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DIGITAL HEALTH AND WELLNESS

By Christian Lindholm, Martin Charlier, Giovanna Nicosia.

October 2012

HOW TECHNOLOGY IS TRANSFORMING THE HEALTH AND WELLNESS SECTOR.AND HOW IT AFFECTS DIGITAL SERVICE DESIGN.

Introduction

Digital Transformation

Disintermediation by services

Disintermediation by technology

The Numbers Challenge

Meaning from data

Chart Fatigue

Mechanised Systems

The Behavioural Change Challenge

Learn from Gaming

Digital rituals

Simplicity dilemma

Conclusion and Key Points

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CONTENTS

INSPIRATION FROM THE FUTURE

DIGITAL TRANSFORMATION OF HEALTH AND WELLNESS 2

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• DIGITAL PHARMA •

• THE SOULMATE •

• DIGITAL JEWELLERY •

• DIGITAL REAL-WORLD • • GAMING •


Digital technology is transforming the Health and Wellness sector.

We have moved on from the days of services aimed at early adopting sports geeks: now the world of logging apps and sensor-enabled devices is looking to the mainstream, and the pursuit of well-being for everyone.

At the same time, the new ‘digital generations’ are using the web as a rich source for diagnostics, for researching treatment options, and most importantly, for connecting with other like-minded people to exchange experiences and information.

INTRODUCTION

Lastly, the progression of consumer electronics has not gone unnoticed by the healthcare sector as a whole, as consumer electronics platforms are increasingly being used for professional medical services. This trend includes displaying information in more user-friendly ways, for example on iPads, as well as the use of such platforms as enablers for next generation medical equipment (such as ECG attachments for the iPhone capable of producing medical-grade data).

Fjord believes that digital technology is enabling a move from an old industrial model of ‘one-to-many’ healthcare to a new paradigm of highly tailored experiences built around individuals.

Part of this process is the disintermediation of particular parts within industries and a more fundamental paradigm shift of how an industry works. This move is gaining momentum in the Health and Wellness area, and in particular the field of medicine. One of the main thought leaders on this is Eric Topol, a medical doctor and professor of genomics who calls this shift ‘The Creative Destruction Of Medicine.’1

From a digital service design perspective, Fjord sees both opportunities and challenges in these trends.

This document aims to highlight the most important aspects, with a particular focus on the intersection of digital services and the Health and Wellness domain in developed markets.

DISINTERMEDIATION BY SERVICES

The Web is bringing together two powerful trends.

The first is that digitally literate, empowered users are doing their own research and becoming frustrated with public service experiences that are technologically dated and stagnant. Secondly, we have the ever-growing social interconnection of the web with tools that give interest groups the power to connect and share information, which are in turn catalysing the creation and adoption of new tailor-made services.

Apart from a myriad of online forums for particular conditions, popular examples are services such as PatientsLikeMe.com or Drugs.com, as well as mobile applications aimed at (for example) logging headaches or mood swings.

DIGITAL TRANSFORMATION

Examples of the impact of these include patients identifying and finding ways of accessing better treatment options; patients benefiting from more informed discussions with their doctors about possible causes; and patients performing more self-

motivated monitoring and data collection to provide doctors with valuable information for diagnostics.

While this is a very positive development for users, Fjord’s research indicates that this is today still largely ignored or even discouraged by the professional medical space.

Doctors need to embrace this development. There is a major opportunity for services that can bridge the gap between the professionals and the people; between doctor and patient.

This should lead to services that fulfil the requirements and current shortcomings seen by the professional space, while still offering the

advantages of social networking and knowledge exchange.

Fjord believes that this is a service design challenge that can be addressed through working closely with both sides in the development of such services.

A big part of this opportunity is an adjustment of the role that the doctor plays in the relationship with patients. Fjord believes this role needs to develop into that of a coach with whom patients have an on-going dialogue and who respects and integrates the work done by

services need to bridge the gap between doctors and patients

the patient is the most underused resource in medicine

e-patientAn e-patient (also known as Internet patient, or Internet-savvy patient) is a health consumer who uses the Internet to gather information about a medical condition of particular interest to them, and who use electronic communication tools (including Web 2.0 tools) in coping with medical conditions.

WIKIPEDIA


PATIENT DOCTOR

patients through including it into the consultation, diagnosis and treatment process.

