Wednesday, November 5, 2014

The Calf-Path

When attempting to solve the world's problems, whether mHealth or otherwise, sometimes it helps to take a step back and reevaluate your strategy.  Following in the footsteps of others may seem effective and efficient, but often it's necessary to blaze your own trail.

In case it's new to you, enjoy the following poem:

The Calf-Path (1895)

Sam Foss

One day through the primeval wood
A calf walked home as good calves should;
But made a trail all bent askew,
A crooked trail as all calves do.

Since then three hundred years have fled,
And I infer the calf is dead.


But still he left behind his trail,
And thereby hangs my moral tale.

The trail was taken up next day,
By a lone dog that passed that way;

And then a wise bell-wether sheep
Pursued the trail o’er vale and steep,

And drew the flock behind him, too,
As good bell-wethers always do.

And from that day, o’er hill and glade.
Through those old woods a path was made.
And many men wound in and out,
And dodged, and turned, and bent about,

And uttered words of righteous wrath,
Because ‘twas such a crooked path;

But still they followed—do not laugh—
The first migrations of that calf,

And through this winding wood-way stalked
Because he wobbled when he walked.
This forest path became a lane,
that bent and turned and turned again;

This crooked lane became a road,
Where many a poor horse with his load

Toiled on beneath the burning sun,
And traveled some three miles in one.

And thus a century and a half
They trod the footsteps of that calf.
The years passed on in swiftness fleet,
The road became a village street;

And this, before men were aware,
A city’s crowded thoroughfare.

And soon the central street was this
Of a renowned metropolis;

And men two centuries and a half,
Trod in the footsteps of that calf.
Each day a hundred thousand rout
Followed the zigzag calf about

And o’er his crooked journey went
The traffic of a continent.

A Hundred thousand men were led,
By one calf near three centuries dead.

They followed still his crooked way,
And lost one hundred years a day;

For thus such reverence is lent,
To well established precedent.


A moral lesson this might teach
Were I ordained and called to preach;

For men are prone to go it blind
Along the calf-paths of the mind,

And work away from sun to sun,
To do what other men have done.

They follow in the beaten track,
And out and in, and forth and back,

And still their devious course pursue,
To keep the path that others do.

They keep the path a sacred groove,
Along which all their lives they move.

But how the wise old wood gods laugh,
Who saw the first primeval calf.

Ah, many things this tale might teach—
But I am not ordained to preach.

Saturday, November 1, 2014

Why you'll never use CurrentC (and why this matters to healthcare)

Oh! You've never heard of CurrentC? That's ok, you're not missing anything. With Apple Pay making news recently as a frictionless and secure payment system, the spotlight has been shone on businesses who have opted out of the new service. In fact, the biggest complaint with Apple Pay is that not enough businesses are accepting it.

It has also come to light that the reason why many large retailers have opted out of Apple Pay is because of a consortium called the Merchant Customer Exchange (MCX), which is an effort spearheaded by Walmart to encourage customers to replace credit cards (with fees that the retailers loathe) with their checking accounts.

Here is how CurrentC works (according to those who have used the currently invite-only service):

  • Download the CurrentC app (Apple App Store or Google Play)
  • Register for an account
  • Add a PIN to the app
  • Add a checking account to the app
    • NOTE: this requires giving CurrentC your SSN and drivers license number, which, in their own words, "is not stored in your phone."  As if it makes us more comfortable to know that critical information commonly used in identity theft will be stored in the cloud of an organization that has already been hacked.
  • Add any rewards programs you would like to use with the app
Alright! Now you're ready to pay! To do that, just perform the following steps:
  • Take your phone out of your pocket/purse
  • Unlock your phone (if you have a PIN/passcode)
  • Find the CurrentC app on your phone
  • Type in the CurrentC app PIN/passcode
  • Navigate to the payments section of the app
  • Hold the phone steady to scan a QR code near the cash register
Credit: TechCrunch

Finally, rest comfortably knowing that this data resides in the cloud and that your purchase history could be shared among all participating MCX retailers so they can use that information to send you targeted ads and loyalty offers.

Sounds consumer-friendly, no?

That's exactly the problem - this is a solution that primarily benefits retailers, not consumers. CurrentC is trying to use the thin veil of loyalty rewards to mask their true intentions. Some consumers will see right through this ruse, while others will simply balk at how cumbersome the service is to use. I understand the desire for retailers to bypass the 2-3% processing fees that come with credit card transactions, but until they find a solution that gives consumers a substantially better experience than the current status quo, they will fail.

While the 2-3% processing fees might hurt retailers, credit cards provide significant benefit to consumers through:
  • Convenience in grouping transactions together in one monthly payment
  • Robust fraud protection
    • I've been automatically mailed a new credit card twice in the last year due to the Target and Home Depot breaches. Any fraudulent purchases (where were none) would have been reimbursed, no questions asked.
  • Compelling rewards programs
    • Cards now offer up to 2% cash back on all purchases, assuming they are paid off on time
  • Last but not least, the ability to purchase something using credit, and pay it off over time
This is where Apple Pay succeeds in providing additional value to consumers. In addition to retaining all the benefits of credit cards noted above, Apple Pay:
  • Simplifies the checkout process to a single motion involving moving your phone close to the checkout kiosk while holding a finger on the TouchID button. Because phones are usually immediately accessible to most people, this will be more convenient than pulling out a credit card.
  • Dramatically increases security. Your credit card number is not stored on your device or anywhere else. Transactions are made via a dynamically-generated single-use number at the point-of-sale. In the event of a credit card breach, your number is safe, and no new card needs to be issued.
  • Automatically works with your credit card issuer to update expired cards without any user intervention.
  • Keeps your purchase history private. The credit card issuer will still know, but Apple does not have access to this information; it will not be shared with anyone else.
So what does this have to do with healthcare?

I've previously discussed the importance of creating mobile apps that start with the problem and integrate into users' workflows. These concepts are not unique to healthcare, but we happen to be at the beginning of a movement to take healthcare mobile in the hope that we can fully realize the benefits these emerging technologies may provide to healthcare quality and efficiency.

Ensuring that these technologies are useful and usable will be key to our success, and the contrast between initiatives like CurrentC and Apple Pay is instructive.

Even so, the financial world is relatively simple compared to healthcare (which includes the financial aspects plus much, much more). Integrating into a consumer's workflow is far easier than integrating a new intervention into a provider's workflow, and then attempting to scale that intervention across multiple hospitals and EHR vendors.

Yet this is exactly what we need to do. Standards-based frameworks such as the SMART platform show promise that this is achievable. I will have more to say on this topic in the near future. Until then, keep your eyes open for other examples where usability is sacrificed for secondary gains. CurrentC is not alone.