Healthcare Needs Radical Revision. Agitating for Change...

My Dad’s Experience with a Shiny New Tablet…

2013-01-10T09:46:00.000-08:00

My Dad’s Experience with a Shiny New Tablet…

I was fortunate to spend the holidays this year with family. It’s one of my favorite times of year and one for the few times when I get to see my folks live face to face. All of the distractions of the year are put behind me for a while and we connect in a way that’s difficult across the distance. It’s also a time when I’m keen to observe my dad. How’s his mobility, his mental acuity, are the stairs a problem. He’s almost 80, but as far as I can tell he’s in fantastic shape. I always get a second opinion from my sister who’s a doctor and she concurs. We’re fortunate and we know it.

My dad will tell you he’s a little challenged when it comes to computers. That usually puzzles me. Throughout his career as an engineer doing design work for the sophisticated electronics that kept our Air Force planes technically superior to all others, he was no stranger to the highly technical. He setup his own broadband. All of his computers are networked. He uses Skype to video conference like a champ. I wouldn’t exactly call him challenged.

Dad sent me a note before the holidays and told me he’d be bringing a shiny new tablet for our annual visit. This piqued my interest. The tablet form factor seemed like a nice fit for technology that can help with aging in place. In general I’m a big fan of the power of User Experience (UX) and User Centered Design. I have no classical training in UX, but observational research and the simple art of watching people do things isn’t terribly difficult to master.

It’s no great mystery where I inherited my love of new technical toys from. Dad proudly showed me his shiny new tablet and he was completely jazzed up about it. The brand isn’t important. Like most it has a large HD screen and a touch screen key board. You can use gestures with it. It has an app store with apps for productivity and pleasure. Dad did well. I could see he was frustrated with the key board and the “helpful” auto correct was quickly disabled. But he could navigate, use the internet, check his email and use a few apps. In addition he showed me how he could use the infrared on the tablet to interact with the TV.

Next up he wanted to use a book reader app. He had “heard” from many of his friends that they used tablets to read. Nothing like a little peer envy to motivate. He got the app, downloaded a free book and then the fun began. The backlighting and ability to increase font size really makes a difference for seniors reading and he loved it. Disappearing menus with no sign of how to bring them back were frustrating, but a painful trial and error discovery process finally paid off.

During a little downtime in the action I watched Dad play solitaire dragging cards with his finger. He was totally engaged and I could tell he was having fun. The graphics and sound were phenomenal. I also watched him use a Hubble Telescope app to look at images out in space for a huge bit of entertainment. The quality and beauty of the imagery on the device was incredible.

Selfishly I wondered if I could introduce Dad to a healthy app and see what happened. I have personally used MyFitnessPal to track diet and exercise and I enjoy the web and mobile functionality. We had the app installed in no time and I walked Dad through the basics of the setup with only a small hiccup on what his definition of sedentary is versus the MyFitnessPal version, but I convinced him to play along. We ran through a few of the meals we’d had and how that impacted the calorie count for the day versus the exercise. Exercise adds calories to the bucket the user can afford to eat and meet their goals. Pretty soon it was clear that entering every single morsel was going to be a little bit tedious so I pulled out my ace in the hole. I asked dad to get one of the Trader Joes boxes from my sister’s freezer and bring it over. I told him you know Dad I think this thing is smart enough to scan the bar code and enter the calorie info for you. He pointed it at the barcode and voila. It worked. That earned the app a big smile and a head shake of amazement. I wouldn’t say it’s as easy to use as it could be, but it’s at least within the realm of possibility.

I thoroughly enjoyed watching Dad use the tablet and I’m convinced it could be a good form factor for a device to help with aging in place. The hook could actually be the reader that helps someone enjoy an activity that’s more difficult otherwise. The games are engaging. The connectivity to the world through internet, email and video help maintain social connection. The birthday reminder app was well received and I believe other reminder apps could work for healthy behaviors. Several fitness and biometric devices integrate to the tablet through blue tooth. And this device is not senior ready or friendly with no modifications. Imagine what could happen if it were designed and skinned to support seniors. Again we know we’re fortunate that Dad is doing well. I believe a tablet will be helpful for him and others like him as they remain active and engaged in life with a few reminders along the way.