As ePatient David deBronkart puts it, “the patient is the most underused resource in medicine today.” 2

DESIGN IMPLICATIONS:

» WORK CLOSELY WITH ALL PARTIES WHEN DEVELOPING A HEALTH AND WELLNESS RELATED SERVICE: BALANCE AND FACILITATE REQUIREMENTS TO MAKE IT A MEANINGFUL SERVICE FOR ALL PARTIES.

» WHEN DESIGNING FOR THE PROFESSIONAL SIDE, DON’T UNDERESTIMATE WHAT PEOPLE CAN COMPREHEND. TAKE INTO ACCOUNT THE TECHNO-LITERACY OF THE COMING DIGITAL GENERATIONS.

» DESIGN SERVICES SO PROFESSIONALS CAN EASILY INTEGRATED THEM INTO THEIR PROCESSES WITH LITTLE OR NO NEED FOR INSTITUTIONAL OR TECHNOLOGICAL CHANGE. CONSIDER PATIENT-DRIVEN SERVICES THAT DOCTORS CAN INTERACT WITH EASILY.


As digital service designers, Fjord believes that part of such a bolder and more radical operating model could be the digital transformation bringing Pharma companies much closer to the actual patients and consumers, as well as a shift from the current centralised mass-production model to a distributed, on-demand, customisation model.

Genome sequencing and new drug production technologies currently being researched like 3D printing 4 are potential enablers of such a new model.

The opportunities:

» Simplifying treatment regimens by combining multiple medications into single pills.

» Custom designed dosages that allow for regimens centred on individual habits and lifestyles.

» No more pill boxes and generic leaflets, but customised information leaflets for the particular user.

» Dynamic systems that allows for adjustments of dosage and mixture with each pill – this enables a continuous improvement and tweaking through the doctor.

» No more medicine cabinets filled with half-empty packages, only the pills actually needed are produced.

» User empowerment to include personal preference into medication design. Parents could chose the preferred taste based on what their child will be happier to take.

While these ideas are creative explorations into the long-term future of pharma, Fjord sees potential even in the near-term for companies to use platforms like smartphones to create relationships directly with consumers. This could be achieved through value propositions like medication-logging apps which provide a record, reminders, information and explanation and drug interaction checks, while the pharmaceutical companies benefit from brand awareness and gain valuable data about user preferences and usage behaviour.

Of particular relevance to digital transformation is the Pharmaceuticals industry.

Although it is a private sector, the big companies are suffering together with the healthcare systems. Challenges stem from increasing amounts of regulation, growing costs for development, and smaller more agile companies in the growing life sciences and biotech sectors that outpace the big companies in terms of innovation.

A recent article by McKinsey & Co. suggests that the Big Pharma companies need to think about a bolder and more radical operating model. 3

• DIGITAL PHARMA •

DISINTERMEDIATION BY TECHNOLOGY

Apart from new services enabled by the web, Fjord also sees the increasing accessibility of technology as an important development transforming the Health and Wellness domain.

Powerful, reliable new sensor technologies are increasingly available to consumers and are being adopted through devices like smart phones or wearables.

The poster-child example of this is the dramatically dropping cost of genome sequencing.5 While this is not yet affecting the typical medical process yet, it has the potential to make the doctor-patient relationship more efficient and meaningful.

Perhaps a better example is the thermometer. A technology first invented in the 16th century, it was not until the 18th century that it was first used as a clinical diagnostic device. At that time, the medical profession was largely unconvinced, and it was not until the late 19th century that it was widely adopted by medical professionals.6

Today thermometers are simple consumer devices found in most homes. Perhaps more importantly, doctors have generally accepted their patient’s use of them and this ‘user-generated data’ is typically taken seriously and integrated into the

consultation process. Fjord sees this as an example for the level of integration that other consumer-medical devices need to achieve.

However, the pace at which new technology is developing today is of course dramatically different to that in the history of the thermometer. Sensors for tracking human physiological values are making their way into our environment fast. This is even going beyond physiological values, with consumer services like 23andme.com offering DNA genotyping at affordable cost.

One of the aspirations in this area is the Tricorder handheld diagnostic device made popular by Star Trek. Although confined initially to the realm of science fiction, the Tricorder constitutes such a revolutionary

concept that the Qualcomm and the X Prize Foundations have established a competition with a 10 million dollar prize for the first functioning Tricorder-like device. 7

While the thought of such a medical device being in consumer hands raises questions over its necessity and adoption, there is another prime example of a medical device that has achieved a state of cultural adoption probably not anticipated at the time of its invention: eyeglasses.

