Category Archives: Week 11

Case Study: Telehealth by simplepractice, from the Patient’s Perspective

Jalyn Marks

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.

Telehealth by simplepractice homescreen. There is the brand logo and name, a space for users to add the link to the video location and their names.

Telehealth by simplepractice homescreen. There is the brand logo and name, a space for users to add the link to the video location and their names.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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.

Text reads: "Wait one moment while we check your internet connection." There is a status bar and a time countdown. Text reads: "Less than 30 seconds left."

Text reads: “Wait one moment while we check your internet connection.” There is a status bar and a time countdown. Text reads: “Less than 30 seconds left.”

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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.

References

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/

What does it mean to be on the Internet

The internet looks like a monolith when we engage with it but there are many cultural and socio technical factors that play into it being viewed as such. When we think about what it actually is, we cannot point out to anything in particular. The internet shows itself to us via our computer and mobile screens. But this doesn’t mean that the internet is behind our screens? It is so metaphorically but what does it mean? GUI’s provide us access to the internet but we need to breakdown the internet into its multiple components and layers to understand what does it mean to say “we are on the internet”.

The internet began as ARPANet, a project in the 80’s to solve a network engineering problem of how to connect mutually incompatible computer systems in different locations with no single point where the network could be broken (Irvine, 4). US government via DARPA, managed funding for research projects related solving problems in data communication methods between computers. Telecom companies were far away from such research because they had already invested so much in switched network telecom infrastructure. What came out of these government funded university research labs was the TCP/IP protocol and data packets as ways of sending messages. The Transmission Communication Protocol or the Internet protocol is a method for sending and receiving data packets that work end-end regardless of the incompatibility of computer systems on each end (Irvine, 6). Data Packets as opposed to the single, continuously held, closed circuit connection used in phone calls, make up bundles of data packed in smaller units (Irvine, 6). The packet itself has no information but much like carrier waves in radio signals, it carries data that can be called the “payload”. This packet has other information in bits that determines its path in the network (which computer to go to based on IP address) and the payload has the message stored in it which is received, and converted for the GUI on the other end (White, 258-259). This is the symbolic-technical aspect of the information system we call the internet.

The physical system comprises of the Coaxial cables that run underneath the ground that carry these data packets to your house, the routers, modems, etc in accordance with Internet Protocol. The internet is treated like a monolith as if it’s a totalized unified entity with a force and agency of its own (Irvine, 2). But underneath we see that it is a symbolic-technical system that transfers syntax that we convert into meanings using our GUIs, all grounded in physical technologies likes high-speed phone lines, fiber-optic connections, and microwave links (White, 280).

 

References –

Martin Irvine, The Internet: Design Principles and Extensible Futures

Ron White, How the Internet Works.” Excerpt from How Computers Work. 10th ed. Que Publishing, 2015.

In the Age of Internet with Internet Thinking

How did Internet thinking come about? Productivity determines production relations, and the characteristics of Internet will be likely to affect its business logic to a certain extent. The building blocks of industrial society are tangible atoms, while the basic medium that constitutes the Internet world is intangible bits. This means that the economics of the industrial civilization era is kind of scarce, while the economics in the Internet era is rich. Moreover, a network structured Internet has no central node as it is not a hierarchical structure. Although there are different points and they have different weights, no point is in absolute authority. Thus, the technical structure of the Internet determines its inner spirit, which is decentralization, distribution, and equality. Decentralization is a very important basic principle of the Internet.

In a networked society, the value of an individual and an enterprise is often determined by the breadth and thickness or richness of their connections. The broader and thicker/richer your connection is, the greater value you may hold. This is also probably one of the basic characteristics of a pure information society. Your information content determines your value. So openness has become a necessary means of survival – if you are not open, you will not be able to get more connections. Therefore, I believe that the Internet business model should be based on equality and openness, and Internet thinking must also reflect the characteristics of equality and openness. Equality and openness can indicate democracy and humanity and in this sense, the Internet economy can be truly a people-oriented economy. In agricultural civilization era, the most important assets were lands and farmers. Yet the most important assets in the industrial era were capital, machines (machines are solidified capital), and people who have been alienated on assembly lines. In the early industrial age, alienated people were considered the most because they were also treated as machines as if they were just screws in the assembly line. Now in the era of knowledge economy, one of the core resources we have is data and another one is knowledge workers. Enterprise management will also move from a traditional multi-level approach to a more networked and more ecological approach. Let knowledge workers truly create values and let them become one of the most important players in any organization and society as a whole.

