Over the years, Mad*Pow has found some great charities to support, but we don’t always like to blindly send money or items to them. It’s not the best option for either of us. Instead, we get involved by working with the charity – helping their digital channels, getting our hands dirty building houses, or advocating for them in social media channels.

This December, we wanted to help the Seacoast Food Pantry. The winter months can be hard for both the charities and the families they support, so we debated how we could help. The final decision: a chili contest, where participants brought in either $5 or canned goods as an entry/tasting cost. We knew a little bit of friendly competition would create a fundraising activity everyone could enjoy.

The rules were simple: Make a chili and bring in the recipe in for sharing. The winner would be determined by total votes from all judges – both chili contest participants and the rest of the Portsmouth office. Voting was based on five criteria: Smell, Thickness, Color, Flavor, and Aftertaste.



So how did the contest pan out? There were eight entries and 18 judges. The chili ranged from classic recipes to banana pepper chipotle chili. As three entries vied for the top spot, the contest came down to one last voting sheet from one of our resident chili experts. It was his final vote that push one to the top.

With a score of 146 to 145, Mike Woodard, our Creative Technical Director, took home the top prize. Just behind him, tied for second, were Will Powley (Founder & CCO) and Mike Hawley (CDO). These three recipes were all classic chili, beating out some of the more exotic and new school recipes. Lesson learned: Always go with the classic – at least when it comes to chili.

You can download the top three recipes here.

Mike Woodard received the As Seen on TV Swivel Store for taking the top chili.



So what did this mean for the Seacoast Food Pantry? Mad*Pow Portsmouth raised a lucky $77 and over 25 canned goods, which were donated directly to the pantry. By creating a fun and competitive contest that everyone enjoyed, Mad*Pow gave to those in need and came away with some great chili recipes to try. A great day, if you ask me.



If you want to help the Seacoast Food Pantry, you can learn more about them here.

Taking On The Health Design Challenge
Mad*Pow participated in the Health Design Challenge, an open design competition sponsored by the Office of the National Coordinator for Health Information Technology (ONC), a division of the US Department of Health and Human Services. The challenge was to produce a design for a health record that would be understandable to the patient, their families and doctors. The ONC described this as “an opportunity for talented designers to reshape the way health records are presented to create a better patient experience.”

Competition rules state that all entries are submitted under a Creative Commons open source license, so that other designers and firms can continue to evolve the best entries going forward.

What We Were Given
The Challenge was inspired by the current state of the Blue Button Record, a service provided by the Department of Veterans Affairs. Today any patient at a VA healthcare facility can download a record of their VA treatments as a text file. The file contains a mixture of Electronic Health Record data and patient-supplied information. Given the TXT file format, the visual formatting of the record is limited to word spaces, carriage returns and line separators. The sponsors understand that the current service is difficult to read, to print and to understand.

The ONC challenged us to rethink, within specific limits and goals, how this information should be presented. The Continuity of Care Document (CCD), an output format for an Electronic Medical Record systems used by Healthcare Systems, Hospitals and Medical Practices, defined the boundaries of what we had to work with. By way of documentation, we were given two small example records that matched the CCD sections and fields. We were told the design should serve “a wide variety of personas” including parents caring for their children, family members caring for an aging relative, and patients with literacy and vision issues.

The Mad*Pow Entry: Visionary and Practical
[download the sample record in PDF]
We wanted to produce the best information and experience design within these constraints. Early discussion focused on the gaps – things we could do if we had things we didn’t have – but our effort quickly refocused on what could be squeezed out of what we had. For this project we wanted to think Out-of-the-Box from Inside-the-Box. We did a series of user interviews with friends and neighbors who represented the audience we wanted to reach: people of different ages, health conditions and family responsibilities. The common answers we heard were: make it available to me anytime anywhere and don’t make it depend on a software application or rely on a specific device or brand. The way our audience manages their health care records today is printed on paper because it is reliable. Our experience told us that we could apply information design principles to a modular solution for paper, then apply Responsive Web Design to make it work on mobile devices with various screen sizes and resolutions. So we set out to create a modular system that worked on the most common denominator: letter-size paper. The information had to be understandable in color and in black and white.

Our audience wanted the record to tell the story of their health, for themselves and to communicate with others. We began by organizing the sections into three chapters: the present state of my health, my medical history and my lab tests. We identified the most common unit: Date and Name, then designed each chapter around this core element.