Eyeglasses are medical devices used to treat sight related conditions like myopia, hyperopia, astigmatism, or presbyopia. However, by being embraced as a market by the fashion

powerful sensor technologies make their way into smartphones and wearables

consumer generated data needs to be integrated into the consultation process

Cost per genome in US dollars. Genome.gov (2012)


FIRST THERMOMETER

CLINICAL THERMOMETER

INFRARED EAR THERMOMETER

20001900180017001600

$ 10,000,000

$ 100,000,000

COST PER GENOME

20012002

2003

20042005

20062007

2008

2009

2010

2011

2012

$ 1,000,000

$ 100,000

$ 10,000

industry, they have changed into status and style symbols. In other words, they are a medical treatment that is ubiquitous to the point where people may even want to wear eyeglasses even though they don’t need them. This is a success story that follows a transformation from medical necessity to cultural absorption.

Nevertheless, Fjord believes that just as the consumer thermometer did not replace doctors, other advanced diagnostic and medical technology in the hands of consumers won’t replace them either. Instead, they change the relationship patients have with doctors.

It’s clear to Fjord that our design focus must closely examine how the patient-doctor relationship, and healthcare generally, can embrace the new technologies that consumers are increasingly surrounding themselves with.

DESIGN IMPLICATIONS:

» DESIGN HEALTHCARE SERVICES THAT IMPROVE WITH THE INTEGRATION OF CONSUMER-GENERATED DATA.

» FOCUS THE UX OF CONSUMER-MEDICAL SERVICES ON USABILITY TO ENSURE A QUALITY OF DATA THAT IS ACCEPTABLE FOR THE PROFESSIONAL MEDICAL SPACE.

» CONSIDER POSSIBLY BENEFICIAL INTERCONNECTIONS BETWEEN SERVICES PROVIDED BY HEALTH INSURANCE, MEDICAL INSTITUTIONS AND CONSUMER COMPANIES.

» MAKE THE CULTURAL AND SOCIAL IMPACT OF CONSUMER MEDICAL PRODUCTS AND SERVICES A KEY COMPONENT OF THE DESIGN PROCESS.


• THE SOULMATE •

COULD THIS BE THE FUTURE OF THE SMARTPHONE?

The mobile phone has evolved to become an essential object of mobility. It is gradually replacing our wallet and our keys: now we wouldn’t dream of leaving our homes without it.

But the smart phone is set to go through more transformations.

The first one is the evolution to a Liferecorder, a device that understands the context of the user and her environment. This transformation starts with constant

sensory awareness. Today each sensor is turned on and off as needed, as there is simply not enough battery power to keep sensors on.

But with the Liferecorder, a core bundle of sensors are constantly on – sensors that record our lives autonomously, including GPS, light sensors, motion sensors and the camera. By intelligently combining sensor input, the device can create meaningful awareness and thus a base for smarter decision making.

For example, an alarm is only displayed when the device can attract the users attention; it is relevant in terms of location. For example: an alarm to buy wine with Bob for the dinner party would only trigger when you are close to a wine shop, and Bob is available to discus what to buy. If the dinner party is approaching


being used on others. It becomes an indispensable tool for diagnosis when you travel. It enables you to scan your children and connect you with the right information.

It will help you decide if you should involve a doctor, it could also start numerous parallel medical analysis. The SoulMate will through its sensors generate medically robust data that can be packaged into the right physician-friendly format.

HUMANS ARE NOT THE SILOS THE MEDICAL PROFESSION THINKS WE ARE

Because the SoulMate provides a parallel lens to multiple experts in parallel, it will help the physician and other life coaches to see a longitudinal view, rather than forming diagnosis from a snapshot in time. As it provides a holistic picture and it keeps a dialogue with ones GP it can help its user with proactive life management. When travelling in a foreign country it can also translate and help make sense of the conversation with the medical professional.

The SoulMate can see deeper than the skin: it is the X-Ray machine of the 21st century.

We are already seeing the beginnings of the SoulMate in iDoc24, which allows user to ask a dermatologist questions about ones skin.

KEY POINTS FOR DESIGNERS

There are many significant challenges with designing the SoulMate, one being to invent a robust and user-friendly interface to self. Currently medical data is expressed in Latin and chemistry, but increasingly it is being expressed into curves. It will be crucial to invent experience that make the rich data accessible, actionable but not dumb.

