As previously mentioned, Anikto is working in conjunction with Real Food Farm and the Baltimore Civic Works to create the first pilot. The app was submitted to the App Store for approval last week. Once approved, a six-acre urban farm in the heart of northeast Baltimore will be able to take orders via mobile phones.

However, to truly extend the farm’s reach we need to add two very important features:

• A farmer’s dashboard to let Real Food Farm update the app inventory on their own. Because seasonal crops and market locations are always changing, this will save a lot of administrative effort for the great folks who run Real Food Farm.
• A GPS tracking device located inside the Mobile Farmers Market delivery truck. This device will “speak” to the technology we’ve already developed, helping Baltimore residents see in real time where and when deliveries are taking place. Imagine looking at your phone to find that you can buy farm-grown food just down the street, right now!

Anikto has self-funded all activity for this effort to date. To achieve the next phase, an outreach campaign has been created through the crowdfunding website Indiegogo. The funds raised in this campaign will cover development costs of the dashboard, purchasing of GPS devices, and any training necessary to ensure that everything works the way it should. The funds will also be used to kickstart similar programs in other cities across the nation.

We sincerely thank those folks who have already contributed to the cause of healthy, affordable eating in today’s disenfranchised communities. Every dollar earned will go towards the funding of this pilot. In the campaign’s first four days, we’ve already achieved 18% of our goal!

Karl Groves once said that accessibility is about providing fundamental human services to people of all abilities and backgrounds. What could be more fundamental than ensuring that people have healthy food to eat? Learn more through our Indiegogo campaign page.

Wet AMD is a chronic eye disease in which abnormal blood vessels leak fluid into the center of the retina, causing the inside back wall of the eye to pucker. The result is visual distortion that gets worse over time, ultimately deteriorating a person’s eyesight if left untreated.

In preparation for the meeting, I tested three consumer-facing websites using the JAWS and NVDA screen readers and captured the outcomes on video. The results were predictable: the screen reader picked up neither the primary navigation nor the main content from any of the three examples. In fact, the sites were among the worst I’d ever tested in terms of accessibility.

The first site skipped over all the primary navigation (images with blank ALT attributes) and ignored the page content to read a disclaimer in the footer. The second website was in Flash and completely ignored by the reader except for two graphics read as “button” and “button,” respectively. The third website had one of those “three A’s” text manipulators and a hidden text DIV requiring a mouse event to activate. None offered anything of value to users of screen readers.

The responses from those in the room ranged from bemused to astonishment. Yet, as of the last time I checked, the accessibility of those sites (as well as that of my prospective client) was only marginally improved. A quick perusal of other vision-related pharma web properties reveals a similar story: poor accessibility, lack of meaningful content, little value. And remember, these are websites specifically targeted to reach patients who have difficulty seeing.

Something’s really wrong with today’s healthcare communications for people with vision disabilities, so perhaps it’s time to figure out what we as digital accessibility professionals can do about that.

Healthcare Communication for the Blind

As today’s healthcare industry strives to make medical records friendlier to patients, physician offices and hospital networks have increasingly adopted Meaningful Use measures to increase the connectivity between health data and personal devices. But what if the patient can’t access their information because they are blind or have low vision, or if they cannot receive content the same way as sighted patients?

Health literacy for blind patients is a critical issue, and it goes beyond simply treating vision-related disorders. Someone who is completely blind cannot detect blood in the urine nor conduct a melanoma self-check without assistance. Many EMR diagnostic tools remain largely paper-based, despite our healthcare ecosystem’s increasing reliance on digital interoperability, and the needs of blind patients are not as well communicated among medical staff as those who are sighted.

With this in mind, Anikto recently asked members of the blind and low vision community to take part in a very brief survey. The intention was to get an idea of how effectively today’s healthcare materials—whether they be printed brochures, television, radio, social media or commercial websites—communicated anything of value to this audience.

A brief disclaimer before evaluating the results:

• This survey was conducted over four days and broadly defined on purpose
• No pre-filtering of candidates was performed in advance
• Participants did not provide specific details of their vision capability in order to participate
• It cannot be conclusively verified that every respondent was blind or had low vision

In other words, pretty much every criticism Indi Young details about surveys could be applied to this anecdotal and unscientific representation of data. It’s merely a snapshot of thirty-six recent patients who self-identified as having a vision disability and chose to answer eight questions related to their experience.

With that being said, let’s take a look at the results:

How knowledgeable is your doctor’s office staff on handling people with low vision and blindness?

• Extremely knowledgeable – 3.70%
• Very knowledgeable – 3.70%
• Moderately knowledgeable – 22.22%
• Slightly knowledgeable – 29.63%
• Not at all knowledgeable – 40.74%

According to respondents, there are gaps with regard to how doctor’s office staff members handle people with low vision and blindness. It would be interesting to do another survey that more closely investigates specific incidents.

During your most recent visit, did your healthcare provider give you information that was relevant and helpful?

