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Punch Cards and Apps- What’s the Connection?


According to a recent report from the IMS Institute for Healthcare Informatics, there are about 165,000 mHealth apps (as the report calls them) available for download. That’s about 10% of all mobile apps.

If you spent only a single minute to evaluate each one, you’d be busy for about 4 months. Without eating or sleeping.

About 1/4 of these 165,000 are related to disease; most of the rest are wellness-related. The top apps were for exercise tracking and dietary management.

2015 12 11 Tech Blog Apps Everywhere 1 Pie Chart

Some people have asked when PSS plans to create an app. The short answer is “When it makes sense” but there’s more to it than that.

Because we focus on improving participant behavior, our hypothetical app would need to capture behavioral data, analyze it, and provide meaningful insights about it. As it happens, this is a difficult problem that doesn’t yet have many good solutions.

Capturing data about people is a longstanding problem, and the 1880s Herman Hollerith took a shot at a solution by inventing this:  

2015 12 11 Tech Blog Apps Everywhere 2 Punch Card

Punched cards were wildly successful. They cut processing time for the 1890 Census from 8 years to 6 thereby assuring their place in data processing for about a century. Hollerith also had to invent a way to punch those holes into all those cards, so he came up with this:

2015 12 11 Tech Blog Apps Everywhere 3 Machine With Woman

One side effect of Hollerith’s efforts was IBM, which was formed by merging 4 companies, including Hollerith’s. Another side effect was that It provided office jobs to millions of people, almost exclusively women.
60 years later, the only improvement to punched cards was that rectangular holes generally replaced round holes.

2015 12 11 Tech Blog Apps Everywhere 4 Punch Card Modern

But women were still doing all the keypunching, which was decidedly not an improvement.

2015 12 11 Tech Blog Apps Everywhere 5 Keypunch Department

And 50 years after that, punched cards gave us hanging chad in Florida.

2015 12 11 Tech Blog Apps Everywhere 6 Chad

Perhaps those rectangular holes weren’t an improvement, after all.


Today’s smartphones have some advanced data capture capabilities but it’s not that easy for an app to truly connect with a person.

Consider a “simple” fitness tracker. It needs to read faint GPS radio signals from an array of 32 satellites orbiting 12,600 miles above the earth, and then use that data to calculate your location, altitude, direction, speed, and more. It may then post those results on a website by accessing a network of cellular telephone towers, using a built-in cellular radio—or by accessing your smartphone using a third type of radio network called Bluetooth. It’s not so simple after all.

The net result of all this technology may be little more than an educated guess about whether you’re walking or riding a bike, or in a car, or jogging. Perhaps there will be estimates of calories burned, or measures of heart rate—valuable information, of course, but it would be a stretch to call that a real connection.

And while PSS  aspires to that level of service in an eventual app, the issues that participants come to PSS for don’t yet have off-the-shelf sensors. We currently have to rely on our people to read each participant’s personal situation and take the action best suited to help that person at that moment in time.

At the recent HiMSS conference, and last year’s Health 2.0 conference, we saw some fairly sophisticated, sensor-based assessments of physical health. I think we’re not far from seeing useful automated approximations of a participant’s emotional state, but considerable legal, regulatory, and clinical practice issues will need to be resolved before we can deploy that technology widely. After all, you’ll be OK if one of your daily jogs isn’t Tweeted to your running club, but a false positive (or false negative) when assessing emotional state could cause considerable harm and ultimately be fatal. At PSS we believe we need to be extra certain that what we deploy will be the right thing for our participants.

So people will always remain in the equation at PSS.

This is an exciting space, and we’ll talk more about it in the future… please stay tuned.


One more thing…

Although punched cards for data input are not mourned, they did have some properties that were, at the time, considered useful.

2015 12 11 Tech Blog Apps Everywhere 7 Wreath

Just try that with a stack of used smartphones…


Patient Adoption of mHealth  IMS Health Incorporated, Research report (Free Registration required).


One Response to “Punch Cards and Apps- What’s the Connection?

  • It’s hard to find well informed individuals on this topic, but you seem like you understand what you’re talking about!

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