In most cases life goes on and the SoulMate sits in the background without making a fuss. If it constantly nags, users will probably turn it off: so designing the right level of ambience is crucial.

The SoulMate will not be an overnight transformation. It will be a gradual evolution of the Smartphone. At some point in the future, the Liferecorder will merge into the SoulMate. And on the way to it, we have become addicted to some of wellness factors the Liferecorder records.

instrument used in the Star Trek movies.

The SoulMate is the first fusion where biology and

electronics merge, an interface into the self. It knows and understands your genome. It knows your habits, your cravings and it can keep an autonomous dialogue with the coaches, experts and expert systems that you have empowered to help you live healthier and perform better.

The SoulMate is like a smart mirror or lens into your life, it tracks changes in your skin, it could track patterns on your tongue, it could analyse your breath for anomalies. As such it has some abilities to see the future, as it can based on computing lots of past data predict how you will react. For example if you select fish for starter, then maybe meat and broccoli is the best complement. If you display a certain symptoms it can make a prediction when you will be well again.

The Soulmate can also be used as a scanner of life, quickly and easily

then maybe Bob might automatically be dropped from the decision if he is not available, or then the choices are converted into a smart questionnaire ‘on the fly’, which he can react to via messaging. This again would expire after the user has left the wine rack in the shop.

We see the smartphone become a smarter phone: The SoulMate concept is a development of this idea.

THE SOULMATE IS A SMARTPHONE THAT KNOWS MORE ABOUT YOU THAN YOU KNOW YOURSELF

Eventually the SoulMate will become a fusion of the Liferecorder and the Tricorder, a vision for a diagnostic

While Fjord believes there are big opportunities for digital services to transform the Health and Wellness area with lasting effect, we believe there are substantial challenges to overcome, too.

MEANING FROM DATA

Turning raw data into something meaningful is one of the primary challenges. Most of the current wearable wristband devices and other tracking products and services are little more than aids for data collection and visualisation.

As the information hierarchy suggests, from data comes information, leading to knowledge and then finally wisdom.8 At the moment, it is down to the user to take even that first step.

While there are efforts in the interface design of some products to give alternatives to numbers, there is still a clear mapping relationship. In other words, FitBit’s growing flower is still a number in disguise. At the recent NESTA HotTopic discussion about the quantified-self movement, it was pointed out that currently only the user is able to contextualise the raw data, and any system is likely to misinterpret such context-free data. 9

This challenge also relates in part to the element that went missing when such systems moved from human to technology, in other words, the removal of the doctor or coach. Both were able to interpret data, taking into account an understanding of context and turn numbers into meaningful information.

Fjord believes this shortcoming can be overcome with service design. A perfect example is the way Wired magazine redesigned the blood test results sheet. By visually putting the results in context of health averages, something the doctor would normally do in a verbal consultation, the user is able to gain a better understanding from the raw data.10

current devices and services are mere data collection and visualisation aids

DATA

gathering raw facts

INFORMATION

understanding relations

KNOWLEDGE

understanding patterns

WISDOM

understanding principles

Test Name In Range Out of Range Reference Range Lab CHOLESTEROL 211 125-209 mg/dL 63

TOP Excerpt of typical blood test results sheet.

Authors (2012).

RIGHT Excerpt from Wired Magazine’s redesign of the blood test results sheet.

Leckart (2010).

it used to be the doctor that gave meaning to numbers

CONTEXT & UNDERSTANDING


THE NUMBERS CHALLENGE

TOWARDS INTIMATE ELECTRONICS AND SERVICES

Humans have decorated themselves with jewellery and worn ornaments on the wrist for millennia. More recently, we came to incorporate timepieces as objects of desire, and as watch movements shrunk, we were able to incorporate these into our jewellery.

At Fjord, we think the wristwatch and also the armband are now evolving into smart objects.

It’s part of a process in which electronic devices become more intimate, as they start to record our personal data. This kind of intimate data recording is set to take place on wrist wearables as they become the next major frontier in device and service design. Intimate and biological data recording is best done on the wrist.

These devices will start to uncover your life patterns, using information that previously we would only share with loved ones and professionals in confidence.

Activity and movement will become a central component of proactive wellness.

