Apps for What Ails You

Could a mobile app save your life? Aza Raskin thinks so. Formerly in charge of design and user experience for Mozilla's Firefox Web browser, Raskin left the company last year to start Massive Health, a startup based in San Francisco that's pursuing secretive plans to launch a mobile health app later this year.

While Angry Birds and other addictive games may top the app charts today, Raskin is among a growing number of entrepreneurs who think that apps will be powerful tools for health care, too. (See six mobile health apps highlighted by Technology Review.) That is because mobile apps offer the sort of intimate interactions the health-care system doesn't: they are always connected, always by your side, and they can have a very personal feel.

"Health really happens in between doctor's visits," says Raskin, who at 27 is already an influential thinker on design and user experience in Silicon Valley. "We now have these always-on connections, rich interfaces, mobile devices, and people who are willing to share," he says. "All that creates a substrate on top of which you can create designs and interfaces to change behavior."

The market for smart-phone health apps is only a few years old, and market analyst IDC says that this year some 14 percent of adult Americans will use one. According to Nielsen, which tracks 5,000 smart-phone users in the United States, the most popular health app today on the Android phone is WebMD, a source for consumer medical news. It is followed by Instant Heart Rate, a 99-cent app that permits people to use their phone's camera to measure their pulse. In third place is Epocrates, a free quick-reference guide to prescriptions.

However, Raskin thinks that health apps have yet to reach the people who really need them. Most existing apps, such as those that track sleep or workouts, are what he calls "wellness" tools that attract people who already take a close interest in optimizing their health, rather than not-so-healthy people who must manage chronic diseases.

Raskin isn't ready to detail his own company's plans—Massive Health's app will remain under wraps until it is launched late this year—but he says he is taking on the challenge of helping just that population. The idea is to make health care a constant in people's lives, not something that occurs only during a checkup.

Using apps to encourage healthy behaviors could be particularly valuable as the population ages and more people develop chronic conditions that require active management, such as diabetes. By 2020, according to health insurer UnitedHealth, 52 percent of adult Americans will be diabetic or pre-diabetic. "That's terrifying, and our current health care system is not ready for that," says Raskin. Mobile apps could prompt or remind diabetics to manage their blood sugar and diets better and, in Raskin's words, become a sort of "computer interface to our bodies."

The prospect of hundreds of millions more people living with such diseases explains why, after helping create a browser used by half a billion people, Raskin decided that health technology was the next big user-design challenge. "What needs the most help? It's not social photo sharing, it's health," he says. "The U.S. has a growing problem with chronic health conditions, and the costs of managing them are going up. We need new tools to address that." (Technologyreview)

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Internet VCs Circle Health Care

Some prominent venture capitalists are betting that the Internet strategies that created giants such as eBay and PayPal could reshape the ailing U.S. health-care system. That system currently devours 18 percent of the world's largest GDP while delivering mediocre health results.

In August, the online health marketplace ZocDoc, which lets patients look up doctors by specialty and zip code and make appointments over the Internet, raised $50 million from the investment fund of Russian billionaire Yuri Milner, who in the past has backed companies like Facebook, Twitter, and Groupon.

The idea behind ZocDoc and other startups getting funding is that our costly, paper-based health-care system is ripe for the same technological fixes—such as data visualization, cloud computing, and mass-market self-service concepts—that have transformed industries such as consumer banking and travel.

However, many venture investors say that investing in health-care IT (HIT) isn't as easy as putting money behind, say, the latest social-media company. Health care is more complicated, more regionalized, and subject to more government rules. The U.S. Food and Drug Administration surprised many software entrepreneurs this summer when it said it planned to regulate some health software apps for phones.

"A lot of venture capitalists say they are investing in HIT, but right now, there seems to be more education going on than investing," says Rebecca Lynn, a partner at Morgenthaler Ventures, based in Menlo Park, California.

According to Dow Jones VentureSource, venture investments in HIT rose about 20 percent in 2010, to $460 million, or about a fifth of the $2.3 billion that venture capitalists invested in all health companies, including biotech firms.

Jessica Canning, research director for VentureSource, says half the deals counted in 2010 were seed-stage or first-round financings. She called that "very promising at a time when VCs are struggling to keep their existing portfolios alive. It means a pipeline is being built in HIT."

Even so, many entrepreneurs are running into difficulty finding investors who understand both the heavily regulated health-care industry and software innovation, says Sonny Vu, cofounder of Agamatrix, which manufactures a diabetes monitor for the iPhone. "On the one hand, you have people raising money who know nothing about regulation or reimbursement codes; on the other, a bunch of health-care guys who think Zynga is some kind of fruit. There is truly a chasm between world views."