• Yes, definitely – 33.33%
• Yes, somewhat – 48.15%
• No – 18.52%

Nearly three-quarters of respondents seemed to have positive experiences when interacting directly with a trusted doctor or specialist. This wasn’t surprising, since such interactions are often more productive during private one-on-one sessions than with someone we perceive to be working for a system. This is pretty much the case whether or not a patient has a disability.

During your most recent doctor’s visit, did you find any of the materials in the doctor’s office helpful and easy to understand?

• Yes, definitely – 8%
• Yes, somewhat – 20%
• No – 72%

A large majority of respondents did not find any of the materials in the doctor’s office helpful and easy to understand. Not surprisingly, most blind and low vision respondents had no use for printed brochures and posters in the doctor’s office. It could be speculated that their point of entry was the reception desk, a potential opportunity for better communications using Braille cards or mobile delivery.
 

How long has it been since your most recent visit with your healthcare provider?

• Less than 1 month – 11.11%
• At least 1 month but less than 3 months – 37.04%
• At least 3 months but less than 6 months – 29.63%
• At least 6 months but less than 12 months – 14.81%
• 12 months or more – 7.41%

Most respondents had visited their doctors within the past year, with most of them having visited within a range of 1 to 6 months. This was slightly surprising, since studies demonstrate that many people with disabilities tend to put off doctor visits due to logistical reasons. For example, someone may want to avoid inconveniencing a friend or relative.

It was encouraging to see such a high percentage of respondents who had recently been to the doctor.

In the last 12 months, how many times did you visit your healthcare provider?

• None – 0%
• 1 time – 15.38%
• 2 times – 38.46%
• 3 times – 23.08%
• 4 times – 11.54%
• 5 to 9 times – 11.54%
• 10 or more times – 0%

In the past 12 months, most respondents had visited their healthcare provider at least twice and some as many as 3 to 9 times. It was encouraging that a number of respondents had been to the doctor not only recently, but also regularly and with some frequency. Obviously, each case varies according to diagnosis, treatment options, comorbid conditions, etc.
 

In the last 12 months, how often did you make a health-related decision based on promotional material collected either through television, radio, or offline media?

• Never – 88%
• Sometimes – 12%
• Usually – 0%
• Always – 0%

Very few respondents made a health-related decision based on promotional material collected through television, radio or offline media. In fact, nearly 90% of respondents said they never do this.

The ineffectiveness of television and radio advertising was an interesting discovery. A blind colleague reported during a conversation that he never listens to commercial radio; his preference is Pandora channels or satellite radio.
 

How likely are you to take part in social media discussions related to health and wellness? Include your activities on Facebook, Twitter, YouTube, etc.

• Never – 42.31%
• Sometimes – 46.15%
• Usually – 11.54%
• Always – 0%

Respondents were nearly split down the middle between those who never use social media to make health decisions, and those who sometimes use Facebook, Twitter and YouTube for health and wellness. This was an unexpected dichotomy and an interesting avenue for deeper exploration. Is it the social media itself that’s the barrier, or the way content is presented?
 

How much do you agree with the following statement: “Most medical and health-related advertising reflects an understanding of what it’s like to be a blind or low vision patient.”

• Strongly agree – 0%
• Somewhat agree – 0%
• Neither agree nor disagree – 11.54%
• Somewhat disagree – 11.54%
• Strongly disagree – 76.92%

A large majority of respondents disagreed with the statement that most health-related advertising reflects an understanding of what it’s like to be blind or have low vision.

This was the only question where participants were invited to offer a personal experience. One respondent made the excellent point that new bottle designs—such as syringes that help parents more accurate dose medication to sick children—might be wonderful for the sighted, yet for a parent who is blind they can be very dangerous.

Helping the “Quantified Selves” Who Cannot See

Through such government programs as Project Blue Button, wonderful things have been accomplished on behalf of patient literacy. However, it’s only a start in the wide spectrum of inclusively designed healthcare communication services.

Remember that for patients with disabilities to take ownership of their own health experience, they must have access to the same material equivalency as those who use all five senses. The digital healthcare ecosystem, which allows patients the ability to manage their health as never before, still has a ways to go before achieving inclusive comprehension.

I think we’ll soon see more innovative ways of utilizing physical space as a point of entry for healthcare communications. Glossy brochures may soon give way to new forms of distribution, not unlike how pharma reps are now carrying iPads as part of their sales toolkits. We may even see franchises within specific disease categories do a better job of recognizing the blind patient as a viable target segment.

This we can say for certain: while medical communities acknowledge that a better-informed patient is a more compliant one, the first step in making health information easy to understand is to ensure that their patients can actually retrieve it.