Reference:
Martin Irvine, The Internet: Design Principles and Extensible Futures (Why Learn This?)

Twitch as a Socio-technical System

Victoria Gomes-Boronat

According to this week’s readings, the internet and the applications that function through the use of the internet are inherently modular in design and belong to a “socio-technical system”.  A sociotechnical system is any system that “considers requirements spanning hardware, software, personal, and community aspects” to inform its design decisions (“What Are Socio-Technical Systems?”, n.d.). A sociotechnical system embodies and tries to understand the social structures, roles, and rights of systems that involve communities of people and technology. It is interdisciplinary in that it requires the contributions and research of experts who study various types of systems, i.e. sociologists study social systems, psychologists cognitive systems, computer scientists information systems, and engineers hardware systems, (ibid.). All of these systems are valid and important in the study of socio-technical systems. Today, we will discuss the socio-technical system that informs the design of the extremely popular streaming platform, Twitch.

The website and video-streaming platform Twitch is the overwhelming market leader in the live broadcast of user-created videos over the internet, especially for video game-play, “In both 2016 and 2017 over two million people regularly broadcast on the platform, resulting in over a million years of video content in total viewed by over one hundred million people,” (Johnson & Woodcock, 2018, p. 1). Content creators on the platform create an online channel that attempts to bridge the gap between themselves and their audience. Twitch streamers usually intend to create large communities where people can come together and share ideas. If we were to examine this using a network view, each Twitch user is a node in the Twitch network, with the edges being the relationships and interactions that connect them all. In attempting to build a community through their channels, Twitch streamers, are trying to become a “hub” of information and influence in their network (Denning & Martell, 2015, p. 237). However, to successfully do this, they must understand the sociotechnical systems that inform the ever-evolving design of the platform.

Recently, my best friend started his own Twitch Channel, and in discussing all of the components that go into building a twitch channel, I realized how complex and modular the design and socio-technical systems for Twitch are. Originally, I had assumed that all you needed was a good computer with a camera and streaming capabilities. However, I was very wrong. In order to build a quality Twitch channel, there are various hardware requirements, software requirements, social structures, roles, and rights of the systems that need to be addressed. With regards to hardware, my friend explained that not only should you have a good quality mic, a camera with streaming capabilities, lighting, headset, desktop, multiple monitors, gaming hardware (if you want to go the gaming route), you also need to purchase game capture cards in order to be able to stream both your game and yourself at the same time. Let me tell you, streaming is not a cheap hobby. knowing the amount of financial investment that goes into doing a quality stream also helped me understand why users would subscribe to or send money to support their favorite streamers. Below is a picture of my friends set up.

With regards to software, your computers must have a fast enough processor and enough memory to properly stream. Your internet connection also has to be incredibly strong in order to run all of the streams and programs at once. I used to believe I had fast internet, however, my friend informed me that any quality streamer has to have a wifi speed of at least 100 Mbps. His is around 120 Mbps. When I tested mine, I received a whopping 80 Mbps, meaning that while my speed was good enough to game online, stream services like Netflix on multiple devices and download large files, my speed would not be enough to stream UHD on multiple devices. Therefore, if I ever did have all of the hardware necessary to be a Twitch streamer, I would not be able to stream quality UHD video.