Some investors also question whether the venture capital model of plowing money into risky early-stage companies will pay off in HIT. "Relatively few VCs have sufficient depth of expertise with both the health system and IT," says Barbara Lubash, a managing director at Versant Ventures, also in Menlo Park. "But the usual reason HIT doesn't get funded is because the opportunities aren't large enough."

One reason is that most large hospitals have already sunk hundreds of millions of dollars into legacy IT systems built in-house or developed by dominant players such as Siemens, or Midwestern companies like Cerner or Epic, and are unlikely to move to new offerings. As a result, many entrepreneurs are looking for underserved niches in HIT, such as health apps meant to run on mobile devices. But those kind of inventions have limited appeal for professional investors, says Lubash: "We look for opportunities that are reasonably large, capital-efficient to pursue, and positioned to achieve sustainable competitive advantage. There aren't a lot of those models in HIT."

Some of the most aggressive investing in HIT is being done by specialized funds outside of Silicon Valley run by people with medical backgrounds. Among them is Santé Ventures, based in Austin, Texas. "I truly believe if you start with a massive pain point and provide a real-life solution, you'll be successful" as an investor, says Santé cofounder Joe Cunningham, who was formerly chief medical officer for the Providence Health System, part of Ascension Health, the country's largest nonprofit health provider.

One Santé investment is Rise Health, a startup that runs call centers where doctors and nurses with electronic medical records triage patients, treating some "virtually" while ensuring that others get basic care. Rise is targeting health systems that both insure patients and provide their health care, such as Kaiser Permanente, with promises to limit costs while improving patient care.

Other startups have been receiving investments from large IT companies who see health care as an important new market. In 2010, both Intel and mobile chipset maker Qualcomm participated in an $11 million funding round for Sotera Wireless, a San Diego company developing a wrist-watch-sized version of the wall-mounted medical monitors common in hospital rooms.

For Qualcomm, the investment was a bet on the growth of remote monitoring—the idea that people can use mobile devices to continuously monitor their well-being while at home, says Nagraj Kashyap, vice president of Qualcomm Ventures, a $500 million in-house venture fund established in 2000. While the remote monitoring market might take a decade or more to develop, Qualcomm doesn't face as much pressure as typical VC funds do to cash in on investments, Kashyap says: "We can take the long view and be patient. Our goal is to make sure that wireless technology gets embedded in health care."

Other investors believe HIT is now poised to explode. Among them is Robert Kocher, a former partner at consulting firm McKinsey & Company and one of the architects of President Obama's health-reform bill. This May Kocher signed on as an investor with venture capital firm Venrock Partners, in Palo Alto, California.

Kocher, who calls himself "wildly optimistic about the potential for positive change in the health-care system," believes changes will be largely driven by data.

Health-care reform legislation and other recent federal policies, Kocher says, are beginning to make a huge amount of medical data available for free to anyone who thinks they can use it. In 2012, for instance, the federal Medicare program plans to open its massive trove of claims and billing data. The impact of having more information on prices, drug use, and health outcomes is "game-changing and underappreciated," Kocher believes.

Venrock is investing in companies trying to leverage such data to help consumers and employers make rational health-care choices. For instance, Venrock is a backer of Castlight Health, a startup that offers Internet-based tools to help consumers compare prices offered for medical procedures using information it has culled from paper insurance forms.

Kocher thinks a transparency on medical pricing and results could have a big effect on health care. "Data is what creates functional markets. It lets suppliers differentiate offerings, and [buyers] understand relative trade-offs," he says. "The problem we've had in the medical system is that money has been made without value creation. That is finally at the point of changing." (Technologyreview)

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The Rise of Electronic Medicine

Last November 9 at 2 a.m., I received a phone call from a hospital in Southern California. "Your mother needs an emergency operation," said the voice on the line. "Your father had chest pain while at her bedside and both are in ICUs. We have no idea what medications they take, what allergies they have, or what problems they have been treated for. Can you help?"

This is medicine today. A sea of paper and fax machines, information silos, privacy barriers, and unconnected data. And yet, we know the public is ready for a better system. According to a 2010 Harris Poll, four in five Americans believe any doctor treating them should have instant access to their medical record online.