WRIST WEARABLES OFFER FOUR UNIQUE HUMAN FACTORS THAT SMARTPHONES FAIL TO MATCH:

1. Worn 24/7

2. Provide skin contact

3. “Glanceable”

4. Always on

Like the smartphone, wrist wearables are touch-friendly. From a business point of view, they offer additional value – they are fashion objects and have the ability to scale in value, far beyond the utilitarian value typically provided by gadgets. This opens up a very large and wide industry ranging from medical to social functions.

Fjord believes that these objects, despite having a strong Health and Wellness implication, should be packaged into consumer goods. Turning wearables into communication tools is a great opportunity because at present there are no great ambient communication solutions for the deep relationships in life.

DIGITAL JEWELLERY

Early entrants into the digital jewellery sector have come from three directions: casual in the form of Aliph’s JawboneUP; medical with Bodymedia’s FIT; and sports from Nike’s Fuelband.

All have pros and cons, and these varying approaches shed light on the tough challenge posed by the mix of functionality, size and battery life. But each of these solutions suggest there is no early dominant design paradigm.

It’s crucial to understand that these objects are part of a larger system: phone, computer and cloud. The creators of these smart service solutions need to master hardware, user experience and connectivity software. What makes this a difficult domain is that these objects are expected to be high value objects for which marketing, positioning and branding are critical.

These objects will rely on the phone or the computer for communication to the Internet. The key enabler for connectivity is low power Bluetooth 4.0.

As functionality grows, so do requirements for user interface. At some point the object morphs from a piece of jewellery and becomes a wristwatch. We think there will be a market for both smart connected jewellery and for smart connected watches.


• DIGITAL JEWELLRY •

THE EMERGENCE OF NEW INTERACTION PATTERNS

Fjord expects to see rapid innovation in gestural input along with the emergence of a general interaction framework across all wrist wearables, comparable to that which has emerged in the smartphone market.

These are likely to include tap, doubletap, and rotating gestures, some onto the device, some in the air. Such gestures provide the active inputs. We expect touch to be integrated; early signs of this exist for example in the Mutewatch. The biological inputs are entered automatically. Initially these are based on a 3D accelerometer with sophisticated physio-algorithms.

The output part of the interactions will rely on vibrations as well as on visual cues. The most interesting will be designing the ambient signals where either attention is required; motivation increased or maintain feedback is provided. Due to the limited real estate, a new form of language will emerge based on patterns, visual and light intervals and multi-modal combination of light and vibrations.

THE INTIMATE ARMBAND

Enabling users to communicate with their performance and physical accomplishments, the intimate armband will motivate users through social motivation from friends and specific advice from a coach or guru.

Think of it like this: Your loved ones are able to hug, kiss and stroke you remotely, and you will be able to use your wearable to love back. This ambient communication is built on the World Health Organisation’s classification of Wellness: Physical wellbeing, Mental Wellbeing and Social Wellbeing. These can be represented as colours, Blue for social, Green for physical and Red for mental. By leveraging colour and gestures one can create inputs.

For example, a hug would be a blue task and a gesture. The user would touch the wearable in the ambient blue area or activate the wearable into blue mode and then perform the gesture either positive swipe towards the blue area. Similarly, if the user is walking up stairs she can touch the green area and make a negative swipe indicating an element of fatigue. The mix between input and communication should be natural and smooth.

It is important that it is low effort intensity, and can be done while doing other tasks, like walking up stairs. It can also act as a reminder for something that is love related. The device can flash in a particular manner to remind you to pick up flowers for you loved one. No textual notifications are

needed. If it is a reminder from or about ones loved, the blue area might flash three times. It is ambient and it is intimate: only you know the meaning. The device allows you to keep a constant communication with yourself. You can simply enter your mood, and energy levels and overtime collect valuable information allowing you to live healthier or perform better. Again press the area where red exist and make a corresponding gesture. A simple ambient input and output language can be constructed that will enhance well-being.

We may also see personalisation, as users dress the armband with digital charms that could light up depending on action: for example, your loved one thinks of you and a little diamond lights up.

The armband is then visible via an app on your smartphone. This app provides richer controls and settings. The smartphone app is what keeps the armband focused, energy efficient, but without it would not work. Settings complexity is moved to the app, where one has a richer user experience. Digital wearables are in symbiosis with the smartphone, but provide unique value.

Of course, the level of interruption or distraction that people are willing to accept varies from person to person, and also from moment to moment: the design needs to be sensitive to these varying thresholds and respond in an elegant way, without the owner having to adjust settings or modes.

