. There are many reasons for this, the ‘life saving’ clinical effectiveness of health infomatics is much harder to prove and past solutions, frankly, haven’t inspired the clinical leaders who drive the health care agenda.

ICT also represents change, and change isn’t always automatically a great thing, especially when it is driven by over simplistic ‘visions’. Communism and Council tower blocks are two of my favourite examples of what happens when the rich complexity of human nature is somewhat oversimplified in the interest of ‘leaders doing good’. To these ‘top down’ examples, we can now add ‘Lorenzo’ the national NHS system which, according to the head of the British Medical Association was developed ‘without consulting the doctors who were supposed to use it, to an accelerated development timescale set by that renowned IT specialist, Tony Blair. The technology industry has a bit of a track record here. This isn’t the first time new software has failed to deliver promised productivity gains when exposed to the weird, often overlooked, ‘failure mode’ of human behaviour. If there is no obviously apparent benefit ‘on the job’, is it any great surprise that the Health care sector often chooses to reject change? 

But the context in which healthcare operates is changing, to a degree that means ‘do nothing’ is no longer an option:

Ironically, thanks to advances in health care, more us are being kept alive longer by expensive healthcare while at the same time, we are producing fewer young to pay the taxes needed to fund this extra care burden. This chilling demographic effect is called the ‘dependency ratio’. Not too long ago there were 24 working age adults available to fund every old person, in the not too distant future there will only be two. 

The growing percentage that is old, is also from the 60’s ‘me’ generation that expects a much higher level of service, in all things, compared to the ‘make do’ wartime generations.

And of course, medical science isn’t standing still. New drugs and treatments are being rolled out constantly, and ‘Job 1’is still the priority. 

So in the best of times, health care spending would have to go up. But of course this isn’t the best of times, as a nation we are already in debt up to our eyeballs from the massive increase in government spending over the past decade.

Luckily, the drivers for change in HealthCare trends aren’t all bad. The over numerous and picky baby boom generation is also thankfully discovering that simply being kept alive by medical science isn’t much of an end of life to aspire to. What matters is the quality of that life. In short, more people are seeing the benefit of keeping fit and active and eating well. The availability of information, (things like heart rate monitoring on a run combined with GPS ‘no lies’ tracking of how long the run was) is key to motivating and guiding this quest for wellness. The Who famously announced they wanted to die before they get old, in fact, the boomers wish to die before they feel old may, just may, help to reduce the cost of end of life care. 

Genetics is also bringing infomatics into core ‘job 1’ medicine. Personal medicine is the future, driven by massive number crunching of personal Genomes. Likewise faster collection and analysis of vast databases containing information from millions of people will create powerful new insight, just as mapping the location of cases helped to identify the link between sewers and Cholera in London in the 19th century, but on vast scale.   

Where else can ICT help? It is, after all, a family of technologies with huge transformational power: conquering huge distances at lightspeed, connecting billions of information artefacts and conducting an unfathomable number of complex calculations every instant. It is enabling the creation of a parallel virtual universe where useful new stuff can happen.

But ICT has an equal ability to frustrate and disappoint the people who have to use it. The benefits aren’t guaranteed, the new virtual universe can be a cold, unfriendly place but it can only help us all if we are all willing to interact there. 

 This is why user experience is such a hot topic in ITC. Progress these days is less about knowing how to do things and more about knowing what to do to go with the flow of human nature, to grow willing engagement and eliminate new frustrations.

This is why Apple was briefly the world’s most valuable company. They know how to innovate from an experience led perspective. It is in fact at the main core belief that will prove to be the enduring legacy of Apple’s founder Steve Jobs. 

Another great example of new ICT working well is Amazon, and more specifically the Kindle. The hottest product for sale on the website is the physical dispenser used to buy yet more stuff from the website. Commercial life doesn’t get any sweeter than that. 

Everyone involved with Lorenzo and other recent healthcare IT needs to study and understand what Amazon calls their ‘backwards’ innovation process which they describe as follows: step 1 write the launch press release, step 2 anticipate and answer FAQs (frequently asked questions), Step 3 Design the experience, Step 4: technical development. A more ‘Experience Led’ Innovation process is hard to achieve. 

The Amazon example is also indicative of another big trend: web services. Closed vertically integrated software database systems face as big an extinction risk as paper books. 

The driving momentum of progress in ICT is swinging from technology led ‘systems in boxes’ and ‘closed databases’ towards ‘human behaviour inspired’ wide area web service systems. 

ICT is starting to look more like the rest of industry where ‘things the customer doesn’t see’ are planned with maximum economies of scale in mind, (the fate of engines both physical and virtual) and the user experience is tailored to be precisely as personalised as they desire. ( the screen on your I-Pad). 

This commercial trend towards web architectures is morphing at light speed into the next big shift in ICT thinking: The Internet of Things.

In a nutshell, the number of things connected to the internet is growing exponentially as the cost and size of sensors and ‘connectivity’ processing plummets. We are moving rapidly toward a world where pretty much anything can be detected and shared anywhere in the world, from the location of a wheelchair to the body temperature of thousands of pensioners across a region.

The internet of things can enable so many new ways for information flows to improve things that technologists themselves are already so swamped with potential applications they are finding it hard to identify individual ‘killer apps’ onto which they can focus any kind of traditional ‘top down tech’ approach.

This is good news for healthcare, it creates a fertile ground for new, ‘experience led’ thinking on the big healthcare challenges, this is also good news for the experience led designers in the creative industries. It is also worth noting that the TSB is planning a number of calls around the ‘Internet of Things’ in the new year. Innovation proposals that also address big ‘national challenge areas’, like Healthcare, tick a lot of extra boxes. 

So what are the specific Healthcare challenges that modern ICT (the internet of things in particular), is well placed to help with? 

• Improving clinical productivity: doctors and nurses are swamped with data and hate ‘entering’ things. They are hungry for anything that ‘captures’ information automatically and converts it into useful presentations that cut the time they spend on administrative decision making.

• Fewer and shorter hospital visits: Hospitals are expensive and dangerous places, the more they can be avoided the better for all. New information flows can help reduce the need to go, speed up passage through, and make it possible to go home sooner, under remote supervision.

• Health and Quality of life in old age: New information flows can help us manage our own conditions and maintain our independence by keeping us more connected to the outside world. The TSBs recent ‘whole system demonstrator’ project has just provided the first ‘clinically valid’ evidence that ‘connected e-health’ saves lives. This will stimulate interest and belief in the health care community.

• Joining up a multi-stake holder world: The Healthcare world is a warren of poorly connected information silo’s that are looking to communicate better. This has been the ‘good intention’ at the heart of the large ‘top down’ national initiatives. The internet of things can help ‘join up’ a complex world with looser, more ‘bottom up’ web-service systems.

• ‘Experience Led’ solutions: Success with all these challenges depends totally on the willing and motivated engagement of end users. Each and every stakeholder involved in any health care scenario, from the overburdened theatre nurse to the retired pensioner taking his own blood sugar reading, must find their new interactions to be totally natural and useful, this won’t happen without the empathy and vision of Experience Led Designers.

The UK’s creative industries, Industrial Design and Computer gaming in particular, have a world leading track record in the development of this kind of ‘experience led’ solution.

This is why the HealthCare challenge is such a great opportunity for the Creative Industries, especially so in the context of the Internet of Things.