Today, we are moving quickly in this direction. In 2009, President Obama signed the HITECH act, creating a $27 billion stimulus package to accelerate health-care information technology in the United States. The law pays doctors to adopt electronic records, and penalizes those who don't. Fueling the change are data standards that make it easier to share health information, maturing software, rapid innovation linked to mobile computing, and policies to protect patient privacy. As a consequence of this perfect storm of incentives and disincentives, the next five years will see an unprecedented acceleration of electronic medicine in the U.S.

Other countries are moving along a similar path. Some wealthy nations with socialized medicine are far ahead; in the Netherlands, 98 percent of primary-care doctors already use electronic records. But most nations—including Japan and China—are just beginning to bring IT to bear on health care in a systematic way.

Will we solve the problem of runaway health costs? The health reimbursement system in the U.S. pays doctors and hospitals for how many treatments they provide, not how good that treatment is. In Massachusetts, for instance, I estimate that 15 percent of lab and radiology tests are redundant or unnecessary. Evidently, one man's redundancy is another man's country club membership.

An important aim of health-care reform is to change our broken incentive structure by instead paying doctors a yearly fee to keep patients healthy. For doctors to survive this reimbursement change, they will need to keep electronic health records, share data, apply telemedicine to monitor sick people at their homes, engage patients continuously, and integrate the latest treatment knowledge into their workflow. That's electronic medicine.

The transformation of the health-care industry to embrace the levels of automation typical of travel and financial services will not be easy. Health care has unique payment models, referral patterns, workforce expertise requirements, customer needs, and privacy regulations. For these reasons, the centerpiece of the HITECH Act is the concept of "Meaningful Use"—paying doctors and hospitals only after they have installed electronic records and shown that they are using them wisely as measured by specific goals. Starting this year, your doctor will need to keep a computerized list of your medications, problems, and allergies. By 2013, your doctor will need to be able to share these data among all your caregivers (with your permission). And by 2015, the hope is that the combination of electronic health records, data sharing, and novel technologies will enable your primary-care doctor to recommend best treatments based on the experience of tens of thousands of similar patients.

Here's my prediction for the major developments in the next five years:

Electronic Health Records in the Cloud

Doctors are great at diagnosing and treating disease. They are not good at server hosting, database administration, and implementing government data protection rules, nor do they want to pay for costly hardware and software. I believe the only way to rapidly implement electronic health records is via the cloud.

Cloud computing—storing data and programs in centralized servers rather than in the doctor's office—requires novel security engineering to resist malware, denial of service, and sophisticated hacker attacks that could jeopardize private health information. But they solve other problems, such as making it possible for complex software to be scaled up and maintained without any technical involvement in clinician offices.

In the near term, regulatory requirements will result in the rise of "private clouds" hosted by large hospitals and software vendors, but commercial cloud providers are likely to develop secure hosting, given the enormous business potential of hosting electronic records for the more than 500,000 physicians in the U.S. At Beth Israel Deaconess Medical Center in Boston, where I am chief information officer, I estimate that moving infrastructure and applications to my hospital's private cloud has reduced the cost of implementing electronic health records by half.

Modular Software Unleashes Innovation

Less expensive cloud-based software, combined with tablet computers, will unleash a wave of software innovation. Until very recently, innovation in medical IT has depended upon the development schedules of a few very large vendors who sell hospital systems with $100 million price tags. In the future, electronic health records will become increasingly modular, similar to the online app stores where consumers download games or programs for their phones. Imagine a cool new app that provides a dashboard for diabetics, showing their daily glucose readings and sounding an alert if they aren't managing their disease well. Doctors today must wait for their medical center's single monolithic vendor to develop such an app. In the near future, modular software will let doctors and patients tap the creativity of thousands of entrepreneurs.

Consumer computing hardware will accelerate the new innovation ecosystem and bring it to the patient bedside. Already, over 1,000 clinicians at my hospitals have purchased tablet computers like the iPad and Samsung Galaxy Tab, using their own funds. Although developed for general consumers, tablets are proving to be an ideal computing device for doctors, too: they weigh under a pound, have a battery life of 12 hours (or about one shift), can be dropped five feet without significant damage, and can be wiped down with disinfectant.

A Network of Networks

Many people believe that doctors continually share data electronically with one another to coordinate treatment, do research, or track disease outbreaks. The reality is that only a few hospitals and cities in the U.S. are able to securely exchange health records, and even fewer have economic reasons to do so. Over the next few years, however, new standards for secure e-mail of data between providers will be integrated into electronic health records. The use of the fax machine will wane and patients will expect that every time they see a new doctor, or visit a new hospital, their health record will follow them.

