After my last post about mobile site development, I found two other resources that I thought were good and expanded on my basic thoughts about designing a mobile site.

Mobile Web Developer's Guide which I found on Network Solutions' web site.

And Get your website ready for the Mobile Web in 10 steps which I found in a Google search.

What I find the most interesting about developing sites for mobile devices is that it takes me back to when I was learning web development in the late 90's when dial-up was the norm and broadband the exception.  But it also adds more form factor challenges because of the size of the devices.

We have been working on adding additional features of Community Health Network's Personal Health Record (PHR) and a question occurred to me.

What is the expectation of privacy a patient has about the data they enter into a PHR on a health care provider’s web site?

If we used the information to help with providing patient care, do we need to ask the patient's permission before viewing the information?  Or is there an assumption that we can use the data because they have entered it into a health care organization's PHR as long as we follow the requirements detail in HIPAA?

Google, Microsoft, Revolution Health and the other non-health care organizations offering PHRs do not need to follow HIPAA guidelines as far as I understand because the law was only written for health care entities.

I think I'm leaning to that we should ask for permission but it is not required for us to view it.  Or we should detail in the PHR terms of use that we can use the information to help provide patient care and that we will not sell the information.

What do you think?

When creating a mobile website, several adjustments or considerations need to be made.  Obviously, you don’t just port your current website, optimized for a monitor, over to a mobile site.

You need to build the site as if you were building a site for dial-up users.  The download/upload speeds on smart phones are not yet comparable to the speed of a broadband connection.  Image sizes need to be minimized and html simplified.

The page layout needs to be more vertical than the page design for display on a monitor.  The user on a smart phone will be scrolling up and down to look at the page and the screen resolution is not very wide.  Also, the page length should be kept as short as possible to avoid long, endlessly scrolling pages.

Applications need to keep this rule in mind also.  The forms should only contain a few fields of data entry because it is more difficult to enter data on a phone than a keyboard and the load times will be slower.

The most important consideration, I feel is to make sure that what you put on a mobile makes sense for the user to use.  An obvious example is that you wouldn’t put an application on a mobile site that requires the user to print a page.  Less obvious is applications that can be built with all the other requirements in mind, but don’t consider whether the user will use them or not, don’t consider the process.  We can build a mobile site that has the full features of our Find a Doctor application, including the ability to compare physicians and request appointments, but we realized that a patient would not be doing that on their phone.  A patient would be looking up a doctor’s phone number, location, office hours, etc.  

So that’s what we built:  http://mobile.eCommunity.com.

Take a look at the site and see if you agree or disagree with what I’ve said here, or have comments about the site.

We just made an update to the Find a Doctor application on eCommunity.com, basically an update to correct some application flow issues.  One of the major issues was our attempt to stop users from using the back button because it was causing issues with the session and search results of the application.  It was causing several unintended effects like not being able to come back to a profile page or leave a profile page each occurred in a different set of circumstances.

Shouldn't have done this in the first place.

Attempting to stop back button use is a major usability must-not-do.  There are many articles and books and web pages discussing this usability problem.  Probably the most famous is Jakob Nielsen's "The Top Ten Web Design Mistakes of 1999" which still applies today.

I recently read his book "Prioritizing Web Usability" (written with Hoa Loranger) which was published in 2006 and many of the usability problems that he wrote about in 1999 are still relevant today and relevant for the future.  It shows how timeless design issues can be and that developers who don’t understand the past are doomed to repeat design mistakes of earlier developers.

I was reading my month old copy of Wired today and they had an article about Twine which is a Semantic Web software to filter and provide users based on their browsing history and bookmarks. It's the type of application that I have been discussing in my last few posts.  And it supports what I've been writing about.

I visited the site to sign up and they are only accepting applications for the beta release which is disappointing.  I wanted to use this site.

I read some of the articles on the press page and some of them were extremely intriguing discussions of Web 3.0 and the Semantic Web.

I am responding to a comment posted on my last entry:

"Didn't you just argue against your own point? The constant communication is already happening, and will continue to happen, the filtering has nothing to do with Web 3.0, or Web 2.0, or anything. I am in constant communication with everyone i know, via email, blogs, SMS, etc., and filter out simply by not checking, and only allowing certain communication methods to reach me when I choose them to. I'm not clear what your not buying."

I decided to respond with another post.

First of all, no one today is in the constant level of communication with user generated content that is described in the book.

Second, I disagree that filtering is not part of Web 3.0 (or whatever you want to call it).  Web 3.0 is also sometimes referred to the Semantic Web which means that web documents will be more structured and machine readable.  I believe this will be part of the evolution of web technologies and will ultimately create a vast world wide library of information.