Another factor to bear in mind is finding the right mode of interaction for the armband. For example, the armband will never actually be the same as your loved one, and trying to approximate it too closely could end up being creepy (see: Uncanny Valley). But on the other

hand, simple LEDs and vibrations may be too simple and not emotional enough. Designers need to pay attention to finding the right tone of interaction that enables the armband to thought of as a trusted companion, neither ‘almost but not quite human’ nor ‘dumb object’, but a warm and trusted member of a species that sits somewhere in between.


expose information that is likely to confuse and upset the user rather than help. What is missing is any form of human common-sense threshold, which traditionally would be the doctor subtly asking a few additional questions and reassuring the patient that it is probably nothing.

CHART FATIGUE

Fjord has identified another shortcoming within the current services: one that we call ‘Chart Fatigue’.

While some of the current products are effectively motivating users to be more active and help them achieving a goal, the excitement and interest generated by self-measurement quickly wears off.

This is a design challenge. These services need to move from a focus on helping to achieve to a focus on helping to maintain. There are also implications for the interaction with, and presentation of the service.

For example, if a service gives the user the power to check how she is doing during an ‘achieving’ period, the service needs to scale down into the background, offering glanceable and ambient interfaces. This avoids bothering the user with what is effectively ‘no news’ during ‘maintaining’ periods.

MECHANISED SYSTEMS

The challenge of numbers and meaning becomes ever more critical when the subject matter becomes more critical, too. Consider for example symcat.com, a service using crowdsourced data to calculate diseases the users could have based on symptoms he or she puts into the system.

While this is a great service for empowering people to do their own research, the mechanic nature can

services need to move between helping to achieve and helping to maintain

ACHIEVING MAINTAINING

GOAL

INTERESTING!

SO WHAT?

automation can have confusing and upsetting results

Excerpt from Symcat.com results list.

Screenshot by authors (2012).


using game mechanics does not mean a service has to feel ‘game-like’

Feedback loop, adapted from Goetz (2011).


Another important aspect of the digital transformation of Health and Wellness is creating behavioural change that lasts. Many of the biggest health problems in the developed world come in the form of diseases related to lifestyle.

LEARN FROM GAMING

Some of the examples mentioned above are already utilising game mechanics to help users achieve goals, including points systems and leader boards.

But these mechanics can take different forms and don’t obviously have to feel ‘game-like’ to the user. Take the example of the re-designed blood

THE BEHAVIOURAL CHANGE CHALLENGE

test results. The way in which the own result is put in context of health averages in combination with a simple good/bad scale is effectively the same as a leader board at the end of a game, showing you where you are compared to the points other people score in the same level.

exactly in that way, many games create addiction through creating such a loop. The combination of your points score, the possible hi-score in the level or other people’s scores, and the ‘play again’ button is such a loop.

A difference in games is that the ‘action options’ step is often reduced to just playing again for the sake of not making it too easy. However, especially in racing games it is common to use the ‘player ghost’, a ghost-like model displaying the precise best run of the player on the course to help follow the same path and see where the path can be improved. This provides options for taking action to change the data.

DATAACTION OPTIONS

CONTEXTCONSEQUENCE

This is a leader board, you just don’t see names of other players.

Excerpt, Leckart (2010).

There are more aspects from gaming that can be taken as inspiration for the field of Health and Wellness though.

A very effective way of creating behaviour change is a feedback loop. The idea is to put raw data in context, show consequences and offer actionable options to change the fact.11 Although not necessarily designed

feedback loops can be very effective in creating behaviour change


Although not entirely connected to creating behavioural change in users or patients, it is important to point out that gaming mechanics are also a rich source for the design of professional equipment. Some examples are controllers allowing for precise analogue input, joysticks turning virtual forces into actual physical feedback or user interfaces using glanceable graphics and audio effects to output a multitude of data in real-time.

These examples show that the requirements of the gaming industry overlap with other professional areas. This can be seen in the US military using XBOX joypads to remote control drones and robots, and it is the same for the professional medical sector where technologies like augmented reality and robotics are also increasingly used. 12, 13

• DIGITAL REAL WORLD GAMING •

Games are becoming ‘real’ again. Not only are console games like Nintendo Wii or XBOX Kinect involving full body activity in the gameplay, there are new technology-enabled niche games like Geocaching 14 and Pervasive Gaming experiences like the ones designed by Hide and Seek 15 that typically take place outdoors and involve a considerable amount of physical activity.