However, there is evidence that these factors alone do not tell the entire story. Many cities are investigating the role that urban farming can play in alleviating these burdens, but purely locational markers can be misleading. As Emily Badger wrote in a piece last month in The Atlantic Cities:

“By using a static map that looks at the distribution of homes and food stores, you get a rough cut,” says Michael Widener, an assistant professor of geography at the University of Cincinnati. “You get a general idea of what spaces have worse access than other spaces. But ultimately, these are just models.” And they’re models that completely miss the picture of human mobility … if we could more realistically capture where people shop and how they move through their day, that could help us better identify who’s really at risk and what would help them.

In many ways, food deserts are about creating incentives for two entities. One is the consumer, who must make a decision to pursue a consciously healthy lifestyle through better eating habits. The other is local grocery shops and corner bodegas, who may remain unconvinced that stocking their inventories with healthier choices will ensure commercial survival.

In an effort to move the needle on a topic of growing national concern (check out an NPR piece that came out this week), Anikto announced this week the launch of a nutritional support program called Aisle Won. The first release is being piloted in Baltimore in coordination with the Mayor’s Civic Works office, with additional sites currently under negotiation. The goal is to retain commitments in at least four cities by the end of 2013.

The purpose of Aisle Won is to improve education and access by economically empowering community-supported agriculture groups, extending their reach into markets where residents do the bulk of their shopping. In addition, Aisle Won helps families better manage their budgets and menu planning through simple recipes and bundled price packages. The program also helps consumers make better sense of their purchases, so they have some idea of what to do with that eggplant they just bought.

Rollout is still very early, so quite a bit of tweaking is expected before the program can operate nationally. But it’s at least one way that we can help a few communities overcome a problem that threatens the wellness infrastructure of our nation’s ecosystem.

The term “outcast” covers numerous demographic categories. It can represent the 54 million Americans currently living with a disability. It can refer to patients who live in isolation during long-term rehabilitation. It describes those living in economically disenfranchised neighborhoods. And it covers anyone who relies on a product or service for basic life functions, but are prevented access by poor design. This presentation will detail real world case studies of digital outcasts – members of disenfranchised populations who transformed their communities through a “grass roots” approach to technological innovation.

Below are a couple of slides to give you a sense of the presentation — expect a few surprises! I’ll be discussing (in no particular order): aging rock musicians, primitive housing in Asia, why it’s easier to jump out of a spaceship than make an accessible website, health literacy for outcasts, the difficulties of buying vegetables in the city, and why a robot nurse may one day wipe your backside.

The session takes place on Tuesday, March 12 at 3:30 PM and is located at the Austin Convention Center. Looking forward to seeing folks there.

Update: Sara Peralta of SXTXState listed “Digital Outcasts” as one of the Top 5 Picks for community activism. Thanks, Sara!

Later in 2008, I accepted a position with Euro RSCG Life (now Havas Life—what’s with all these companies changing names?) and experienced unprecedented personal growth in skill competency and confidence. Although I had previously told myself that I would never again work in a healthcare communications agency, I was fortunate to work for two of the best mentors I’ve ever had in my professional career. When I finally left in late 2012, it was with the solemn acknowledgment that I needed to stretch out and challenge myself.

Fast forward to today. Anikto has built its currency on the strength of smart marketing and thought leadership activities, while occasional projects have helped the company maintain financial solvency. I love what the brand has become and really appreciate all the folks who have supported its endeavors. But as its five-year anniversary approached, I knew that something was missing from the arsenal: nothing had been built. Anikto needed a product.

With that in mind, work has been underway to secure funding and drive efforts towards the creation of not one, but two unique digital product offerings for 2013. One of them is very close to completion and will be announced this March at SXSW; the other is still in early stages and will show itself later in the year. Both involve the participation of partnering companies and dedicated colleagues who are committed to Anikto’s mission: the creation of barrier-free technologies to support evergreen innovation and achieve a greater social purpose.

Has Anikto accomplished what it set out to do in 2008? Not exactly, but that’s the point—entrepreneurship is a constantly fluctuating landscape of pivots and hunches. I will say with all honesty that Anikto is in a better place than I could have ever forecasted, and I look forward to extending its reach over the next five years.

By the way: if you’re attending the SXSW events in Austin, I’d love to see you there. Likewise at CSUN in San Diego, World Future in Chicago and the IA Summit in Baltimore.

Yesterday also saw the passing of two all-time baseball greats: Hall of Fame outfielder Stan Musial of the St. Louis Cardinals, and longtime Baltimore manager Earl Weaver. I lived in Baltimore from 1987 through 1994, during a time when the Orioles were something of a joke. Prior to that, however, the club was among the most successful sports franchises for the better part of a generation.

Volatile, irascible, sarcastic, meticulous, visionary and profane, Weaver was a brilliant strategist whose teams won at least 90 games twelve out of his first fourteen years as manager. On six occasions his team won more than 100 games in a single season, including five division titles and three pennants. It’s unfair that Weaver is remembered more for his battles with umpires and for chain smoking in the dugout, but this is typical with damaged geniuses.