The cover page is critical to the user experience. We wanted this page to tell the patient what she was looking at, where it came from, what it contained. It also should summarize the most health-critical information.



We saw an opportunity to fill in information that the patient could be motivated to contribute: the name, role and telephone number of her Health Care Team. To make this useful beyond the report, the page includes a card that can be cut out, folded and placed in a standard wallet slot.



For the Lab Report chapter, we added a graphic history that could be driven by the data itself: current lab components outside the recommended range. The lab data allows us to combine values for the same component, and expand the single “target” threshold in the report to include additional thresholds taken from a trusted source, in this case NIH. The combination of seeing the values of a component over time in relation to additional thresholds provides the patient with additional context to interpret her results.



For a fourth chapter, Additional Information, we combined the six dated sections into a timeline to help the patient tell her health story. We chose to align the six sections in columns according to date. We believe that this format makes it easier to see the chronological relationship between a problem, encounter, procedure and medication.

Demonstrating Flexibility
The sample data for the competition was a small record for a middle-aged woman. We wanted to demonstrate the flexibility of our design by applying it to additional realistic examples. Through research with actual medical records, we fabricated two additional documents: an infant with the first two years of well-baby visits and immunizations and an elderly man with ten years of information on several health problems.
[download Infant record]
Infants may have few problems and procedures and many encounters and immunizations.
[download Elderly record]
An Elderly record may contain numerous medications and lab tests.
Using this data we demonstrate how the design can expand and contract, flowing the information into a form that can communicate to the patient, family caregivers and physician.

Identifying the Gaps
The process of creating the design solution from what we had revealed a number of missed opportunities: gaps in the data that, when filled, will make the Continuity of Care Document far more useful to the entire audience. We want to share with the community what we could have done if the data supported it.

Guardian: This field is ambiguous. Does it mean the person legally responsible for all medical decisions (parent of a minor, legal guardian for a disabled person)? Does it designate a family member or trusted friend who supports a patient responsible for her own medical decisions? Is it the “emergency contact” we are asked to provide on medical forms? If it is meant to cover all these cases, the name Guardian is inappropriate. We would need to know more about how it is meant to be used before suggesting an alternative.

Allergies: If we had controlled vocabulary for SEVERITY we could introduce symbols to communicate importance.

Problem List: We think that Medical Concerns is a more supportive name for this section, but we chose not to modify it. If we had data linking these items to Encounters, Procedures, Medications, Lab Tests (and Imagining – see below) we could produce a chapter of the CCD organized by problem/concern.

Medication: This section presents several missed opportunities. If we had controlled vocabulary for TYPE we could introduce symbols to communicate type and quantity (2 tablets, 1 puff). The data lacks any indication of whether a prescription is ACTIVE. With it, we could be sure that patient’s current medication is on the cover summary. The data for QUANTITY and REFILLS is also absent. With that we could calculate the quantity of medication consumed and suggest the time to refill a prescription.

Encounters and Procedures: If we had the role of the physician-provider, this could be used to identify members of the patient’s Health Care Team.

Immunizations: We could do a much better job with Immunization if we had the NUMBER OF DOSES and the DOSE NUMBER for an immunization. We could produce a chart similar to those used for pediatric immunization records organized by dose, which serves as a reminder to parents of any incomplete immunization series.

Imaging: This part of the medical record is entirely absent from the data. X-ray, sonogram, echography, CAT Scan and MRI images are as critical part of telling a patient’s health story as Lab Tests. Collecting both the image and the meta-data about the image in the health record will be important to everyone in the target audience.

Patient Feedback: If we knew more about the context in which the patient could communicate with the Provider we could account for patient feedback in the design. The CCD represents all the information about the patient held by one institutional Provider. There should be a simple way for the patient reviewing her own Continuity of Care Document to provide immediate feedback to the Provider. Did she find any mistakes? Is there information from other Providers that should be included?

The Results
To Be Announced.

With over 200 entries received for the Health Design Challenge, the results of the judges is put off until December 19.

The Mad*Pow Team
This work was a close collaboration between Andrew Klein, James Christie and myself over a few busy days in November, 2012. We want to thank our colleagues who helped enormously by contributed their ideas and feedback throughout the process: Amy Cueva, Joan Vermette, Jamie Thomson, Susan Mercer, Magga Dora, Emily Dotton and Krzysztof Lenk.