Will one giant database hold all our health records? Will a monolithic network link insurers, doctors, and patients? Given privacy concerns, that's unlikely. What we are seeing instead is that cities, states, and regions are developing regional data exchanges. Just as the Internet has many e-mail providers and many Internet service providers, a collection of private and public "Health Information Service Providers" will be able to exchange data among themselves, creating a nationwide health information network that is a federation of subnetworks.

Engaged, Connected, E-Patients

In my parents' generation, doctors were considered largely infallible, and the medical record was something owned and viewed only by clinicians. Today, with credible medical knowledge available on the Internet and electronic records allowing doctors and patients to view the same data, joint decision making is becoming more commonplace. Research shows that shared decision making between doctor and patient results in better outcomes. An engaged patient is also less likely to assert malpractice and sue.

New reimbursement models will pay clinicians to keep patients well rather than for ordering tests or performing procedures. Such an emphasis on early intervention will lead to the rise of home-connected devices such as electronic blood pressure cuffs, glucometers and bathroom scales that report data wirelessly to clinician offices and patients' personal health records. Teleconsultation in the home will become much more common. The pendulum is swinging. Fifty years ago, doctors made home visits and attempted to keep you well. Today, we have abbreviated office visits that result in prescriptions to treat disease. Home monitoring and telemedicine will return us to the bygone era of wellness.

Genomes Lead to Information Prescriptions

The first human genome was sequenced in 2003 at a cost of nearly $3 billion over a 10-year effort. Today, the full DNA code of an individual can be sequenced for under $10,000 in about a week. I was one of the first 10 people sequenced (via the Personal Genome Project) and can say there is still a wide gap between knowing one's DNA and acting upon it. For most people, DNA just doesn't yet tell us that much.

This situation will change sooner than many expect. Researchers are already investigating novel ways that people's genome data might be stored inside electronic health records and used to speed up diagnosis, for instance by predicting ahead of time the chance a person will develop diabetes. Treatments will be more effective, too, as your DNA is compared electronically to that of thousands, maybe millions, of other patients. Rather than just medication prescriptions, doctors will use your DNA to write "genomic information prescriptions" for personalized educational materials describing the risks, evidence, and likelihood that a treatment will work for you.

In my opinion, a golden age of electronic medicine is now dawning. And just in time. The U.S. currently expends 18 percent of its gross domestic product on health care, and that is hurting America's position in the world marketplace. Health-care IT can bend that cost curve by ensuring that patients receive the right care (not too little or too much) at the right time, and by improving quality, safety, and efficiency. While health care reform has proven controversial in Washington, the good news is that reform of health-care IT is universally embraced. With $27 billion in federal stimulus, an urgent need to change, and alignment among government, insurers, and providers, we'll create an electronic future for health care in our generation, not our children's.

John D. Halamka, M.D., M.S., is a professor of medicine at Harvard Medical School, chief information officer of Beth Israel Deaconess Medical Center, chairman of the New England Healthcare Exchange Network, and co-chair of the national HIT Standards Committee. (Technologyreview)

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Recognizing Customers Wherever They Are

A company's customers can use dozens of methods to get information about a product, buy it, and talk about whether they're satisfied. A person interested in a car, for example, might get curious after receiving an ad on a mobile device. She might follow up by researching the car on a desktop computer, watching it in action on YouTube, or visiting a dealership for a test drive. If she bought the car, she could take it to any number of places for service, buy accessories at stores or online, and maybe discuss it on social-media sites such as Twitter and Facebook.

This multiplicity of avenues can make it hard for a company to assess how well it's doing at enticing and pleasing customers. How can it connect the dots and track a customer through the whole course of learning about a product, deciding whether to buy it, using it, and telling people about it?

"That is a very disaggregated process today, and we're trying to build a process around it that's very consolidated and uniform," says John Carione, group manager of enterprise product marketing at Adobe Systems. Technology companies such as Adobe are stepping in with tools that help businesses identify customers and remain aware of their preferences and history, whether they're physically standing in a store or posting comments on Twitter.

Last week Adobe launched its new Digital Enterprise Platform, a system that tries to provide all the technology companies need for that process. One of its main features is that it helps keep track of who a customer is no matter how that person chooses to communicate with a company. In some cases, it's possible to detect this identity automatically—for example, the system can identify when a person returns to a company website and call up other information that's been collected about him or her. In other cases, the company would have to take steps to centralize its record keeping, maintaining records related to in-store transactions in the same system that tracks interactions through social media.

