Tuesday, October 20, 2009

A Self-Service Health Kiosk and Empowerment

I selected as the subject of my conceptual investigation an existing technology, so perhaps this is in part a kind of retrospective analysis. About eight months ago, a self-service health kiosk was installed in our office. It is a booth format with a seat and occupies a footprint of about 2.5 feet by 3.5 feet. The kiosk is positioned just inside one set of main entrance doors in a roomy space with high foot traffic but also somewhat private in that there is little loitering in that area. There was no fanfare accompanying the installation of the kiosk. It was simply placed there, and a couple of months later we received company correspondence stating that health kiosks were available in the major WebMD offices--in New York, Atlanta, and Portland--and that employees were encouraged to use them. The kiosk is for employees only, and requires the user to login using their existing employee ID and set up a personal password during their first visit. The interface takes the user through a series of questions and exercises, collecting data on weight, body mass index, body fat, blood pressure, and pulse, that is then passed onto our online health record.

Sociotechnical Space
This self-service health kiosk offers a straightforward benefit. It makes available to employees a fast and easy way to assess their health via a set of primary health measurements--anytime they wish to. Taking a step back, the aim is to increase health among all employees. Instead of relying on ownership of weight scales and more expensive equipment such as body fat analyzers and blood pressure cuffs, this one-stop shop enables users to gather key health measurements in one sitting during a few minutes break away from their desk. The presence of the kiosk should have the added benefit of increasing overall health awareness and supports the idea that the company cares about our health. Also, it provides a golden opportunity to impart immediate and highly relevant health information based on data just collected.

It is also a case of practicing what we preach. As a part of WebMD, WebMD Health Services develops private portal websites that are used by employees, members, and patients of corporations, health plans, and hospitals. The websites provide tools and resources for managing, monitoring, and improving one's own health. The end benefit, especially to employers, is of course a healthier (and happier) workforce that is therefore more productive and has higher retention rates. Data that is captured in the health kiosk is available for viewing and tracking when we log onto our own personal health monitoring website. It is a kind of self-referential experience, especially for those of us involved in the design and development of the personal health monitoring site's tools.

There exists a body of research on effectiveness of kiosks in general and health kiosks in particular. Issues for consideration include location of the kiosk and how it pertains to visibility and use, accessibility to users, the interplay between the kiosk and associated websites as a source of information, the 'push' versus 'pull' of information provided, kiosk maintenance, whether or not to offer printouts, and how to attract repeat-use. Health kiosks are typically categorized as either integrated or opportunistic (Jones, 2009). Integrated refers to kiosks that are used as part of a service, for example during the check-in process in a clinical setting. Opportunistic kiosk use tends to be optional and complementary, and stands on its own in attracting users, as does our self-service health kiosk.

Value Implicated: Empowerment
The Merriam-Webster dictionary defines "empower" as: "1. to give official authority or legal power to, 2. enable, 3. to promote the self-actualization or influence of." Wiktionary.com fleshes out the third definition with "to give the confidence to do something (inspire)." The emphasis here is on what one is empowered to do.

The most pragmatic definition is the idea of enabling, or giving permission to. This self-service kiosk enables employees to assess their health at anytime. We are freed from office visits and co-pays and freed from having to own any of the scales and analyzers that are incorporated in the kiosk. We are also essentially permitted to use it all the time if so desired, or never at all.

Perhaps just as important is that by the kiosk's mere presence and availability, we should be inspired to improve our health. It serves as a constant reminder of the importance of health, promoting health awareness throughout the office. Since the barriers to health assessment are so low, we can easily track our measurements, seeing what changes in behavior and diet lead to improved results. For example, is my daily dark chocolate consumption lowering my blood pressure? The data is intercepted by our personal health monitor website, thus enabling an integrated experience. There are myriad ways for motivating employees--particularly through data analysis and information push--to continue to make health a priority.

With empowerment--or authority--comes responsibility. Given the power to check up on our own health, it is up to us to make use of it, and to use it for good. This is mediated of course by the experience of using the machine. The easier and more enjoyable it is to use, the lower the barriers to use. Those accustomed to using it derive a sense of reassurance and satisfaction that is likely self-reinforcing. It is also our responsibility not to rely on these statistics alone when monitoring our health, and to use it in conjunction with other health resources including regular and preventive visits to our primary care physician.

The primary direct stakeholders are the intended audience, in this case, WebMD employees in the Portland office. We are a largely health-conscious, fairly young, computer-literate, and active group. With such a homogenous audience, there are fewer accessibility concerns. The poster in front of the kiosk with detailed and somewhat confusing instructions for logging in can be waded through by anyone willing to take the effort. Once in, the screens are crowded with text and the navigational options not completely transparent. Still, it should not be too challenging for this intended audience. The benefits of using the health kiosk should be apparent to all, and yet, in the eight months that the kiosk has been there, I have witnessed in total only a few people using it.

Directly benefiting from our better health is, as noted earlier, our employer. Also as the entity responsible for placing--and paying for--the kiosk, it can also be considered a direct stakeholder. If the kiosk achieves the intended aim of improving our health, the company should see reductions in sick leave, hence greater productivity. Also, fewer doctor visits and treatments should lower the costs of company-sponsored health insurance. Many public kiosks that have been studied appear to have a fairly brief shelf-life (Jones, 2009). This is often attributed to either poor or difficult maintenance or perceived low ROI by key stakeholders, taking into consideration costs versus actual use. Even harder to trace are lifestyle and behavioral improvements as an outcome of extended use. I would be interested to see the statistics on use--how many times per day, how many employees have ever/never used, patterns of use. I am also curious to see if there will be a greater marketing efforts--and possibly incentives--to increase use of the kiosk.

Indirect stakeholders include those situated near the kiosk and others passing by while it is being used. Although I find the location of the kiosk somewhat questionable (in terms of privacy, comfort, and freedom from intrusion), alternative locations must have been considered and abandoned--possibly because of its impact on its environs. At the same time, this is a fairly non-intrusive kiosk: there is no audio that accompanies the interface.

As with any technical endeavor, the indirect stakeholders also include the designers and engineers responsible for building the interactive kiosk. I would argue that those of us who build the personal health monitoring website where the collected data is fed into are also indirect stakeholders, as the entire experience is meant to be an integrated one. And unfortunately, the whole user experience would have been more successfully integrated had we been given the opportunity to work in partnership.

In 2007, Microsoft in a visionary move, organized 'HCI 2020,' a conference with the aim of investigating HCI practitioners' responsibilities relative to the increasing pervasiveness of computers in society. "For the HCI practitioner, its purpose is to map out the terrain and suggest new approaches while keeping an eye on the main prize: the embodiment of human values at the heart of computing" (Harper, et al., 2008, p. 5). In practical terms, one of the concrete steps forward proposed is to add an initial stage to the design process, called "Understand," where more conceptual and reflective thinking occurs. This is the stage where stakeholders are interviewed, ties to other disciplines considered, and values implicated explored in detail. The results of this Stage 1 should then feed into Stage 2 ("Study"), pointing to areas requiring further research and and more in-depth investigation. In the case of our self-service health kiosk, there are obvious usability hurdles for anyone attempting to use it. Aside from that, had an attempt been made to investigate the sociotechnical space from the outset and how it would fit into and augment the intended user's life and daily activities in regards to the implicated value of empowerment, I think the resulting kiosk experience would be quite different. Fortunately, we are in an industry where the next release is always on the horizon.

~Jenny Wang


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