One example is the iPhone running game ‘Zombies, Run!’ The game uses the data collected by the iPhone to combine the activity of outdoor running with an immersive audio game scenario delivered

through radio messages and voice recordings. The player has to run away from zombies, defend buildings and collect virtual items like medicine. 16

Augmented reality glasses in combination with high-resolution depth cameras, once both reliable and effective, could increase the level of engagement.

The opportunities:

» Outdoor games involving physical activity with the levels of engagement and immersion known from console and computer games.

» Internet-enabled multiplayer gaming in the real world.

» Training and practicing modes for single players.

» Goals and achievements set by or shared with the doctor-coach.

» Play anywhere – a patch of grass can turn into a busy football pitch with goals, lines and audience.


DIGITAL RITUALS

Another important aspect of prevention through behavioural change is establishing rituals or habits. The medical domain enjoying most success in this are is probably dentistry. Kids are taught from an early age about the importance of regular brushing, and the combination of this activity with getting up and going to bed routines has ingrained it into our daily lives.

However, rituals come in different flavours. While there are daily rituals like tooth brushing, there are less frequent health related rituals like having your blood picture done once a year. The lower the frequency, the harder it is to remember and keep doing it. Again, dentistry is a good example since in many cases patients are actively reminded of such less frequent check-ups through postcards or reminder emails.

Introducing new rituals is very complex, however. In the case of tooth brushing, it involves components like understanding of consequences (for example in the form of pictures and stories about what might happen to one’s teeth, or fear of going to the dentist and therefore doing anything to prevent that) and enforcement (like parents making their children brush their

teeth). Both components go away with age. This makes it hard to introduce new rituals, unless your life depends on it in a short-term, that is.

establishing rituals involves engagement, education and enforcement

existing rituals can be used as mediums

dentistry was very successful at creating a ritual around prevention

SMART SCALES TAKING ECG AND BLOOD PICTURE

TOOTHBRUSH MONITORING NUTRITION AND EATING

MIRROR DOING TONGUE DIAGNOSIS AND MONITORING SKIN MOLES

EDUCATION ABOUT BIGGER PICTURE

IMPACT ON BEHAVIOUR


Fjord believes that rather than establishing new rituals, new services might be more successful when using existing rituals as their medium. Users of the Withings body scale have little problem stepping on it on a regular basis, because the new technology enabled service has replaced a ritual they had already adopted. For Withings, this is a base to grow from. If the service grows into taking additional measurements, an easy way of getting the users in a routine of frequent data sampling would be to include such sensing technology in the body scale, rather than introducing a dedicated product.

Some promising potential mediums are:

» Getting up » Going to bed » Having a cup of tea or coffee » Brushing teeth » Weighing oneself » Taking a shower » Going to the toilet » Running » Sunday breakfast » Setting the alarm when

going to bed

SIMPLICITY DILEMMA

Lastly, education and messaging are important variables in behaviour change, too. A good example is the common diagram of the ‘food pyramid’. An important tool for education about healthy diet, it has been subject to much debate and redesign.

Critics of this, like the Heath brothers in their book Switch, suggest that it is too complicated and illogical. Better solutions may be condensed and actionable messages, but even then we start to glimpse a dilemma between educating about the bigger picture and making an impact on actual behaviour. 17

Another example is the debate around the messaging used in fighting obesity, where the simplified message of ‘eat less, move more’ ignores research suggesting that concentrating on what exactly should and what shouldn’t be eaten might me more effective. 18

there is a trade-off between education about the bigger picture and impact on behaviour

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CONCLUSION

KEY POINTS

Digital Health and Wellness services need to bridge the gap between doctors and patients.

Fjord believes that service design will play an integral role in overcoming the challenges, and seizing the opportunities, in the digital Health and Wellness space.

Services will make a real difference when they are of significance to the doctors.

Turn data into knowledge. Design needs to focus on conveying a humanising, meaning-giving role.

Beware curve fatigue. Services need to move between helping with achievement and helping with maintaining whenever appropriate.

People are analogue. Treat the possibly confusing or upsetting side effects of automation.

Learn from gaming, but don’t turn everything into a game. Use game mechanics to give meaning and help with behaviour change.

Weave interactions into daily life. Consider existing rituals as a medium for recurring service interactions.

Educate in actionable terms. Develop the right balance between educating about the bigger picture and offering immediately actionable advice.

