App: Telehealth by simplepractice
Network of socio-technical dependencies: “The way we are socialized into media and computers, the pressure of consumerist ideologies, and technology marketing hype on products keeps the Internet blackboxed and the deeper histories and dependencies closed off from awareness and understanding” (Irvine, 2018). The internet’s design principles of being “complex, modular, scalable, and extensible system” (Irvine, 2018), is what contributes to the structure of the socio-technical dependencies of all apps and internet-related tools.
Looking at Telehealth, is a very simple layout for patients. There are no navigation options, just a single homepage for users to enter the link that their doctor’s office sent them and their name.
The app’s complexity is hidden; if users are having difficulties, they are directed to either contact their doctor’s office or test their internet connection. When one clicks on the connection, a status bar displays that the “test” is happening–what the “test” is remains blackboxed.
The latency of the app is covered up with the loading bar/status bar image.
The app is modular; you can test your internet, have a phone call, or make a video call. The app is scalable; you can use it on your phone, tablet, or computer. The simplicity of the app makes it extensible; anything could easily be added on in the future, allowing it to adapt to patients’ and doctors’ needs.
History of Technological Development: “Probably one of the earliest and most famous uses of hospital-based telemedicine was in the late 1950s and early 1960s when a closed-circuit television link was established between the Nebraska Psychiatric Institute and Norfolk State Hospital for psychiatric consultations” (Institute of Medicine, 2012).
“Per the Association of American Medical Colleges, come 2033, the United States could have between 54,100 and 139,000 unfilled primary and specialty health care physician roles (Pando, 2020). Telehealth was initially used to try to offset the increasing dearth of physicians and patient wait-times, and extend hours to after the business day and weekends, but has become normalized since the start of the pandemic.
Economic Ecosystems: The app is no additional charge for patients (included in payment to the doctor’s office). Doctor’s offices pay $10 per month to use the app (simplepractice, 2020). “The global Telehealth and Telemedicine Market is projected to reach USD 55.6 billion by 2025 from USD 25.4 billion in 2020″ (MarketsandMarkets, 2020).
Institutions of Mediation (standards, policy and regulation, industry groups, patents): All hospitals, public and private, have to abide to the state medical board. There are few federal laws that govern medicine (like the ACA, HIPAA, and rules around using patients as test subjects), but most standards are state-regulated. This includes how hospitals and doctor’s offices deal with insurance companies, having an impact.
simplepractice “meet or exceed all the requirements of HIPAA as a business associate, including the Business Associate Agreement (BAA) in which SimplePractice agrees to be responsible for keeping all client information private and to immediately report any breach of personal health information” (2020).
Markets and demographics: Telehealth is designed to make going to the doctor more accessible for everyone. The goal of telehealth is also to prevent patients from turning to the ER in non-emergency situations due to lack of insurance (Pando, 2020).
Some of the barriers to telehealth are the same ones found in all medical situations. These include rural situations, older patients not used to technology or disclosing health information, acceptance (or lack thereof) of insurance types (especially Medicaid), and the fear of private health information being shared.
Board on Health Care Services; Institute of Medicine. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary. Washington (DC): National Academies Press (US); 2012 Nov 20. 3, The Evolution of Telehealth: Where Have We Been and Where Are We Going? Available from: https://www.ncbi.nlm.nih.gov/books/NBK207141/
Irvine, M. (2018). “The Internet: Design Principles and Extensible Futures.”
MarketsandMarkets. (2020). “Telehealth market worth $55.6 billion by 2025 – exclusive report by MarketsandMarkets™. PR Newswire. https://www.prnewswire.com/news-releases/telehealth-market-worth-55-6-billion-by-2025–exclusive-report-by-marketsandmarkets-301030816.html#:~:text=Telehealth%20Market%20Worth%20%2455.6%20Billion%20by%202025%20%2D%20Exclusive%20Report%20by%20MarketsandMarkets%E2%84%A2,-News%20provided%20by
Pando, A. (2020). “Telehealth and the future of the US health care industry. Forbes. https://www.forbes.com/sites/forbestechcouncil/2020/08/10/telehealth-and-the-future-of-the-us-health-care-industry/?sh=41291d8666d6
simplepractice. (2020). “Telehealth FAQs”. https://www.simplepractice.com/telehealth-faqs/