Just a little ways into the future Cassie buys a pair of Google Glasses. At first they feel slightly imbalanced, as if their hummingbird weight were tilting her head incrementally to the side so she begins to drift in that direction when she walks. The age-old adage about the impossibility of crossing a desert on foot- slight imbalances between the muscles of each leg inexorably draw you off course until hours later you are leagues from where you intended to go. Cassie wonders if wearing the glasses will veer her off course ending up- who knows where?

Cassie is like everyone around her- surrounded by smart products: GPS-fed teapots that fire up when her bus rounds the corner to drop her off, heat and light sensors that watch her tirelessly and accommodate her needs like a legion of Renaissance attendants waiting on a thankless queen. Outside the home she waves at faucets, expects toilets to flush themselves, thinks any space without Wi-Fi is a waste. She leaves rivulets of data in her wake, soundless and unseen. Data flows from her fingertips, pools in her footsteps, radiates from the thermostatic changes she brings upon entering a room, creates deluges when she purchases or conducts online searches. She is the source of her own personal Nile, the deltas of herself fluctuating to unseasonal rhythms she has difficulty predicting as her data confludes on its way to the Big Data Sea.

So buying the Glasses seemed a natural thing. Not that Cassie is planning on crossing any deserts in the near future. Just navigating Boston and graduate school is complicated enough. (In the depths of her third year of thesis research she's not sure which is worse.) So deserts, no, but desserts on the other hand, now there's a challenge.

Not that the glasses could help her there. Cassie's nurse practitioner refers to her as someone who "struggles with her weight." Cassie accepts this, but sees it differently. Her weight is a constant companion. It draws her attention like a hyperactive teen when she least wants it- standing in the press of commuters on the train, slipping into a narrow theater seat only to find herself not so much siting on the chair but wearing it like a girdle. It raises its voice when she takes even short flights of stairs, limits her life destinations to places with close parking. It's not so much that she struggles, it's more like she just can't break up with this bastard body following her around getting between her and the world. What chance would a pair of glasses stand against all that weight?

The first time Cassie walks augmented through Boston with Glasses on it's to pick up a latte and bran muffin from the local patisserie. She walks past the bricked brownstones and byways of this sneaker-casual city she and is thrilled to see it come to font-astic life. Trees sprout name tags, buildings espouse histories, stores grow elaborate whorls of supposed infatuation, the path home blinks in discrete green footsteps for her to follow, sweatshirted passersby become armored warriors, part of a game she apparently has a free invitation to but can't seem to uninstall.

The visual intrusiveness overlaying her life creates a giddy kind of disequilibrium. The real world but better. Mostly. Two weeks later this intertextuality has become part of her life vocabulary in the way that smartphones became auxiliary extensions of her memory when they evolved from “cell” to “smart.” Her mind freed to do . . . whatever it is minds do when not weighed down with trivia. Yet while she begins to rely on the ability not to commit to memory the names of seldom-met people the glasses recognize for her, the glasses nonetheless begin to feel like a one-trick pony. Another interface through which she can– literally– see the world. But with labels. And ads. She can't wear the glasses all the time of course. Trundling around the house getting readouts on your potted plants can only hold one's fascination for so long. In Cassie's case it was about two months until she stopped wearing the Glasses full time. Now she puts them on to slip until the digital zone, much like she used to slip under a laptop and settle into the couch for a long snuggle with the Internet while watching TV.

She dons them around the house when she wants to get into the cleaning and cognition zone: mainlining flash cards and grad course material as she scrubs the house clean. For some reason the combination of cramping physical labor– scrubbing corners and crannies heretofore undiscovered, razing colonies of dust creatures in the strange moonscapes of her bathroom– helps her digest grad school arcana like nothing she had tried before. Her apartment has never been cleaner, her roommates happier, or her grades higher. Some digi-wit blogger dubbed the act of donning the glasses for focused multitasking "cog-walking."