The platform also keeps track of how customers prefer to get information. For example, it can track what a given customer focuses on when visiting the website—video, images, or interactive forms. Adobe's system provides a central repository where companies can store and update all that information, making it easier to meet the customer's preferences in the future.

Finally, the platform tracks how well all these interactions go. Are customers completing forms or abandoning them? Are they watching videos all the way through? Are they discussing their experiences through social media?

While Adobe's system may work best for companies aiming massive marketing efforts across a variety of digital platforms, other companies are looking to address the needs of more modest marketing efforts.

For example, Greenrope, a company based in San Diego, aims its product at small and midsize companies that simply want to be able to identify their customers in different communication settings.

"Small businesses have so much to keep track of with just doing their work," says Lars Helgeson, the company's CEO. They know that personal responses to comments on Facebook pages can give them a leg up—"By tailoring a response to someone, it makes them feel special," he says—but in practice, it's difficult to know that the person commenting on Facebook today bought a product at the store last week. Helgeson says, "We're trying to create a convergence of information."

Such systems aren't perfect, he acknowledges. For example, Greenrope's technology can search for Twitter handles that obviously match the real names used on LinkedIn and Facebook or in e-mail addresses, but some Twitter handles don't reveal the user's name. In that case, it's up to the company to make the initial connection. Then the system can track all the person's interactions from that point forward.

Companies are still trying to figure out how best to communicate with consumers. "There's still a lot of experimentation going on," Helgeson says. Systems such as Greenrope's and Adobe's, however, can help them unify their efforts, collect data about what works and what doesn't, and ultimately get better at using new media and mobile devices to stay connected to their customers. (Technologyreview)

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An Office on Every Surface

In a futuristic demo video that he showed in an internal sales meeting in 2009, Craig Mundie, Microsoft's chief research and strategy officer, imagined what work and life might look like a decade hence. The technologies showcased included massive touch screens connecting offices around the world, computer interfaces in tabletops, and mobile devices that receive data seamlessly.

Since then, mobile devices have surged in popularity, and companies including Cisco are sketching future offices based on them. Major companies are also embracing cloud computing, with Microsoft itself recently releasing Office 365, an online version of its productivity software.

In a time of such rapid change, Mundie recently described to Technology Review why his vision of data-driven spaces with interfaces built into every surface has essentially remained unchanged.

TR: What today is Microsoft's vision of the future office?

Mundie: We will continue to see desktop computing. In fact, one of the things that I have predicted is that there will be a successor to the desktop, and I think it's the room. There will be what I call a fixed computing environment, and it should evolve in quite dramatic ways to become a much richer and immersive experience.

We will see a lot more displays in the office, and they will be built into surfaces horizontally and also be on the walls or in the walls. I think that a kind of completely continuous model, where you are using speech, gesture, and touch in a more integrated way, will become more commonplace. There will be a subset of that fixed environment that you will want to take with you, called the portable office, and the evolution of the laptop will be that. And there will be a mobile environment, which is the phone and other devices [including] tablets of certain types.

Tablets are big right now. Why don't you see that as a key trend?

It isn't clear to me whether the tablet, in that exact form factor, will be a persistent thing or not. There may be other display technologies that people may look at over that longer horizon. Tablets will still be important over the next five to 10 years, but there are still things that they are not great at, particularly in this area of lifelike collaboration and interaction.

So tablets and mobile devices become what, then?

If you walk into an office and there is a big screen on the wall, and even if you have a tablet or a phone, you may decide to use them in conjunction with one another. Or the computing that is in your phone or tablet may project something on the large screen while you are there.

And will we interact with these surfaces in the same way as today?

While the graphical interface won't disappear—as it will still be optimal for a number of detailed types of tasks—I do think that you will start to look to the computer to provide assistance at a much higher semantic level of tasks. Computers in many scenarios will present themselves to you in a personified way. You can see it happening with things like Avatar Kinect [Microsoft's motion-capture gaming system for Xbox, which allows users to meet virtually with up to seven

Where is Microsoft with this technology?

Some of the last things I talked about, such as Avatar-based telepresence, are here. Avatar Kinect went worldwide [in July]. For the very first time, there really is an ability to have meetings of up to eight people in a telepresence type of environment.

How soon will this technology emerge in the workplace?

In a decade, I don't see a reason why the kind of technology that we have in Kinect cannot ultimately be miniaturized to a large degree, much like other cameras are, where you have one on the back of your phone or in the lid of your laptop.