Weaver’s Legacy

One of Weaver’s greatest strengths was the ability to capitalize on the individual strengths of his players. Perhaps this was due to his own experience as a middling ballplayer who would never make the major leagues, as well as the mental transition he needed to make when he became a manager:

“It broke my heart. But right then, I started becoming a good baseball person, because when I came to recognize and, more important, accept my own deficiencies, then I could recognize other players’ inabilities and learn to accept them, not for what they can’t do, but for what they can do. And in the process, I suppose, I broke some hearts.”

Weaver was especially adept at identifying roles in which his players could excel. He routinely picked players from the Orioles’ farm system, or from other teams, and architected game scenarios in which they would be most productive. Weaver understood better than anyone that a successful baseball team requires contributions from all 25 players on a roster.

Weaver on Strategy

I have a copy of Weaver’s 1982 book, Weaver on Strategy. I’ve always found it to be a fantastic guide to managing people in any occupation, and I refer to it frequently when confronted with leadership challenges. I recommend it highly for emerging leaders; here are some highlights:

• On starting a new role: “A rookie must make an impression right from the start. He doesn’t have the luxury of playing himself into condition.”
• On preparation: “I could tell the minute a player walked into camp if he had done his work over the winter.”
• On practice: “The best players could execute fundamentals in their sleep. They never let down or forgot the importance of drills.”
• On priorities: “No one’s going to give a damn in July if you lost a game in March.”
• On keeping composure: “What good does it do to throw a helmet? It makes no sense, and your teammates don’t respect you. No one is impressed.”
• On dealing with a malcontent: “Sometimes these situations are very simple. You let the guy play his way off the club.”
• On meetings: “When meetings are rare, players usually get the idea that it must be something important.”
• On keeping your options open: “No promises. None. If you don’t make any promises, then you won’t break any.
• On regret: “After each confrontation I’ve had, I could go back and say that I could have handled it differently. But each time you learn something and get better at dealing with these things.”
• On building teams: “When a manager can walk through the clubhouse and enter his office and sit there by himself, he knows he has a pretty good ballclub.”
• On adapting: “It’s what you learn after you know it all that counts.”

Stage Three of Meaningful Use

Taking place in 2016, stage three will focus the efforts of selected healthcare providers on improving the decision support for patients. Much of the attention will be placed on self-managed tools, such as remote monitoring platforms and increasing patients’ access to administered data.

In December 2012, the Health IT Policy Committe sought public comment on proposed recommendations for stage three of meaningful use under the Medicare and Medicaid Electronic Health Record Incentive Program. In layman’s terms, this means that the US government is looking for ways to empower patients to take a more active role in their health.

With between 11 and 19 percent of smartphone users having at least one health app on their device, significant change will take place over the coming months. Patients will be empowered to capture and interpret personal health information; they will also have the ability to securely share data within a selected network of providers and stakeholders.

Challenges Facing Meaningful Use Practitioners

While there are several benefits to EHR integration, there are challenges as well. Tying reimbursement to health outcomes implies that patients with poor compliance ratings will risk being “fired” by their doctors. There is also the fear among health care providers that electronic acceptance of patient-generated health information could subject them to a higher risk of medical malpractice claims.

Then there is the matter of trust, not only between doctor and patient but also across practices — how can we be assured that our instructions and knowledge are accurately communicated outside the office? We have yet to see a set of design standards by which meaningful use can be appropriately conveyed to non-medical audiences, let alone between specialties.

Opportunities for Design Professionals

The good news is that we are entering an exciting time in personal health monitoring. All of the above efforts will create new opportunities for designers to optimize patient-centric experiences.

Newly-emerging technologies, such as wireless sensors and haptic interfaces, will forge new paths in self-care. Healthcare providers may have greater success in helping their patients by encouraging the use of these tools — a key advantage towards achieving meaningful use benchmarks.

This increased level of autonomy will require that health data be designed for optimal readability and comprehension, and that systems be architected for maximum usability. Health experience designers would do well to acquaint themselves with the Patient Engagement Framework, released by the National e-Health Collaborative. The guide covers a range of assessments across five phases of decision criteria:

• Inform Me — recommend simple tools to make health information more convenient and accessible
• Engage Me — encourage patients to use fitness trackers and online tools to manage their health
• Empower Me — integrate data submitted by patients into office EHR systems, ensuring security and privacy
• Partner With Me — support condition-specific management tools and providing access to care summaries, using home health devices
• Support My e-Community — offer participation in online groups to help patients and caregivers make more informed decisions

Accessibility and Meaningful Use

One attribute of personal health records that doesn’t get mentioned is how to ensure digital accessibility across all delivery streams. A paper printout faxed to a blind patient has little to no benefit on improving her health experience, nor does a remote monitoring device that cannot be used by a person without the use of one limb.

It is also important that electronic systems be developed according to the same accessibility guidelines used for other media; this includes captioning instructional video and ensuring that text-based communication can be interpreted by screen reading software.