Yet despite bi-weekly house scrubbing cog-walks, her weight fails to recede beyond a certain unimpressive tidal flux. So when she learned of the SugaR sensor, a software enhancement for her Google Glasses she was intrigued. By itself it is a delicious novelty: a Terminator-like screen readout in front of her eyes when she looks at food. It delineates calories, ingredients, sugar levels, and in those rare moments when she visits foreign lands, warnings about ingredients that might cause her gastrointestinal distress. Her own personal augmented caloric reality. Reading its output quickly becomes a habit, then an annoyance, and finally something she considers getting rid of. It's work to turn food text into life-choices and her decisions end up cautionary tales more often than not.

A visit to her doctor confirms that her natural nurture of her love for food has resulted in a diabetes diagnosis. Her doctor, a card-carrying member of the digerati, suggests Cassie try pairing the Glasses with an application called SoFree. Frustrated with herself, biology, and the general unfairness of things Cassie gives it a try.

She fills out a SoFree survey that asks hr to identify her goals, motivations, favorite foods, times to bear down and times to break the dietary rules. SoFree promises to track, filter, and make culinary connections. It asks her to identify her moods, discretely, over the next two weeks, noting the tidal flux of Cassie’s intake, cross referenced with myriad other factors: where she’s eating, the weather, her workload, the approach and departure of professional deadlines and milestones, her needs for culinary stimulation, reward, and asceticism. It begins to see patterns in the sweets, saltys, and synchronicity in Cassie’s behavior, even if Cassie herself can’t see it alone. What SoFree helps Cassie see are the foods she views through visual overlays that provide suggestions for pairings and omissions based not on inflexible dietary guidelines, but what she's been eating lately weighed against medical and nutritional professionals’ best advice. SoFree can also interface with her electronic healthcare record, take into account her physician's recommendations, pull in exercise data from a ring she wears when working out, and promises to guide her softly, flexibly, into the realm of healthy eating. (And to send up a social media or direct-to-physician flare in the event of emotional meltdowns or diabetic trouble.)

When Cassie peers into the fridge unaugmented she sees nothing but temptation, a slippery highway traversed at high speed without brakes or guardrails. With SoFree and SugaR activated she sees menus, calories, consequences. She quickly becomes a believer. She begins to learn what constitutes healthy pairings (carbs AND proteins are a particular surprise) and finds that “healthy diet” doesn’t mean “nothing fun” but rather a chemical calculus that can be learned, and in the learning leave her fulfilled, if not always full. So on the glasses go when she dives into the fridge, off they come when she emerges. (Removing them and being her unaugmented self again brings a kind of cognitive vulnerability, like waking up in soft pajamas.) Her refrigerator becomes over time a green zone instead of ground zero in the War on Calories.

What SoFree brings to the dining table, she finds, is twofold: filters to help her weigh her intake against the rhythms of her soul. The way she sees it, if her email program can warn her before ingesting a potentially lethal message, why can't the same mechanism be applied to her eating? Where the SugaR sensor identifies caloric realities and broad threats, this new SoFree app tracks what she eats, watches what she likes, computes the seemingly incalculable food options around her into a clarity of calories. What has she eaten today? Yesterday? How near or far is she from her goals? Which ingredients in the grocery store will combine to make her more of herself by having less of herself? SoFree surprises her as well with text and MMS reminders to eat, of all things, when the rhythms of health suggest it. (She’s now keeping veggie sticks and almonds in her desk drawer at work.) Who could have imagined?

This is not just a dumb smart tool spouting lists of figures (like the glasses). SoFree is a thoughtful companion helping her safeguard the one figure that matters most- hers. By blending what is before her, helping her weigh her options against her weight, she becomes the arbiter, informed by the machine but free to decide, empowered to live. She instructs it to present her with “reward moments” once a month, vary big protein-rich breakfasts with modest lunches throughout the week, help her find energy during the day when she needs it most, find relaxation when she doesn’t, and recommend substitutes that only rarely detract from the meals she eats. SoFree knows all this by tiptoeing (with permission) through her day planner, her email calendar, a hundred other open-source apps Cassie uses to keep the ship of herself on course. SoFree dishes up quick, often funny, mood check-ins during the day and gives her up to the minute “readouts” she can view online and use to tweak her preferences even while SoFree tweaks her right back with friendly but firm facts and fun, crowd-sourced images that inspire her focus. She takes to varying her grad school flashcards with nutrition facts while she cleans house, literally and metaphorically, brushing away old habits and misconceptions.