What future-office technologies are your overseas research labs, in Beijing and elsewhere, working on?

If you look at Kinect and all the machine-vision stuff, that came from seven groups in three labs—Beijing; Cambridge, U.K.; and Redmond. For more and more projects, the research is blended together on a more global basis to create these next steps. I don't perceive any dramatically different way that knowledge workers work in China than they do here.

What about offices and work in developing countries?

If you talk about mobile phones in developing countries, it is true that they have become very popular, but I would not tell you that [a mobile phone] is the computer for the knowledge worker. Today, the knowledge worker, even in the emerging countries, is using PCs. As phones become smarter, people will want to do more, but that will also require expensive data plans.

How do you plan to get back into the tablet market?

When Bill Gates and I pushed the company to do tablets—about a decade ago—the technology to use both pens and touch [interfaces] really didn't exist. And the interface of Windows was optimized for high-def pointing, not finger pointing. What Apple showed—and coupled with the growth of the smart phone—is they got on that when touch was more viable and economical, and they created a family of products that were touch-first. Microsoft will have a version where it's a touch-first model of interaction.

How does cloud computing fit into Microsoft's vision of the future of the office?

The cloud is important in that it democratizes access to super-scale computing and storage facilities. Now any guy in the garage with a credit card can economically, for some period of time, get access to facilities that are larger than most companies historically had access to.

And what about Office 365?

When you talk about Office 365, I think the cloud will be a point of integration for the individual. All these different devices in their life, whether they are at home or at work or in their cars, will gradually become a more organized set of things that work together as opposed to a disjointed set of little computers that the user has to manage. And I think the cloud is an integral part of making that happen. (Technologyreview)

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New Options for Starbucks Wi-Fi Squatters

A consultant who works from home wants to host a meeting somewhere with a professional atmosphere. A marketing VP traveling abroad wants a place to work other than the hotel lobby or a Starbucks. A software engineer wants a quiet spot to resolve office problems while on vacation.

Workspace-finding applications, such as Desktime, LiquidSpace, Loosecubes, and OpenDesks, are cropping up to help people in situations like these find good places to get things done. Some apps also help office owners fill extra space with people who have established a reputation for reliability.

Typically, a service can be accessed via either a website or a mobile reservation and payment app. These contain a catalog of temporary office spaces—some in dedicated shared work buildings, work-friendly coffee shops, and business centers, and others within the offices of startups or corporations that have unneeded space. Loosecubes, for example, offers about 1,800 spaces in 52 countries.

The apps aim to take advantage of the trend toward increasingly mobile workers. These days it's not just freelancers, consultants, and the self-employed who go hunting for wireless signals with a laptop bag slung over one shoulder. Forty percent of IBM's workforce works outside IBM real estate. The U.S. General Services Administration announced at the end of July that it will renovate its Washington, D.C., office building to accommodate about three times as many employees, mostly by eliminating private spaces and instituting a system whereby employees schedule desk space when they plan to come in to the office.

More than 10 million people in the United States are entirely mobile workers, with no permanent office space outside the home, estimates Chris DiFonzo, founder and CEO of OpenDesks. Adding in those who are mobile at least three times a month puts the number above 40 million.

For a time, many of these mobile workers parked themselves in coffee shops, but, DiFonzo says, "the café era is over." For one thing, coffee shops nationwide have taken steps to discourage people from squatting for hours over tables and outlets. Workers might be better off finding new workspaces anyway, says Anthony Marinos of Loosecubes. "I don't know if anyone ever liked working at coffee shops," he says. "What do you do when you have to go to the bathroom? Do you pack up all your things every time? How often do you have to buy drinks?"

Marinos argues that shared office space not only is more practical but also can provide valuable social opportunities. For example, he says, instead of requesting informational interviews, perhaps recent college grads could spend a few days working in the offices of companies that interest them, where they would have a chance to make natural social connections with potential employers. Loosecubes itself opens its office to mobile workers, and recently partnered with a graphic designer it found that way.

However, to attract offices, apps have to offer a variety of amenities. "The extra spaces are still an outlier," says DiFonzo, explaining that there's still a lot of education and outreach to be done to persuade most companies to share their space with mobile workers.

While sharing space can bring in extra money for an office, many companies aren't prepared for the headaches of managing mobile workers, says Sam Rosen, who runs Desktime. Apps need to help companies schedule their spaces, ask people for rent, and perform other vital tasks.