The ‘creative destruction’ of medicine is well under way. Those that quickly adopt digital and mobile innovations across their Health and Wellness offer will find new opportunities – and tough challenges – rapidly coming their way.

IMAGE CREDITS

Clinical mercury thermometer by J Hicks of London. http://www.phisick.com/a1mhicksthermo.htm

Braun Thermoscan Ear Thermometer. http://www.shopping.com/Braun-Braun-IRT3020-Thermoscan-Ear-Thermometer-White/info

The Blood Test Gets a Makeover. Leckart (2010). http://www.wired.com/magazine/2010/11/ff_bloodwork/all/1

Screenshot of Symcat.com. Taken by the authors. http://www.symcat.com

USDA MyPyramid. http://www.fns.usda.gov/eatsmartplayhardhealthylifestyle/tools/mypyramidtracker.htm

1% or less, yes! Campaign in West Virginia, USA. http://lightenupdhs.blogspot.com/2010/07/milk-1-or-less-campaign.html

REFERENCES

1. The Creative Destruction of Medicine, Eric Topol, M.D. (2012)

2. Meet e-Patient Dave. Dave deBronkart Ted Talk. (2011) http://www.ted.com/talks/dave_debronkart_meet_e_patient_dave.html

3. A wake-up call for Big Pharma, McKinsey Quarterly, (2011)

4. DNA Sequencing Costs. Data from the NHGRI Large-Scale Genome Sequencing Program. (2012) www.genome.gov/sequencingcosts/

5. A brief history of the clinical thermometer. J.M.S. Pearce. (2002) http://qjmed.oxfordjournals.org/content/95/4/251.full

6. http://www.qualcommtricorderxprize.org/

ABOUT THE AUTHORS

CHRISTIAN LINDHOLM

e: [email protected] t: @CLindholm

Christian is Fjord’s Chief Innovation Officer.

MARTIN CHARLIER

e: [email protected] t: @marcharlier

Martin is a Product and Interaction Designer in Fjord’s London studio.

GIOVANNA NICOSIA

e: [email protected] t: @strisceapois

Giovanna is an Interaction Designer in Fjord’s Helsinki studio.

7. 3D printers could create customised drugs on demand. (2012) http://www.bbc.com/news/technology-17760085

8. Data, Information, Knowledge, and Wisdom. Gene Bellinger, Durval Castro, Anthony Mills. http://www.systems-thinking.org/dikw/dikw.htm

9. NESTA Hot Topic. Hack Yourself: Measuring Wellbeing.(2012) http://www.nesta.org.uk/assets/topics/hack_yourself

10. The Blood Test Gets a Makeover. Steven Leckart. (2010) www.wired.com/magazine/2010/11/ff_bloodwork/all/1

11. Harnessing the Power of Feedback Loops. Thomas Goetz. (2010) http://www.wired.com/magazine/2011/06/ff_feedbackloop/all/1

12. http://technabob.com/blog/2007/06/05/us-army-remote-vehicles-using-xbox-360-controller/

13. http://www.pyrosoft.co.uk/blog/2007/11/04/army-fly-uav-spy-plane-with-xbox-360-controller/

14. Geocaching. http://www.geocaching.com/

15. Hide and Seek. http://www.hideandseek.net/

16. Zombies, Run! https://www.zombiesrungame.com/

17. Switch: How to Change Things When Change Is Hard, Chip & Dan Heath. (2010).

18. Why the Campaign to Stop America’s Obesity Crisis Keeps Failing. Gary Taubes. (2012) http://www.thedailybeast.com/newsweek/2012/05/06/why-the-campaign-to-stop-america-s-obesity-crisis-keeps-failing.html


DIGITAL HEALTH AND WELLNESS

FJORD OCTOBER 2012

www.fjordnet.com @fjord

ABOUT FJORD

Fjord is a leading user-centric design consultancy, currently ranked by Deloitte and the Sunday Times as the fastest growing in EMEA. Fjord works with visionary clients to design world-class digital services and is driven by one guiding principle: elegant simplicity.

Fjord has worked on flagship projects providing strategic direction and design for major brands including: BBC, BBVA, Citibank, Ericsson, Foursquare, NFL, Nokia, Skype and Telefonica.

Fjord was founded in 2001 and is led by Olof Schybergson, CEO. Fjord has offices in Berlin, Helsinki, London, Madrid, New York, Stockholm and San Francisco.

digital health and wellness - martin charlier€¦ · perspective, fjord sees both opportunities...

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