• Why I’m Down on Health Apps

    I met today with a bright young doctor from the Harvard School of Public Health who was working with Blue Cross Blue Shield on a study of “health monitoring tools.”  As she put it, the Vitality GlowCap was her “poster-child” for an elegantly designed behavioral change tool, and she wanted to learn more about the design philosophy behind the product. She was especially interested in our use of AT&T’s cellular network to reduce the complexity of bluetooth and other short-range wireless options. Chronic diseases make up about 75 percent of our healthcare system’s $2.3 trillion costs, so the need for more and better tools is acute.

    Her first question was familiar. “Wasn’t I excited about smart phone apps for helping people track their blood pressure, diet, weight, and other indicators?” As I told her, I’m skeptical that people will use these apps every day, even the well designed ones. It’s true that more people have cellphones than computers, and many of these phones will support vast appstores in the coming years. But that doesn’t mean people will have the discipline or interest to use these apps, especially for logging what they eat, or if they have taken their medications..especially if they haven’t. Brian Dolan from Mobihealth news or Susannah Fox from Pew Research should do a study on actual health app usage over time (all of the current numbers are based on downloads only).

    The availability of great literature, for free, on an iPad doesn’t mean we’re all reading Jane Eyre.

    I’m an avid self-experimenter. I try to adopt early and often to form grounded opinions about any new shiny thing, especially those that innovate on the human-computer interface like Nintendo’s Wii Fit, Sony PS3 Move, and Microsoft’s Kinect; or connected health devices like the WiThings scale, FitBit, Philips DirectLife, Nike+, Garmin’s bike GPS, etc.

    On my Apple iThings, I download and try to use health apps like LoseIt (where you choose from a large database of foods to count calories) and MealSnap (where you take a picture and it estimates calories in each meal). Both seem like a great idea, but I can’t seem to do it consistently three or four times a day.

    Back when I was CEO of Ambient Devices, we discovered that peripheral displays like the Ambient Orb were remarkably effective at encouraging energy conservation because it didn’t require active engagement. When color is mapped to energy price, it’s hard to avoid glancing across the room and noticing it. The Vitality nightlight (with AT&T connectivity) leverages this same glanceability. It’s usually steady blue, or pulses orange if any of your GlowCaps need your attention. It’s unavoidable.

    Other behavioral change tools need the adhere to the same big idea: Be Ambient.

    So far, smartphone apps don’t provide this type of persistent, unavoidable display because apps require launching and focal attention.The Vitality dynamic wallpaper concept (image below) summarizes how healthy you are. Each pedal of the flower maps to a different aspect of vitality: sleep, activity, diet, meds, and stress.

    What about texting you ask? I know my colleague BJ Fogg at Stanford, and many others, believe that push-messaging will provide an effective coaching tool for behavior change. Maybe given hyper-personalized messages, and an understanding of context, such a system won’t feel too annoying. For now, I turn off push messages for almost all apps because the cacophony is unbearable (especially you, FourSquare). Would you adopt a coaching program that texted you a few times a day with meal and exercise suggestions and medication reminders? I think you’d hate it after about three days.

    Sorry health apps, you need a way to become ambient to be effective.


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