The Final Word

With our population living longer (but not necessarily better), the number of people requiring frequent medical attention is expected to rise. Along with that will come an increased demand on fundamental human services. Success in life is largely a process of adaptation. We as a design community have a wonderful opportunity to guide this important transformation, hopefully resulting in a collectively improved life experience for everyone.

To learn more about how you can be involved in the ongoing health policy debate, visit the Federal Advisory Committees website at HealthIT.gov. You can also submit comments on stage three of meaningful use at Regulations.gov.

Soon after the year 2015, for the first time in history, there will be more people older than 65 than those younger than 5. By the year 2050, in fact, the population ages 65 and over will be more than two and a half times that of the population aged less than 5 — an exact reversal of the situation in 1950, when less than 5 percent of the global total was older than 65 years.

Considering that the human body stops growing between the ages of 20 and 25, this trend indicates that we have succeeded in lengthening the distance between natural mortality and current life expectancy. It also speaks to the importance of well-designed health experiences, since we are increasingly reliant on these services as we get older.

A quick study of electronic health records (EHR) may reveal opportunities for today’s design professionals to drive healthcare transformation. To understand EHR, however, we must first recognize meaningful use.

What Is Meaningful Use?

“Meaningful use” is the term applied to a set of standards defined by the Centers for Medicare & Medicaid Services (CMS). Meaningful use governs the implementation of electronic health records, allowing eligible providers to earn incentive payments by meeting criteria established by the CMS. The intention is to improve health outcomes by increasing the quality, safety and efficiency of care by promoting health IT services.

Medical practices have much to gain by adopting meaningful use. Medicare is reimbursing compliant practices up to $44,000 per physician over five years, with up to $63,750 over six years from Medicaid for meeting requirements. Doctors are required to adopt electronic health systems and achieve meaningful use criteria by October 2014, else they will see reduced payments the following year.

As of this writing, there are two regulations which define the objectives of meaningful use that qualify providers and hospitals for reimbursement:

Incentive Program for Electronic Health Records. Issued by the CMS, these rules define the minimum requirements for providers to adopt EHR technology within their practic to capture, share and advance data relevant to clinical processes.

Standards and Certification Criteria. These rules identify how EHR technology will be certified by the Office of the National Coordinator for Health Information Technology. Eligible healthcare providers — both individual physicians and hospital networks — must be assured that any systems they adopt are compliant with the required functionality.

Stage One of Meaningful Use

To put these in terms more relevant to today’s healthcare consumer, think of meaningful use as occurring in three stages between 2011 and 2016. The first stage, which reached completion at the dawn of 2013, was to ensure that EHR systems were set up to capture health information in a standardized format. With this capability in place, benchmarks can be set to track key clinical conditions and establish reporting criteria for large-scale public health initiatives.

For example — to meet stage one of meaningful use, a practice must be able to enter at least 30 percent of patients’ medication into an online summary dashboard. They must also confirm that they are equipped to enable drug-drug and drug-allergy interaction checks for the length of the reporting period. The practice or hospital must be able to provide a clinical summery for patients upon each office visit, in addition to recording vital signs and smoking status for patients of a certain age.

Stage Two of Meaningful Use

The second stage, which begins in 2014, is to focus on more rigorous procedures for exchanging health information. Where stage one was intended to demonstrate that a practice was capable of accommodating electronic health records, stage two dictates that these activities actually be implemented.

For example, there will be increased requirements for e-prescribing and incorporating lab results into diagnostic reports, as well as the use of computerized order entry for all medications and radiology orders. Practices will also need to examine their options for exchanging data with local hospitals — both in and out of network.

From a technology and user experience standpoint, stage two will be the crucible of proof. Vendors who guaranteed that their systems would meet stage one criteria will now be tasked with delivering actual results. Patients will also need to be educated on the importance of accessing their EHR and ensuring their availability.

According to Jeff Loughlin, project director for the Massachusetts eHealth Collaborative, physicians will bear the onus that medical knowledge is transfered accurately and completely to their patients. “The mentality is that patients think medical records are for medical professionals,” he says.

To Be Continued

In part two of this post, we’ll investigate where today’s user experience professionals can have the most impact on the current healthcare ecosystem. Here’s a hint: it’s in stage three.

Imagine that it’s 1989 and we’re watching late-night television, probably a bad horror movie or dramatic comedy from earlier in the decade. During a commercial break, we see an elderly actress falling to her bathroom floor. She flails around for a bit before touching a gadget around her neck. Pressing a button, she yells, “I’ve fallen and I can’t get up!” Within seconds, a dispatcher is seen being sent to the woman’s home to assist her, thanks to a subscription medical alarm and protection service called LifeAlert.

The intention of the piece was to deliver a powerful example communicating the importance of long-distance care for older people. Unfortunately, most critics took note of the camp, unconvincing performance overshadowing the message. As a result, “I’ve fallen and I can’t get up” became a satiric pop-culture landmark for the late 1980s. Thankfully, the joke has lost currency in today’s comedic vernacular.