I’m an eternal optimist and want to be a part of changing healthcare. That’s why I titled the blog Healthcare Change Agitator.

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What to Do, Where to Start? Conversational Hypotheses...

2012-12-11T08:39:00.000-08:00

What to Do, Where to Start? Conversational Hypotheses...

Now we’ll continue our journey with the follow up to my last post Why Do I Care and Does it Matter if I Do? We’ve looked at the market and it seems promising, but are there really unmet needs and if so who can help us understand whether someone would pay for us to solve them? It’s time now to formulate some hypotheses. In other words, it’s time now to ask questions. We will try to ground our questions in the research we’ve done. Our guesses should be as smart as possible, but they are, in the spirit of The Lean Startup and the Startup Owner’s Manual, only guesses.

I took a stab at some of these needs and guesses in a previous post and here they are again:

· Support seniors in living their absolute best life where they want to live it!

· Keep families and caregivers connected, even across long distances

· Support and promote socialization

· Promote safety and peace of mind

· Assist with activities of daily living

· Help coordinate the myriad of care activities

· Enable easy interaction with community services and businesses

· Are easy to setup, intuitive, and easy to use

· Are affordable to acquire and to keep

This isn’t an exhaustive list and there are many more needs than I can blog about in any one post, but they’re at least a good place to start. Let’s dive a little further into some of the issues. I believe technology can help with all of these:

1. Information and resources for Aging in Place are difficult to find and it’s hard to know who to trust.

What could help: Secure, comprehensive one-stop shopping website resource for families and seniors creates an ecosystem of resources that support Aging in Place

2. Caring families recognize that their senior loved one needs assistance at home, but a change in home location is neither financially feasible nor desirable.

What could help: Easy, intuitive, and affordable technology solution providing monitoring, reminders, entertainment, as well as linkage to community services, family, and friends. Provide a subscription model that keeps costs low.

3. Getting started with any technology can be intimidating.

What could help: Intuitive touch and voice controlled interaction with a companion device. Concierge service to ease product setup and provide training and coaching for senior use. Think Geek Squad for the elderly and the Apple store in the home.

4. Seniors can use a little help to remember important things.

What could help: Visual and audible reminders for medications, appointments, social engagements, etc.

5. Seniors don’t want to rely on their families for all daily activities.

What could help: Seamless merchant access to purchase groceries, medications, and more. Mobility enabled through easy access to transportation services.

6. Seniors need to know that help is nearby when they need it.

What could help: One touch access to geriatric care managers, physician office, and urgent care support; video link to family and critical support services.

7. Adult children want to stay engaged, know how their loves ones are doing, and help with reminders and encouragement.

What could help: Web portal snapshot of all the things that matter: appointments, transportation, biometrics, medication adherence, wellness trending reports. Visits to seniors become more social and enjoyable and less about serving their needs.

8. Seniors do not want to feel isolated in their homes; they need social engagement and encouragement to continue interaction with peer groups.

What could help: Notification of activities for seniors in the local community; promotion of senior social interactions and events; companion devices that provide socialization.

9. Seniors may not be able to react quickly in the event of an emergency.

What could help: Environmental and physiologic monitoring and notification; integrated personal and environmental alarm systems

10. Remembering to get and record biometric data is a difficult, manual and error prone process.

What could help: Biometric sensor add-ons to acquire and store data such as blood pressure, weight, glucose, and more.

11. Seniors can use a little help and motivation to do the things that help them live their best life.

What could help: Fun and challenging cognitive games and behavioral economic features to keep seniors motivated and challenged.