Consequently, information retrieval algorithms will be more refined and filtering will be part of this refinement or users will not be able to find what they need when there are trillions and trillions of web documents.  I have observed friends and colleagues with information overload issues in e-mail and other communications.  I have experienced it myself and have set up rules in Outlook to filter e-mails into categories, generally consisting of ones to ignore, ones that are urgent and ones that don’t need immediate attention.

This information will consist of friends, family, etc. and businesses, marketers and other organizations vying for your attention, just like there are issues with e-mail spam today.  The spam will come in many different forms in the future and will use these new social networking/user generated content technologies.

This need for filtering will just grow in the future as the expanse of information exponentially increases.

I’m going to go out on a limb here and make a prediction of the future of the Internet.

I recently skimmed through a book called "Groundswell", written by Charlene Li and Josh Bernoff.  The last chapter was an extrapolation of the current state of social software that they call the groundswell.

The future that they believe will be here within five years is one where everyone is in constant communication through blogs, ratings/commenting systems, social networking software and instant messaging.  You will get notifications from friends, work, entertainment, etc. all the time.

I’m not buying it.

With all the self publishing occurring, the amount of information on the Internet is growing exponentially and as a result of this trend, users will feel information overload.  This has been discussed since the 90's when there were fewer web pages.

The Web 2.0 trend is a bubble that's going to burst and be shrunk by users filtering out all the stuff that they don't want to see or sort through manually.  Just like e-mail spam filters, there will be self-generated filters on the information you search for on the Internet.

Search profiles stored in a search engine that automatically filter your information through a point of view, a set of criteria, your past viewing history or comparing your profile to results others have searched for and viewed (Wisdom of the Crowds).

Even following a single prolific blogger can be hard because everyone is very busy trying to cram more and more into a day.  Internet filters that filter through blog posts and other information will be coming soon.  And it will be delivered to the user like RSS feeds work today.

Information retrieval improvements and information filtering will be the next new big thing on the Internet, Web 3.0 if you will.  And boxes instead of rounded corners.


"We are all interested in the future for that is where you and I are going to spend the rest of our lives." --Criswell

I bought my wife a 1 gigabyte iPod Shuffle a year and a half ago.  I have a fourth generation 20 gigabyte iPod that I constantly add and remove music on and take time to select what music/artist/album I want to hear.  I also have created a vast network of playlists that coordinate to load the iPod with music.

Recently, I used the iPod Shuffle when mowing.  I loaded it up with a playlist and listened to it with the songs playing randomly.  It felt so nice to just listen to whatever came up.  I was like freedom, freedom from deciding what music I was in the mood for.

This experience made me think of a book I’d read about, 'The Paradox of Choice: Why More Is Less" by Barry Schwartz.  The choice of deciding what to listen to can sometimes be paralyzing because I have so many choices.  Using the iPod Shuffle takes away the overwhelming choices that Schwartz discusses in his book.

I think this applies to health care also.  There are overwhelming treatment options for conditions and making the best decision can be difficult especially because it is a critical choice.  In the health care world, many (most?) patient rely on their family practice physician to guide them.  I know I do.  That physician helps the patients by narrowing their choices in selecting treatments by recommending the best options.  Just like the iPod Shuffle does about music selection.

One of my favorite opening paragraphs, forget that, favorite quotes is from William Gibson's "Johnny Mnemonic":


      I put the shotgun in an Adidas bag and padded it out with four pairs of tennis socks, not my style at all, but that was what I was aiming for: If they think you're crude, go technical; if they think you're technical, go crude. I'm a very technical boy. So I decided to get as crude as possible. These days, though, you have to be pretty technical before you can even aspire to crudeness. I'd had to turn both those twelve-gauge shells from brass stock, on the lathe, and then load then myself; I'd had to dig up an old microfiche with instructions for hand- loading cartridges; I'd had to build a lever-action press to seat the primers -all very tricky. But I knew they'd work.


In VB.NET one of the most common ways I like to go low-tek is to use HTML items instead of .NET controls. Why use a .NET link to go to a page when a regular old HTML 4.01 one will work?

Why use a complicated hi-tek solution when a low-tek one will work? Try to go as low-tek as you can. Just like the quote says, they won’t expect it.

Recently I was in a content workshop we held to share with other member of our department that are responsible for marketing and communications.  We were briefly explaining what RSS was and I said essentially that the most important thing about RSS is that a user does not need to visit your website to read your content, listen to your audio or view your video.  For people who don't use it and are accustomed to controlling the design and layout of content, this is extremely important to understand.