I thought about this while standing in the waiting room at Holland Bloorview Rehabilitation Hospital, located in a leafy section of Toronto. The hospital’s fourth floor waiting area consists of brightly colored squares of carpet laid in front of a large screen. Rather than provide a noisy television to help visitors pass the time, the Bloorview research team installed sensors in the carpet that emit signals to the screen when pressed. Lightly stepping on the carpet produces a slight visual effect; applying firmer pressure results in a kaleidoscope of interesting patterns. The haptic carpet rewards effort by creating an entertaining medley for the eyes.

Smart carpets aren’t simply for fun, however; they also detect and measure imperfections in gait and transmit data when a fall takes place. This is just one example of research being done in the area of haptics, as teams explore interface technologies that operate as touch mechanisms for personal emergency response systems (PERS). You might think of PERS as a “panic button,” not unlike the LifeAlert scenario described above.

A recent article in Mobile Health News has issued a call-to-action for nursing homes, assisted-living facilities and senior residences to explore alternatives to the “panic button.” From a user experience perspective, the flaw of today’s PERS is that the user still needs to push a button to activate the device. From someone who is unconscious and unable to summon help, this is a problem.

The future of PERS is not likely to take the form of a pendant or push-button activation system. We can expect tomorrow’s systems to be more fully integrated into our environments, in the form of sensors embedded into furniture and carpets — just like what I saw demonstrated at Bloorview. Someone laying motionless on the floor would be relieved of the onus, since the decision point to summon help could be programmed directly onto the surface upon which she’s fallen.

What we need is for haptic technologies to respond more passively to the needs of the homebound disabled and elderly. We’ll also need more sophisticated algorithms than a simple phone service. Systems will be required to distinguish between authentic emergencies and false alarms, and they will additionally need to triage the appropriate first responder. This can’t be accomplished with just an iPhone app; it involves the design of living spaces that combine comfort with accommodation.

The prosthesis is implanted in the blind person’s eye with 60 electrodes. The user wears glasses that convert the surrounding video signal into electrical pulses, which are transmitted wirelessly to the electrodes and stimulate the retinal nerve cells.

Although the apparatus doesn’t replicate normal vision, it does allow users to identify printed letters that would ordinarily be felt with the fingers. One test subject produced an 89 percent success rate for identifying individual characters and 80 percent for short words.

While there is still a way to go with this technology, it will be interesting to discover what impact these innovations will have on the way blind people approach their disability. Will the availability of retinal Braille patterns have an effect on people’s expectations for accommodation services? Too soon to tell, at this point.

Max Ortiz Catalan, biomedical researcher at the Chalmers University of Technology, told Wired that “[Patients] will be able to simultaneously control several joints and motions, as well as to receive direct neural feedback on their actions. These features are today not available for patients outside research labs, our aim is to change that.”

At the risk of boring readers familiar with myoelectric prostheses, the device works by placing electrodes over the skin to detect and capture nerve signals from the brain’s white matter. A computer algorithm translates these signals to the skin surface. Catalan’s thesis is that implanting these electrodes directly to the nerves can capture discarded ions with less “noise,” creating a more natural path between brain and muscle.

The procedure that Catalan and his team will carry out includes anchoring the prosthetic limb to the patient’s bone using titanium screws. An implant will transmit signals from the electrodes to the limb, offering a more faithful representation of how arms are designed to work. Patients will be able to use their minds to control their arms, just like able-bodied people do.

Surgeries will be conducted in January or February of 2013, with the first test cases to be patients who had limbs amputated several years prior.

• In advance of this weekend’s appearance in Toronto, Amanda Kwan of the Globe & Mail Canada writes about supporting innovative accessibility as a global concern.
• Coinciding with Anikto’s appearance at Knowbility AccessU came this piece by Omar L. Gallaga in the Austin American-Statesmen. The piece was subsequently picked up by the Denver Post, the Dayton Daily News, the Raleigh-Durham News Observer and Physicians.Org.
• In May, the U.S. Labor Department announced a $10k accessibility award. American Training quoted Anikto and gave the book a nice mention.
• Last but not least, Laura Legendary said some very kind things on her blog Accessible Insights.

It is always a privilege to represent the work we do and the people we serve. Many thanks to those who said nice things and otherwise endorsed Anikto projects.

I usually start by going into some detail about patients with long-term illness or injury, who are unable to leave the house and thus rely on the attention of traveling nurses. I then mention the daily challenges of motivation and interest. I describe the tendency among homebound patients to prematurely cease their therapy exercises, because they erroneously believe that personal improvement has been made.

Or I simply reveal my favorite quote from an old college friend: “We live in a high-tech, low-touch society.”