Now we’ll take that list and get ready for a series of conversations to validate that these are real issues and that the broad based solutions suggested could help. We’ll also be looking for other data points with questions like these:

1. What’s the right age group to benefit from these types of solutions?

2. Does cognitive impairment, hearing or eyesight pose a barrier to solutions?

3. Who would make the purchasing decision for a solution and who would be a strong influencer?

4. At what point does price become a show-stopper?

5. What business model is attractive? Is there more than one?

6. What’s the best channel to reach these buyers and influencers?

7. Is there a need for a holistic solution integrator?

8. Is there anybody making money in the market now?

9. What’s the level of awareness that tech could help among different stakeholders in the ecosystem?

10. What’s missing? What could make a game changing difference that nobody’s doing?

Who should we talk to when we get out of the building? Geriatric Care Managers, Geriatricians or at the very least General Internists that care for seniors, Aging In Place Technology vendors and experts, Home Care Agencies, Silver Centers and Adult Children caring for aging parents. That’s a lot of conversations, but it’s important to triangulate multiple perspectives. We should expect to find that some of our brilliant hypotheses don’t stand up to these conversations. If so we’ll adjust as needed and be glad all it cost us was a phone call or a meeting.

In previous posts in the series I tackled two topics:

· Interest in the space - Why would I be passionate enough to spend my nights and weekends on this?

· Market Analysis – Is there really a big unsatisfied need and what’s it worth?

In this post in the series I tackled this topic:

· Hypothesis for needs and features – What to do and where to start?

Next up I’ll take a look at:

· Getting out of the building – Conversations with Geriatric Care Managers, Geriatricians or Internists, Aging In Place Technology vendors and experts, Home Care Agencies, Silver Centers and Adult Children caring for aging parents

After that we’ll continue the journey with these:

· Using Startup Tools – How can I do this on a budget my wife won’t get mad about? In other words super cheap?

· Web site – I’m no web developer so how can I stand something up that doesn’t suck?

· SEO and Analytics – The tools are free, but they take a little getting used to…

· The lowest fidelity MVP/Bait I could develop – Really low, but you have to start somewhere…

· Learning AdWords by trial and Error – I blew half my cheapo budget before I learned a few tricks…

· A/B advertisements – I’m probably not a copywriter and I can’t predict what the market will like, but the market will vote quickly

· Driving Traffic – I figured out how to pay people to come, but my inquiries from Hawaii weren’t what I was expecting.

· Lessons Learned – It was fascinating and here’s my conclusion

· What's Next – Maybe you guys have some thoughts?

Stay tuned for a series of posts on the journey…

Why Do I Care and Does it Matter if I Do?

2012-12-03T09:18:00.000-08:00

Why Do I Care and Does it Matter if I Do?

Now that the U.S. Thanksgiving holiday, Black Friday madness and Christmas shopping is done, I thought I’d continue what I started in my last post The Destination Was Not What I Expected, but the Journey Was Fascinating. I’ll describe the first parts of my journey in this post. The first test for me when I consider investing time in an idea, a market or even a hobby is whether I am totally jazzed up about the concept. I mean really who can afford to carve out time to spend on things they aren’t totally passionate about?

So why would I care about something to do with getting older, frailer and maybe a little more forgetful. It’s a little outside my normal bent to look at rocket science cool tech for healthcare. I actually started becoming interested in tech for aging in a sideways sort of way by thinking about some of the other problems in healthcare. We have a chronic disease epidemic, hospital readmissions are at the top of the issue list for CMS and for hospitals facing penalties, accountable care organizations are on the hook for what happens when the patient leaves the provider. In almost all these areas the demographic group that has the largest impact is made up of those folks that are getting a little older. That’s enough to make it interesting. I’m also one of the many adult children in the country that doesn’t live in the same city or even the same state as my parents. I worry about them and I want to help, but distance and time is difficult. So my first criteria is absolutely met, I do care.

But does it really matter? That’s where I need to do a little research to answer some questions. Is there a market and is it a big one? Are there unmet needs in the market? Are the problems really hard to solve? Is there room for innovation? Are there a lot of players already providing solutions and do they hit the mark? Is the market penetrated? Does one player have it basically locked up or is it fragmented? Who’s the buyer and who pays? Before you ever “get out of the building” for the real answers to some of the hypotheses you may have, it’s a good idea to get as smart as you can and not waste peoples’ valuable time.