Mark Gilbreath, CEO of LiquidSpace, has taken this principle a step further. "Letting all manner of people use a space is a nonstarter in our minds," he says. "Creating some form of trust mechanism is a critical requirement."

LiquidSpace is designed to build up a set of credentials (a "passport") for each user. Users must apply to a space for a "visa" to get access, or even to see if a spot is available. The system also waits until users have been approved and have arrived to release sensitive information such as door-access codes and Internet passwords.

Of course, the apps have to serve users' needs as well. DiFonzo says that OpenDesks users divide into two groups: those who like to plan ahead and reserve spaces as they would in a hotel, and those who want something on the spot. He and other companies are building in mobile and social features to help users in both situations.

Most app developers believe that sharing office space can help businesses become more responsible and sustainable. "It's about more than empty space," says Rosen. "It's about taking the space that we have and using it better."

However, they agree that if this new way of working is to gain mainstream acceptance, it has to be convenient, inexpensive, and useful. Gilbreath, of LiquidSpace, says that workplace-finding apps need to give users a real-time solution when they need one: "I'm at the corner of Market and Third Street right now. I need to work for the next hour. Where can I work right now?" (Technologyreview)

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Green Mountain State Goes Greener

Offices will probably never be completely "paperless," despite the longstanding technology prophecy to the contrary. But sharp reductions in paper use are still possible, as one Vermont state agency is trying to prove.

Vermont's Department of Information and Innovation (DII) handles IT procurement for the state, and much of that work is paper-intensive. The agency sets up contracts with outside vendors, such as antivirus-software providers or hardware sellers, to maintain the state government's technological infrastructure. A given contract handled by the DII may need to be seen and approved by several people before it can be accepted, and each step still requires printing and signing by hand. The DII might handle 80 such contracts in a month.

About a year ago, officials in the agency began trying to make the process more efficient and less costly by relying more on online tools. The DII became a beta tester for software from IBM and Silanis that lets agency employees sign a document digitally by appending a bit of data that verifies and records the identity of the signer electronically, without the need for unique handwriting. The system then automatically alerts the next person in line that it's his or her turn to review it. There's no need for a physical document to be passed around, collecting signatures. The flow of contracts through the organization is no longer limited by employees' walking speed.

Similar measures in any organization could yield savings that add up quickly. Ken Bisconti, head of IBM's Enterprise Content Management division, says that when companies stop printing e-mails and other documents that are "born digital," they can reduce paper consumption by 80 to 90 percent. François Ragnet, a program manager with Xerox Research Center who focuses on document technology, envisions a future in which many more documents are stored online and automatically update themselves, so that paper is needed only in limited circumstances.

For now, though, paper can be minimized only up to a point, says Kris Rowley, the DII's chief information security officer. Final versions of contracts must still be printed and physically filed. And not every department within the state government is willing or able to use electronic signatures. "Paper in the office is never going to go away," says Rowley. She's also not sure how much money the effort will save. Still, she hopes the DII can do its part to shrink the anticipated $153 million gap in the state's budget. "Vermont has always been about green," she says, and "there's an awful lot of paper wasted—there's no need for it, especially with technology the way it's going." (Technologyreview)

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Telepresence Robots Seek Office Work

Building on the trend toward remote work, two companies started shipping wheeled telepresence robots to customers this year, and other versions are launching soon. While prices are steep and sales tepid, some early adopters find that the robots offer advantages over technologies such as videoconferencing.

Telepresence robots are wheeled machines steered by a person sitting at a remote computer; the bots take the person's place around the conference table or, say, on a facility inspection. They are equipped with cameras, microphones, screens, and speakers so the human controller can interact with real people.

But using one of these robots is far harder than picking up a phone or using a video calling system. I tried one this year (see video below), to stand in for me at Technology Review's main office in Cambridge, Massachusetts, as I worked in San Francisco, and encountered a fairly steep learning curve. Piloting a robot, and contending with its sometimes poor hearing and limited vision, can make interacting with people a challenge.

Still, customers find them valuable, says Ned Semonite, VP for product management at VGo Communications, the New Hampshire-based company that sells the four-foot-tall robot I tried. Some engineers and designers enjoy being able to visit a distant lab or inspect a prototype without leaving the office, he says: "It means they can be there more often. You get the immediacy of walking in the door, and that valuable ad hoc contact." More than 200 of the robots are in use so far, he says, and customers include companies such as Hewlett-Packard and Cisco.

The technology provides advantages over videoconferencing, Semonite adds, because "the person who is remote can choose what they want to see and go places beyond the meeting room."