A Problem of Access

I should provide a little context. Remote care can be a serious barrier for patients with brain injuries, vision/optic nerve reactions, multiple sclerosis, cerebral palsy, stroke and muscular dystrophy. In some cases, just getting to a facility involves a great deal of effort and coordination. Home care nurses are employed to look after such cases with the assigned task of getting their patients “unhomebound” as quickly as possible.

Patients live all over the country and nurses can’t be everywhere all the time. That’s why remote patient monitoring (RPM) technologies are of such interest to the medical community. The idea is that iPhone apps and telephony products allow for the same quality of care with fewer in-house visits. For a nursing population that drives twice as many miles annually as UPS, that’s quite an impressive benefit.

There’s a problem, though. For all the wonderful technology that’s out there, much of it is inaccessible from the standpoint of cost, availability or awareness. Mobile apps and devices continue to proliferate, yet 28% of home health patients return to the hospital due to a lack of follow-up care. Even worse, medical non-adherence is the fourth-leading cause of death in the United States.

Changing Behavior

Let’s go back to that old college friend. She is a healthcare professional who works with homebound patients. We were discussing this when she mentioned that wonderful quote by Nedra Gillette, Director of Research Resources for the American Occupational Therapy Association: “We live in a high-tech, low-touch society,” which perfectly crystallizes the RPM dilemma.

Hearing this quote, for me, defined a personal “ah-ha!” moment when everything suddenly clicked. It became very clear that the problem with RPM mobile apps and devices isn’t merely a question of capability. It’s how the devices are implemented and whether the benefits can be easily distributed among health providers, reimbursement agents and patient communities — from both clinical and financial perspectives.

The early thinking on RPM was that automating as much as possible would benefit both patients and health care providers. Investors have certainly noticed — AT&T last month announced a partnership with Valued Relationships Inc. to deliver an RPM service targeted for physician practices, hospitals and payers. In fact, the RPM industry is expected to hit $295 million by 2015, with such emerging markets as China and India expected to participate in the market’s expansion:

Increases in chronic disease cases and the elderly population, in addition to technology innovations, are seen as reasons why the patient monitoring market will continue to experience strong growth on a global scale. GBI predicts that market to grow at a compound annual growth rate (CAGR) of 4 percent per year. China and India are expected to be “potentially lucrative markets” for growth due to their “huge patient bases and … under-served” populations.

One of the lessons learned is that iPhone apps alone won’t predict outcomes, improve care practices, or make people well. Behavior can only be modified through consistent and productive feedback. Technology is simply a means to better track and understand that behavior, so perhaps the solution is in better alignment of technological devices with everyday life.

iPads From the VA, Computers in Your Clothes

A number of recent developments point to a rosier outlook. One is the decision by the Department of Veterans Affairs (VA) to give pre-loaded iPads to veterans to help them communicate better with their physicians. The “Clinic-in-Hand” pilot program is designed to improve contact points between doctors and patients, using special apps that monitor heart rates, blood pressure and other vital signs. The caregivers can securely track their patients’ progress and intervene when necessary, with full access to administrative tools.

Another development is the creation of wearable computing devices that operate as health monitoring tools. Sonny Vu is an entrepreneur who runs a company called Misfit Wearables, which places wearable sensors in clothing and everyday objects to unobtrusively track health data. Vu sees his company as the next evolution of RPM, and he might be right:

Mobile health devices and software could change medicine profoundly, allowing people to continuously monitor vital signs and better track and modify behavior. That’s important because chronic diseases like obesity and diabetes are on the rise. “We’re seeing an infusion of mobile technologies into people’s lives,” says Susannah Fox, who studies technology and health care for the Pew Internet & American Life Project. “And we’re seeing a very rainy forecast in terms of people’s health.”

The idea of smart textiles is not new (look at what fiber students at the Maryland Institute College of Art are doing). However, the placement of tiny sensors in some haptic interface, such as a glove or brace, allows for possibilities that homecare nurses have desired for some time: improved care and quality touch points despite financial and logistical constraints.

Moving forward, it’s clear that some amalgam of personal technology and behavior modification will cultivate an exciting digital landscape. It is also clear that the quality of care will continue to be determined by the patient/provider relationship. To quote Vince Kuraitis, author of the eCareManagement blog on healthcare technology, “Maximizing automation isn’t necessarily the right way to go. A better way to look at this is as optimizing the right mix of automation and patient involvement.”

During the Q&A afterwards, Molly Holzschlag (of MollyDotCom fame) asked a question regarding my daily activities — how I get started, how I connect with other participants, how I drive innovation among peers and colleagues, etc. My response wasn’t great, so I’m going to take a moment here to answer her question more fully.

In my view, creating and launching a new digital innovation product generally occurs in three steps: Gap Identification, MVP Iteration and Market Development:

Gap Identification

First you have to locate your problem — some need in the social or commercial marketplace to be addressed. The accessibility arena is especially rich with gaps to fill on behalf of people with disabilities. A great start are daily news feeds. Is there an area of exploration in which an underserved population can benefit from a new offering? Is there something of particular interest to you personally?