It’s an interesting space to study. The first fairly blunt instrument to use is just the snapshot of U.S. Census data for 65+. Here’s a chart that show that data through 2030.

That certainly seems like a big market opportunity with 40M 65+ today moving to 55M by 2020. You can also see that are a lot of 60 – 64 Year olds in the pipeline. Those are large numbers, but I’m sure none of you believe that represents the total addressable market. For that matter we don’t even have a segment at this point to try to estimate what could be addressable much less any idea what channel we might use to address any segments we come up with. Research is sort of like peeling an onion and each layer you peel comes with another set of clarifying questions. So there is a boatload of people getting older. What are some of the ripples we see from that? Here are a couple of interesting factoids from further reading:

“More than 65 million people, 29% of the U.S. population, provide care for a chronically ill, disabled or aged family member or friend during any given year and spend an average of 20 hours per week providing care for their loved one.” - Caregiving in the United States; National Alliance for Caregiving in collaboration with AARP; November 2009

“Thirty percent of U.S. adults help a loved one with personal needs or household chores, managing finances, arranging for outside services, or visiting regularly to see how they are doing.” - Family Caregivers Online; Pew Internet; July 2012

Okay so we have a ripple effect in that a large number of people are being pulled into the problem because they’re providing care. Many people describe those folks as adult children and caregivers. I’m not even adding all the care providers (docs, nurses, hospitals etc…) into that bucket.

The numbers look pretty encouraging. Next up I want to read research reports. Many of these are available to the public for free. I read around twenty. At this point I’m triangulating. Does everyone see the market and the problems in a similar way? Are they sizing up the opportunity the same? What are the barriers to entry and resistance points? Are there any show stoppers? I won’t go through all the reports here, but I’ll give a pointer to my favorite by Laurie Orlov of Aging in Place Technology Watch. Her 2012 Technology for Aging in Place Market report is the best work I’ve seen. In the report she describes four categories for solutions in the aging in place market: communication and engagement, health and wellness, home safety and security and learning and contribution. Other analysts have done deep dive reports in these categories for PERS, tele-health and remote monitoring. As I read all of these reports it’s valuable from a triangulation perspective, but daunting from a market fragmentation perspective. Yes there’s a giant market in the aggregate, but are the fragments hard to reach? Laurie has good thinking on the holistic integration of solutions in the space. There really don’t seem to be many systems integrators providing seamless solutions that cross the problem space.

Another sticky question in the market is whether it’s the senior that’s the buyer or is it the adult child? How should we think about the solutions? Is there an age segment that would benefit the most? How about cognitive impairment or decline and even Alzheimer’s? Would those conditions make parts of the market less attractive or more attractive? Who are we helping the adult child or caregiver or the senior?

At this point in the journey it’s clear that there’s a large demographic tsunami causing a large potential market. There are some solutions that are more point solutions to specific issues. There don’t appear to be any clear market dominators in any of the solution categories. I’m also at a point where feel like there are more questions than answers. It’s probably time for some hypotheses in the spirit of those three books I mentioned in my last post: The first is Business Model Generation by Alexander Osterwalder which uses a nine block canvass to generate a set of hypotheses for how a startup business can attack a market opportunity. The second is The Lean Startup by Eric Ries which brings a scientific approach to validating your startup ideas/hypotheses. The third and perhaps my favorite is the Startup Owner’s Manual by Steve Blank.

In this post in the series I tackled two topics:

· Interest in the space - Why would I be passionate enough to spend my nights and weekends on this?

· Market Analysis – Is there really a big unsatisfied need and what’s it worth?

Next up I’ll take a look at

· Hypothesis for needs and features – What to do and where to start?

After that we’ll continue the journey with these:

· Getting out of the building – Conversations with Geriatric Care Managers, Aging In Place Technology vendors and experts, Home Care Agencies, Silver Centers and Adult Children caring for aging parents