When I first started supporting my best friend on his channel, I also had to learn the social structures and roles of the platform. Twitch has its own culture and in order to fully utilize it, I had to work to understand it. For example, Twitch is extremely modular in its design and affords users the capability to completely customize their experience with the creation of “panels” to decorate your channel, emoticons and sound commands to customize a chat, the assigning of roles within channels as a sign of trust and authority (i.e. mods for a channel), and the creation of clips to capture your favorite streamer moments. These were all new and foreign concepts to me because they were norms that were not found on other platforms. Twitch streamers must also be aware of their demographics. If a user is not young audience-friendly, meaning that they use expletives and talk about more adult topics on their streams, they employ warnings and market their channels as 18+. If a channel does want to be open to all ages, they utilize rules of the channels and will employ mods to censor the chats of any explicit content. The website/application itself also categorizes content in order to help users and content creators build strong communities based on similar interests, i.e. art, among us, just chatting, food, etc.

With regards to streaming rights, a user is afforded the right to stream anything that is their own creation, including video gameplay, however, there are some constraints. Twitch users do not have the right to stream content they do not own such as copyrighted music and movies/shows. If a user fails to adhere to these terms of service, their videos could be taken down. Twitch has addressed the music problem by creating a soundtrack of licensed music that streamers may use in the background of their streams, “We understand that music rights are complex and that many of you would like a simpler way to add high-quality music to your Twitch live streams. That’s why we built Soundtrack by Twitch, to give you the ability to feature a curated library of fully licensed music within your live streams,” (Twitch, 2020).

After learning about the socio-technical system that informs the design of Twitch, I have developed a deep appreciation for the creators who put their hearts, souls, and money into creating quality content and strong communities. I also am incredibly impressed by the modularity and complexity of the application design that affords creators the ability to do this.

References

“What Are Socio-Technical Systems?” The Interaction Design Foundation, The Interaction Design Foundation, www.interaction-design.org/literature/topics/socio-technical-systems.

Johnson, M. R., & Woodcock, J. (2018). THE SOCIO-TECHNICAL ENTANGLEMENTS OF LIVE STREAMING ON TWITCH.TV. AoIR Selected Papers of Internet Research. https://doi.org/10.5210/spir.v2018i0.10489

Denning and Martell, Great Principles of Computing, Chap. 11, “Networking.”

Twitch.tv – Music. (n.d.). Twitch.Tv. Retrieved November 4, 2020, from https://www.twitch.tv/p/legal/community-guidelines/music/

The Internet as a Design Philosophy

Mary Margaret Herring

Throughout this week’s readings, I couldn’t help but relate to a scene in The IT Crowd that aired in 2009. In this scene, two IT ‘nerds’ lend their non-technical manager “the internet” for her employee of the month acceptance speech in an attempt to humiliate her in front of the company. They give her a black box with a blinking red light on top and explain that the “elders of the internet” have lent it to her for this special presentation. She is thrilled and eager to present it in her speech and the IT guys are ready for her lack of tech knowledge to be displayed to their coworkers. Much to the IT employees’ dismay, though, no one really knows what the internet is and believes that it is, in fact, the black box.

Once you get past the laugh tracks, I think that this scene from The IT Crowd was genius in the way that it captured how little internet users actually understand about the internet. While an operational knowledge of how to perform certain tasks is needed to ‘use’ the internet, the entity of the internet is veiled. When thinking about what it means to be “on the internet,” it is important to realize that the internet is not a thing but a vast infrastructure and a design philosophy. Irvine (2018) sums this up in a compelling manner by stating “The internet – both as an information infrastructure and as the networked media sources that we use and create – is enacted and performed as an ‘orchestrated combinatorial complexity’ by many actors, agencies, forces, and design implementations in complex physical and material technologies” (p. 9).

To be “on the internet” simply means that a device is running a TCP/IP software and has an active IP address (Irvine, 2018, p. 6). But all of the jargon used in the previous sentence makes this seem quite confusing. I will try to apply the concepts I learned this week to elaborate on this process. The transmission of information between networked computers on the internet relies on protocols. Two important protocols are the Internet Protocol (IP) and the Transmission Control Protocol (TCP). To be connected to the internet, each computer needs an IP address. The IP address is a lot like a postal address and provides a location where information can be sent. When someone streams a song in Spotify, for example, the data is broken down into smaller packets that are routed asynchronously to their destination. When they arrive, the TCP works to reassemble the packets and ensure that all components of the packet have arrived. This process continues over and over again until the entire song has been played. The importance of following protocol becomes clear in the example above. If the data was broken down in a way that the TCP was unfamiliar with, it would not be able to reassemble the packets. As Vint Cerf explains, “the internet is really a design philosophy and an architecture expressed in a set of protocols” (Code.org, 2015).