Research everything you can about the problem. Talk to key thought leaders within the space, ask them questions, soak up all the knowledge that’s out there. When I first started working in accessibility twelve (!) years ago, I spent months asking people with various disabilities about all sorts of everything: their frustrations, their victories, what they desired, what they wished technology would do for them. These conversations have framed my thinking to this day.

The next step is to run a miniature version of SWOT/PEST analyses on your problem. It doesn’t have to be a formal process, just something to help suss out and clarify your thinking. Most people are familiar with SWOT (strengths, weaknesses, opportunities, threats). A PEST analysis examines the political, economic, social and technological factors that constitute a problem’s micro-attributes.

At the conclusion of this step, you should feel confident describing the problem in a succinct 30-second sound bite. You should also have key data points to support your rationale, as well as recent news articles detailing its timeliness. An assumption here or there is appropriate at this early stage, as that’s usually where innovation is derived.

Once you have a problem identified and some potential thinking around it, you’re ready to begin prototyping.

MVP Iteration

I’m a believer in MVP (minimum viable product) prototyping, because it allows things to progress at an advantageous cost point with easily attainable effort. I had a great discussion Tuesday with Karl Groves on the value of the Agile methodology, which emphasizes collaboration and adaptative evolution over feature sets derived from rigid requirements. The Agile approach suits the MVP model well.

Since the best way to solve a huge problem is to break it into manageable goals, I tend to increment the MVP in a series of versions (which I call v.1, v.2, etc.) Remember that each stage is iterated with the intention of achieving the next level. MVP v.1, for example, might just be a Powerpoint slide or one-pager to present to your supervisor to collect her input. MVP v.2 might be a storyboard or screen flow to deliver to project teams.

In a typical project, I usually have a fairly defined milestone in the future I’m trying to target. It might be a stakeholder presentation to solicit funding, or a pilot program to test on authentic users, or a small clinical trial for a medical device. In all cases, the purpose of MVP is to build a series of success stories that collectively operate as a proof-of-concept. The end result is something you’d feel confident putting in front of potential investors.

The most important aspect of MVP is to iterate not only the prototyping, but also the learning. You’ll discover new things along the way that alter your original thinking or even force you to change course. This is part of the process and should be expected. Adaptive thinking is a tremendous asset to innovation teams; the Zen proverb “bend like a reed” applies here.

Market Development

This is where things get fun. At each stage of the MVP, you are honing the message you want to deliver. You should have a very firm idea of how your offering will benefit your identified target audience. You should also be able to predict and meet objections, and to be very open about what you’ve discovered along the way.

It’s at this point where the innovation question evolves from “what if?” to “so what?” Always frame your MVP into a definable context: can you identify a business need to which your offering can bring value? What is the desired outcome for potential investment groups? Can you promise a short-term return on investment, and what is the long-term benefit?

Here is some top-level guidance I’ve learned in the past few years about pitching innovation:

• Invest in yourself. If you haven’t been willing to put your own funds into the endeavor, it’s difficult to expect that others will.
• Be honest. Admit what you don’t know. Emphasize what you do know. Back it up with numbers.
• Care. Bring authentic passion and knowledge to the table. Investors are more likely to fund an idea with confidence, if the concept resonates meaningfully with the person driving it.
• Have a goal in mind. Be very specific: “I want to take this current MVP and test it on x number of users, which I will then translate into x commercial opportunity.”
• Define your targets. Don’t just say “people with disabilities,” for example. Narrow the swath to a segment culled from your research and intuition.
• Ask for the order. This is Selling 101. Respectfully present your offering as an opportunity to do something great together. If you’ve done your preparation, this should come easily.

A Final Thought

The one item I haven’t yet addressed from Molly’s question is how I connect and maintain relationships with stakeholders. To be honest, there’s no magic bullet other than to be genuine and sincere in all communications. I personally value integrity above all else in my personal and professional relationships. I’d like to think that people who work with me do so because they share my value structure and moral compass, and they’re willing to demonstrate that with me as we achieve great things together.

Ridley’s routine is funny, intelligent, and softly self-deprecating:

“In case you were in any doubt I really am disabled. It’s not just really good acting and I’m definitely not just in it for the parking space.”

“When I realized I would never be able to talk again I was speechless.”

“I am not related to Steven Hawking in any way. However I do hate the way people take the *** out of the way he speaks. I can really synthesize with him!”

“People have often asked me why I want to put myself in a position where everyone can look and stare at me. The truth is that it happens to me every day any way. At least this way there’s a scheduled time and place for it.”

Presenters with disabilities who use an iPad is not new; at CSUN 2011, Glenda Watson Hyatt told a wonderful story through the device and captivated a full ballroom. It is nice to see folks transcend the use of technology for a greater purpose, such as expressing oneself or to pursue a career goal.

Many thank to Char James-Tanny for bringing this story to my attention via Twitter.