Cassie is surprised to learn firsthand that a diet of whole grains, natural sugars, vegetables, clear broths (eaten before a meal reducing her overall intake) has her feeling on the whole, balanced, informed and in control to such a degree that fried, fatty foods now taste alien, leaden, unwelcome, in her newly swept self. Yet hurdles remain.

That summer SoFree and Cassie met their greatest challenge: travel and a wedding buffet. Cassie flew a thousand miles to her college roommate's wedding. Disrupted of schedule, limited in eating choices, SoFree and SugaR helped her compromise by scanning the available airport eatery menus, highlighting components of a unlisted meal she never would have thought or taken the time to build, ensuring she raced through the food court's temptation alley largely unbruised. Victory: Stage 1! Scanning the wedding feast (a shoal of sirens calling her to shore amid a maelstrom of memories, social conventions and the urge to throw caution to the wind) SoFree falls back on her pre-determined filters, her predefined compromises (“let me indulge at special events, but only so much”). She eats perhaps a bit unwisely, but better than she otherwise would have, and Cassie avoids, as a single woman of a certain age, the urge to salve mixed feelings with calories. Mostly.

She can trade tonight's cake for tomorrow's cereal but when her hand reaches for substances that would compromise her diabetic treatment she has given the software permission to display The Dress. The slim, breezy, thigh length pot of golden summer freedom at the end of exercise's rainbow. Too much food off the meal plan and up comes The Dress, shimmering in her vision to remind her that life is a long climb, not a quick slide. Should that fail SoFree will let her go, passively noting her hands reaching out and acquiring unsanctioned food. But after more digressions up comes The Bathing Suit. If against all reason The Bathing Suit fails, SoFree is authorized to unleash the nuclear deterrent of foodstuff ingesting: a photo of herself taken from waist height, spilling out of a pair of jeans. It's not about shaming, or cowing her, but rather helping her remember what she truly wants and keep the promises she makes herself.

And after the wedding, for the days that follow, these tools will weave menus for her from available foodstuffs, erasing her event indulgences bit by bit- a suggestion to skip a bag of potato chips here, a gruel thin lunch there, less dessert down the line. SoFree draws deeply from the Big Data sea, including her caregivers' algorithms for success, social media support from relatives, words of encouragement, photos of exotic hikes to be taken, the journal entries she has written to document the days when staying on the path exhilarates (a bulwark against the days when walking the straight and narrow chafes and blisters). Victory: Stage 2! She arrives home if not refreshed, unbowed by distance and caloric intake.

This is the now of the future- augmentation bending the world to her will. And of course, tattling on her. SoFree sends a weekly summary of her regimen adherence directly to her electronic health record, creates report cards for her yoga teacher and her mother. It also posts social media updates to help her extended family applaud her successes and rally to her when her resolve flags.

New millennium healthcare success means the empowerment to be responsible for one’s self in the many life moments that outweigh the few where she interfaces with healthcare providers. Support for healthy living that accommodates rather than dictates, illuminating the math and helping her face the aftermath of inevitable compromise. It's not about harnessing the Big Data Sea to make situational adjustment (lights going on and off when she comes home) but for technology to be the Better Angel on her shoulder guiding her to success.

Now Cassie is crossing the desserts and ending up where she wants to be. A destination she couldn’t have imagined finding alone: losing weight and gaining resolve. The smart dumb glasses and the smart smart apps are a powerful combo. A one- (augmented reality overlays) two- (Big Data dipping algorithmic interpretation) three- (personal filtering and customization) punch that for Cassie just might make her a knockout.

Reading Discussion Questions

1. The author posits a near future where "smart" connected products realize their potential when they are paired with targeted software that data-mines individuals' preferences, open source health records, life goals, and continual tracking of human activity to help make behavioral changes. In effect "the next step" is not augmenting reality, but making it useful. Do you agree? Why or why not?
2. Does Cassie's available technology make her happy? Should it?
3. Is this author sucking up to Google for an advance pair of glasses or what? Did Cassie lose weight? Does it matter?
4. Could you substitute the Google Glasses, fictional SugR sensor and SoFree application in the story with different technologies? Why? Which ones?
5. What is the difference between state awareness and behavior modification? Is this an appropriate role for technology?
6. Is Cassie giving up control to SoFree? Why or why not?