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Somewhere along the evolution of electronics that created your much loved iPAD or Android tablet, a fairly seismic mutation had to happen in the technology family tree. Somehow, the great lumbering, room filling, valve driven computers that were built to serve the needs of venerable business and government institutions, sprouted a delinquent evolutionary lineage, selecting instead for the needs of the individual user.
We can thank Bill, or Steve (W. or J.) or Clive, or the transistor, or whoever you think fit, but this shift away from the development of institutional electronic dinosaurs set the course for the emergence of technology designed for individual use.
This technology has fundamentally shifted the relationship between individuals and the institutions we interact with. Going to the bank, visiting the post office, checking a book in the library, doing your shopping or paying your tax no longer means leaving your house or demands that you work around other people’s timetables and systems of work.
But in healthcare, the shift to supporting personal experiences on personal devices hasn’t really made the same inroads. Like computer development in the 1950’s, the focus of the vast bulk of healthcare technology development has been on serving the big institutional customer. While this development has of course delivered impressive diagnostic and interventional advances, it hasn’t shifted the boundary between expert carer and patient.
In the healthcare world, technology designers are still primarily designing technologies for expert users. Yes, you can buy an app that will tell you how many times you’ve run up and down the stairs, but if you’ve got a funny pain in your chest (possibly from trying the app) you’re still coming to the Emergency Department for a proper assessment, by proper experts using proper medical technology. And until someone develops a Star Trek Tricorder to plug into your iPhone to diagnose all ills, it is likely acute hospitals will continue to serve this function for some time. But even with current technology there are a lot of things that could be done to shift the emphasis away from traditional institutional care to a more home focused approach.
In particular, with an ageing population, the sooner a health problem can be spotted at home and the more chronic conditions can be managed at home, the better. The core technologies envisaged to help support older people stay well and healthy at home aren’t particularly complicated: falls detectors, activity detectors, blood pressure monitors, video consults and ECG monitors all suitable for embedding in home based systems have been around for years. And yet very little impact is visible. If we can’t make progress with these things, how will we ever manage to deploy the more complicated things expected in the future, like in home robots or more complex home diagnostic tests?
Part of the uptake issue is clearly systemic; for one thing no one is entirely clear how a care system with more emphasis on in home technology would be funded, or how technology developers will get a return from it. Equally healthcare providers are reluctant to invest heavily in technologies to support care at home, without proof that the technology makes medical or financial sense. But part of the issue, I suspect, goes back to that technology evolutionary tree.
Healthcare technology has yet to sprout that delinquent branch that says, no, I’m designing for the user, not the doctor. Until then we’re unlikely to see healthcare technologies that older people actually want to use in their own homes and which have a genuine positive impact on health and wellness. Of course designing for the user doesn’t mean designing without the doctor: home based healthcare technologies should embed medical expertise, but still be designed around the user.
Someday, perhaps fairly soon, someone will walk out on a stage in the best tradition of technology unveilings, and pull the covers off a device, or an app, or a concept, and everyone recognise it immediately as the breakthrough idea that will alter older people’s relationship with healthcare. Whoever it is, I’m fairly sure they will have designed with the end user clearly in mind.
In order to shake the tree a little (and stretch my tree metaphor even further) St. James’s Hospital ran a public engagement on Technologies for Successful Ageing as part of Dublin City of Science in November 2012. The concept behind the event was to provide a space where older people, technology designers and healthcare providers could come together to imagine how technology can best support older people in staying well and happy in their own homes. It was our small contribution to redirecting the course of health technology design towards the needs of the older user.
You can check out the outputs of this event at Active Age Space. Dr Gerard Boyle is Principal Medical Physicist at St James’s Hospital and a member of Mercer’s Institute for Successful Ageing. An electronic engineer by background, he has an interest in user-friendly design across the life-span. He is the technology principal investigator for the Local Asset Mapping Project.