I gave the example of news organizations who will subscribe to RSS feeds from all the new release pages (if there is a feed) and this would allow the press to keep up with the organization's announcements without visiting several websites every day, which they are unlikely to do.  RSS pulls any updated content to them so that all they need to do is open their RSS reader.

This idea leads to the second most important thing about RSS:  The user is in control of the content they receive and are able to pull from sources, instead of the typical push marketing that is done with TV, radio, print and billboards.

I recently read an article that reminded me of an episode of "The Office",  Coming Soon: A Web-Wide Social Network?

While some of the article I agreed with this quote was one that I can't accept:

"This is huge, the combination of the MySpace, Facebook and Google all saying basically the same thing, which is say that websites can become more interesting and engaging when you add a social layer to them."

The episode of "The Office" that this reminds me of is the one in which Ryan comes to their office and wants the staff to help input orders because of trouble with the website Ryan wants to work, dundermifflininfinity.com. A brief joke is about how the social networking piece of the website was taken over by some users and it had to be removed.  Part of the joke also is that Ryan added a social networking piece to the website of a paper supplier and who would go there to network.

Unfortunately, I couldn't find the clip on youtube to embed it here.

I think there are websites that social networking like those mentioned above would not work on at all, like a paper supplier or a supermarket or a plumbing supply manufacturer or a potato supplier, etc.  People don't/wouldn't go to those sites to socialize when they can use Facebook, et al. This idea seems to me to be a Meatball Sundae.

Thanks to Dan for sending the article to me.

I recently read this article, The 411 on mobile snap technology, about a mobile phone technology and it made me think about how we could apply this to health care.

I couldn't think of anything that would fit in with what patients would naturally use.

But we are working on a mobile site that will have scaled down/phone optimized applications that make sense to use on a phone.  We will not be putting the entire eCommunity.com site on this mobile site because it won't all work effectively on a small screen with a slower bandwidth.

Which is how our team operates.  Instead of rushing to do something cool, we make the technology fit a need to process.  We make the new application fit in our existing structure and make sure it is user friendly.

A good example is our News section on eCommunity.com.  We have news stories that have an RSS feed linked to them all and the monthly news stories also have a podcast feed.  In addition to offering the podcast, we allow the user to listen to an individual story without subscribing to the podcast.

All made as user friendly as possible with explanations of what a RSS feed is.

We also use Feedburner to make the RSS feeds as easy as possible to use for users on any browser.

We added a Google Maps mash-up to our Find a Doctor application because it made sense to do so.

These are all intelligent uses of new technology that are used to benefit the application they are added to.  They were no implemented just because it’s cool and want to build something with it.  Those types of applications will disappear in a few years leaving only the truly useful ones.  Just like what happened with the tech bubble in the 90's.  The good stuff remained and the bad ideas failed.

Today I read an article from Jakob Nielsen "How Little Do Users Read?" and I began thinking about my experiences as a web developer.  The concept of text scanning and that users read between 20 and 28% of the text on a web page feels right to me.  One thing that I have learned and that I always say:


This is part of what I call the paradox of content.  There exists the desire to fix usability issues with an application by adding more instructions.  When that doesn’t help, even more instructions are added.  All the time, the user is not even reading them.

The way to fix usability issues is by fixing the real issue with application design, flow, etc. and by not adding more content.

This idea obviously can also be applied to content, information architecture, and web site design. 

Actually, I would like to call it a methodology.  The Paradox of Content Methodology. 

Or maybe I can create a movement.  The Paradox of Content Movement.

Today I am celebrating a day of no meetings by working on several things on my to do list, including some blogging. And ironically I read this blog post with the image below from Seth Godin, one of my favorite marketers.

In the interests of being transparent, I would like to state that I think my blog post, Creativity, should have been broken up into a few paragraphs for easier readability.  I realized that after I posted it that I had puked one big paragraph of words into that post and didn't consider that the reader might not be able to quickly scan that post and is being asked to read it more carefully or not at all.  I am trying to be better about my paragraph length to promote content scanning.

I was at the annual meeting for my homeowners' association last night and I begin to think about open communication and transparency.

There a lot of complaints and questions about what's been going on with the leadership of the community.  There is only one meeting a year, the monthly board meetings have been either closed to the public or unadvertised.  The main source of communication has been phone or email from a web site that many homeowners didn't know about.

There have been issues with the former property manager and people in the community didn't know about that or the resignations from the board.  Consequently, many felt disenfranchised, and were distrustful of the board members and how the dues have been spent.

Watching all of this I realized that if communication had been kept in the open and homeowners informed of changes in the board and property management, their distrust would have been minimized.  And giving people a chance to speak during the previous year would have lessened the complaints in the meeting.  I believe that most people respond to open honest communication.  Explanations of community issues before this meeting would have lowered the level of hostility in the room.

