From the healthcare world, the ultimate in end-user development

You hear it all the time: For mobile applications to be successful, developers must make end-user needs their top priority. Invariably that means getting input from users to find out what features and functionality they need from a mobile app to do their jobs more effectively.

But what if you just had the end users develop the apps themselves? While that sounds like a novel (and dangerous!) concept, the roots of “end-user development” actually can be traced back to the early days of the personal computer and spreadsheets such as VisiCalc, Excel and Lotus 1-2-3. And recently I wrote about a new service from Microsoft that provides enterprise employees with the tools to build their own mobile applications.

However, perhaps the most ambitious current example of end-user development comes from the world of healthcare. A new paper published by The JAMA (Journal of the American Medical Association) Network describes the Nightscout Project, a mobile technology system for people with type 1 diabetes.

The paper’s abstract sketches the traditional development framework:

The US health care system has typically embraced a top-down model of health production, in which large-scale organizations, such as pharmaceutical or medical device companies or academic health centers, produce the tools and technologies for improving health. The underlying assumption is that physicians, researchers, and industry professionals are health experts rather than the patients.

Substitute “software developers” for “physicians, researchers, and industry professionals,” “apps experts” for “health experts,” and “end users” for “patients,” and this all sounds familiar!

The Nightscout Project, launched in 2014, was “created by patients for patients” and began with the parents of a 4-year-old boy with diabetes who wanted to monitor their son’s blood glucose level while he was at school. The father, a software programmer, created an app that enabled the parents to access glucose readings from a smartphone via the cloud. He tweeted about his accomplishment, and from there things went viral, the JAMA paper explains:

Those who had technical programming expertise reached out to the father. He shared the computer coded [he developed] with these individuals, and as a group they began using, adapting, and creating new code to to generate novel and personalized mobile technology solutions…

The paper concludes that the Nightscout Project represents “an important development in the healthcare landscape,” in large part because it “reflects the increasing autonomy of patients and caregivers” in the era of mobile, cloud and Internet technologies.

That’s all true, and the point about autonomy is equally true of consumers and employees everywhere. People increasingly are aware of what they want, what they need, and how to get it. Really, it’s the dynamic that fuels shadow IT.

Harnessed strategically and with a purpose, end-user development can transform an enterprise by empowering employees and customers.


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