Telepresence robots are a better bet now that that reliable Wi-Fi access has become standard in the workplace. And the 4G cellular data networks being rolled out by carriers will make them even more capable, says Semonite, whose company has been working with Verizon on a version with a built-in 4G connection. "It will make it possible for the robot to work reliably right out of the box, and to go into places like factories or warehouses that don't always have Wi-Fi," he says.

It's not yet clear whether telepresence robots are cost-effective, however. Semonite claims that the $6,000 Vgo can pay for itself just by saving the need for a few business trips. The only competing robot on the market, the much taller QB from the California startup Anybots, might need to replace a few more trips to justify its $15,000 price tag. Yet both robots compare favorably with dedicated videoconferencing rooms, which are sold using similar arguments and cost hundreds of thousands of dollars.

Tom Serani, cofounder of RatePoint, which helps businesses monitor their online reputation, says that his Vgo paid for itself in about a month by allowing managers to maintain a presence among call-center staffers. He says that this remote managerial presence helped spur a 30 percent increase in sales.

Other companies are preparing to launch telepresence robots aimed at addressing what Colin Angle, cofounder and CEO of iRobot, says is a need for significantly more intelligence. For example, instead of having to steer a robot like a remote-controlled car, he says, a user should be able to ask it to navigate to a particular meeting room, or click on screen to indicate which person to follow or walk alongside.

"The products that have launched so far are really videoconferencing on a remote, driveable platform," says Angle. "It has some appeal, but they don't build a version of you in a remote location able to be as effective as you would in person." His company, which makes the Roomba vacuum cleaner and the military PackBot, is working on a version, dubbed Ava, that he says will solve some of these problems. (Technologyreview)

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Using Games to Get Employees Thinking

Companies have been using crowdsourcing to get large groups of outside volunteers to answer a question or perform a task, but now they are finding ways to crowdsource internally—by using games and contests that entice employees to generate, hone, and implement ideas.

Nearly two years ago the U.K. Department of Work and Pensions (DWP) began asking its employees to play a game called Idea Street in their Web browsers. The game is like a suggestion box for the agency, but it rewards players for generating new ideas: they get DWPeas—a virtual currency to be used in the game.

By implementing suggestions made through the game, the department expects to save roughly $30 million by 2014, says David Cotterill, the DWP's deputy director of innovation. Some of these ideas are deceptively simple but improve the efficiency of the department, such as a new way for employees to reserve conference rooms and a simple app that analyzes the DWP's data-storage availability.

Games are turning up in a variety of business-oriented settings these days. Microsoft created Ribbon Hero 2: Clippy's Second Chance, a downloadable game designed to teach people how to use the company's Office software. Walt Scacchi and his colleagues at the University of California, Irvine, have developed FabLab, which turns a "first-person shooter" game, Unreal Tournament 3, into something that trains people how to work in a semiconductor factory. The ShapeUp platform uses games to encourage employee health. Badgeville, a startup that helps companies use online games to attract consumers, recently secured a $12 million round of funding.

"People have always played games while they work; it's just that now it's being formalized and the games are more fun," says Richard Bartle, a games researcher and one of the pioneers of the massively multiplayer online game industry. The research firm Gartner predicts that more than 70 percent of the world's 2,000 largest companies will soon have at least one "gamified application" by 2015.

At the DWP, players of Idea Street earn rewards in the form of DWPeas not only by submitting ideas but also by providing feedback on others' ideas. Leader boards track employees with the most points.

The points also help the organization select and develop good ideas. Suppose you have an idea that accumulates a certain level of positive comments from the community. It thereby graduates to a team-building phase, in which you'll have to enlist a certain number of teammates to support your idea. If you succeed at this, your idea will move on to the final phase, in which you build a business case for it and try to get other players to invest their DWPeas in the idea. Ultimately, it will go to an approval board, and if it is green-lighted there, all the people who invested in your idea will get a return on their investment. At DWP, Cotterill says, about 25 percent of ideas that make it to the final phase get implemented.

Seeing the benefits, including the way the game breaks up large tasks into smaller, more manageable chunks, other departments of the British government are beginning to use Idea Street. It debuted in the Ministry of Justice and the Department for Business Innovation and Skills last year.

Rajat Paharia, chief product officer and founder of the game service Bunchball, expects to see more organizations following suit. To him, there's an obvious connection between the nature of business and the nature of games. "Most companies haven't thought that hard about it," says Paharia, but the corporate world "already is a giant game." (Technologyreview)

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