How does this apply to health care?

Imagine if health care providers were open and honest all the time about what a patient is experiencing.  

You arrive on time for your doctor appointment but wait forty-five minutes to see the doctor.  Why did that happen?  The doctor may have had a complicated patient case come in and needed to spend more time with someone.  Or other patients’ lateness has caused the doctor to be running behind.  I read an article somewhere I can’t remember that stated that the main reason patients need to wait for their doctor is that other patients before have been late.  I don’t think most people know that.

Would knowing one of those situations help you be less frustrated with your doctor when you have to wait?

There are many other examples that can be imagined.  Ones that apply to hospital visits or even organization decisions.  The tools and technology for open communication are different depending on the situation.  In a hospital, talking to the patients individually would be more effective then later blogging about the event; for an organization blogging about a decision or event is more effective than individually talking to everyone interested.

I believe that open, honest communication in health care would reduce complaints and malpractice suits and allow the health care industry to spend more time treating patients.

Besides just creative and non-creative people, I think there are two types of creative people:  Those who think of lots of ideas and those who think of ideas that they can execute.  I believe that I am one of the latter.  I have at times thought that I am not a creative person, but I recently realized that I have thought of creative ideas, bringing together concepts, etc. and my ideas are ones that we can create or that we have created.  I build off of work that we have already done or have a vision that I work towards.  Just because I don't have lots of ideas (including some that can't be done), doesn't mean I'm not creative.  One of the benefits of the person who has lots of ideas is that they can inspire ideas in others.  I filter the ideas that I have and don't spend time working out ideas that can't be actualized.

Reading this article on NPR, Internet Health Records: Convenience at a Cost?,  prompted me to think more about Personal Health Records (PHRs) and Electronic Medical Records (EMRs).  In re-reading my previous post The Ideal Personal Health Record, I'm not sure that it was clear about my thoughts.

The other day in a meeting I described the relationship between the EMR and PHR this way:

Think of the PHR and the EMR as two separate entities sitting side by side.

The patient’s PHR can look at the patient’s EMR but is not allowed to change it.  The patient can add items from their EMR to their PHR.  Then they are able to modify that item only in their PHR to add additional details, etc.

The physician’s EMR about a patient can look at the patient’s PHR but can’t change it.  The physician can pull pieces of the patient’s PHR into the EMR as they feel it is appropriate because they are ultimately responsible for the accuracy of the EMR.  The physician is able to modify a patient’s EMR.

The two systems exist separately but are able to communicate with each other.

This system will only be able to work if the PHR is linked to a health care provider’s EMR.  The larger PHR systems like HealthVault and Google Health may be used to transmit data between PHRs so if a patient moves they can take their data with them.

I just finished reading John Maeda's "The Laws of Simplicity", and I was struck by an application of one of his laws this morning. I was loading my iPod with some music and I wanted to add my Time-Life "Living the Blues" series to listen to today. I usually load just my favorites from the ~25 CD series but today I wanted to also add the ones that were not ranked five stars. I wanted to listen to some variety and I realized that my favorites weren’t so favorite unless they are contrasted with songs that aren’t my favorites, just like Maeda’s fifth law, DIFFERENCES Simplicity and complexity need each other. Maybe this is the purpose of radio and something that we have lost in the iPod/iTunes/web 2.0-get-what-you-want-when-you-want-it era that we are in?

I had the pleasure of listening to a lecture/conference call with Seth Godin yesterday talking about his book "Meatball Sundae."  I began to wonder how the health care industry fits into his model.  At first glance it seems like health care provides a meatball service, but there are unique aspects to it that work well as the whip cream, cherry and other toppings.  Health care and health care technology doesn’t seem to fit into his model.

The e-Business team has seen a lot of new media/new marketing trends that work really well in health care.  Patient blogs are one example that we have built.  Our SharingSite application allows patients to blog about their condition and treatment in or out of the hospital.  We are also using it to post our baby/nursery pictures.  This eliminates the phone calls to family and repeatedly telling relatives the same information by a patient or family member who is already stressed and busy.

Our discussion boards that we have really not promoted are gaining more and more usage because people want to talk about their health condition, ask questions and compare their experience to other patients.  This is a common patient behavior that used to (and still does to some extent) happen in person, but now you can go online and talk to many more people.

Patients also want to find out more about their health conditions so they are using online health information libraries along with just reading blogs, discussions boards, etc to find out as much as they can about their health issues.

I believe that health care is different, that it doesn't fit the Meatball Sundae model.  Maybe it has to do with all the regulations, etc. on our industry, or that we aren’t selling a product that users generally have a choice about purchasing or not.  But they do have a choice about where to purchase it.