I am unsure of how to reframe the conversation about the internet to be one that is more accurate. This is mainly because it is easier to view the internet as a uniform technology and people don’t need to understand what the internet is to use it. Most of my hesitancy to understand what the internet is comes from the complex jargon used and fear of asking a ignorant question. I do think that the Crash Course and Code.org videos are very helpful when bringing these ideas to a general audience, though.

I am sure that I greatly over-simplified a very complex process but hopefully the gist of this was correct. After reading and watching the videos this week, I am still a bit confused on how the information travels. The Crash Course videos talked about queries for information going from LAN to WAN to mega routers but I found that to be quite confusing. Also, what are the ‘intermediary computers’ that packets travel through? Could we talk a bit more about these processes in class?

References

Code.org. (2015, Sept. 10). The Internet: IP Addresses & DNS [Video]. YouTube. https://youtu.be/5o8CwafCxnU

Irvine, M. (2018). The internet: Design principles and extensible futures. Unpublished manuscript.

Understanding of “Internet”

Understanding of “Internet”

Yingxin Lyu

Now, people can say they are “on the Internet” at any time. It is hard to find one thing that people do in daily life does not need connecting to Internet. However, what does it means to be “on the Internet”? It may look like a huge spider web with thousands of nodes, and people are on those nodes. With the thread between nodes, they are connected and they can share information. A person with his or her devices that can connect to the Internet, as an entity faces with the device, and behind the device, there is a huge network. The entity chats with friends, so they send messages to each other, then communicate and socialize. In this case, he or she is on the Internet means the person can send his information through the network to friends who are physically separated from him or her, or receive friends’ information. The information runs through local area network (LAN), a router, and a wide-area network (WAN), and it goes through a set of protocols, and finally arrive at the destination1. Moreover, the person logs in Google, types the keyword, and search for desired information. He or she first sends order to the Domain Name Service (DNS), than the website address is translated to the Ip address of Google2, so the finally the interface of Google shows on the screen. Then the person’s keyword is transferred to Google’s server and it filters information related and sends to the user. The entity is “on the Internet” if he can go through these processes. No matter what interaction people implement through Internet, like chatting, searching, browsing, or watching videos, the essence of these things is receiving and sending information. Thus, People are “on the Internet” means they can go through a lot of processes to send and receive information with devices.

However, most people tend to consider “the Internet” as a totalized, reified, or uniform “technology”. It is hard to teach everyone to understand the huge network processes and technologies, and protocols behind Internet, but we can use metaphor to enlighten people, leading them to consider Internet as a network with subsystems, subcomponents, and social institutions orchestrated to work together. In Code.org Video Lessons, they metaphors the process of downloading a music as sending packages, and TCP is compared to a guaranteed mail service. Similarly, we can compare the Internet logistics process. That is, whenever you type a sentence or key word in a search box and press the “enter”, it is like you prepare a gift and put it in the package, then give it to the carrier. The keyword is not just show up in the screen, you keyword, or order, is translated in to binary language and go through protocols, servers. Like the package is transported first by the carrier to the small warehouse that keeps all packages of the nearby district, and then by tracks or planes to the other city, arriving at a big warehouse, next it will  be distributed to smaller warehouse, and finally the carrier will sent the package to the receiver. This example is transparent if we try to compare the process of chatting to it. People sending a message to their friends just like sending a package, and they receive them as the same way. There is also a big network of logistics management, and it is more familiar to people, using such a metaphor will let the Internet with its whole big system easy to understand and acceptable.

It is crucial for more people to understand that “Internet” is not a uniform “technology”. Knowing that Internet is a big system designed elaborately will inspire people to apply the similar design idea to create new network design.

 

References:

  1. Ron White, How Computers Work. 10th ed. Que Publishing, 2015.
  2. Denning, Peter J., and Craig H. Martell. Great principles of computing. MIT Press, 2015.