DigiSwitch: Design and Evaluation of a Device for Older Adults to Preserve Privacy While Monitoring Health at Home Kelly E. Caine, Celine Y. Zimmerman, Zachary Schall-Zimmerman, William R. Hazlewood, Alexander C. Sulgrove, L. Jean Camp, Katherine H. Connelly, Lesa Mae Lorenzen-Huber and Kalpana Shankar Indiana University School of Informatics and Computing {caine, celzimme, zschallz, whazlewo, asulgrov, ljcamp, connelly, lehuber, shankark} @indiana.edu ABSTRACT Home monitoring represents an appealing alternative to older adults considering out-of-home long term care and represents an avenue for health care providers to gain decision-critical information about the health and well being of their older adult patients. However, privacy concerns about having 24/7 monitoring, especially video monitoring, in the home environment have been cited as a major barrier in the design of home monitoring systems. In this paper we describe the design and evaluation of “DigiSwitch”, a health informatics technology designed to allow older adults to see what information is collected about them and temporarily cease transmission of data for privacy reasons. Results from a series of iterative user studies suggest that control over the transmission of monitoring data from the home is critical for users’ privacy and that older adult users are able to use DigiSwitch to monitor and direct the collection and transmission of health information in their homes thus providing users with a way to simultaneously maintain privacy and benefit from home monitoring technology. Categories and Subject Descriptors H.1.2. [Models and Principles]: User/Machine Systems – Human Factors, Software Psychology; H.5.2 [Information Interfaces and Presentation]: User Interfaces – Evaluation/ Methodology, Graphical user interfaces (GUI); K.4.1 [Computers and Society]: Public Policy Issues – Privacy. General Terms Design, Human Factors. Keywords Privacy, medical monitoring, older adult, home, aging in place. 1. INTRODUCTION Advances in medicine and technology and improvements in health care access, education and economic resources have contributed to the growing numbers of older adults worldwide. In the United States alone, there are 38.8 million people over age 65 and, if current trends continue, the projected future growth of the older population is expected to reach 88.5 million by 2050 [2]. This is more than 20% of the projected total population in the US. One key health challenge facing older adults is the ability to live independently. Threats to independent living include inability to perform activities of daily living [23], cognitive impairment [19] [23], functional dependence [23], medical burden [20], and even characteristics of caregivers [7][8]. One hope is that health technologies may be able to reduce or eliminate some of these threats [29]. Specifically, health informatics research can inform the design of systems that give older people the support they need to remain in their home and maintain their independence [27]. In this paper, we focus on the use of health informatics technology in the form of in-home monitoring to support older adults and their caregivers, thus enabling aging in place. 1.1 Benefits of Home Monitoring There are a number of potential benefits of home monitoring to multiple stakeholders. First, older adults may benefit from home monitoring if it offers them the option to “age in place” rather than move to an assisted living facility. Older adults often prefer to “age in place” for a variety of reasons. Aging in place provides the opportunity to live in familiar surroundings [25] and may also preserve an older adults’ primary financial asset (their home). Caregivers may also benefit when a loved one ages in place because the decision to put a loved one in assisted living is often related to caregiver guilt [7]. Finally, payers, such as family members, insurers and/or taxpayers may benefit because aging in place is often a less expensive option than assisted living [15]. Finally, community members may benefit if the information from home monitoring is used for population level research. 1.2 Concerns About Monitoring Despite the many potential benefits of home monitoring, there are also concerns. Many barriers to the successful design and use of Permission to make digital or hard copies of all or part of this work for personal or classroom use is granted without fee provided that copies are not made or distributed for profit or commercial advantage and that copies bear this notice and the full citation on the first page. To copy otherwise, or republish, to post on servers or to redistribute to lists, requires prior specific permission and/or a fee. IHI’10, November 11–12, 2010, Arlington, VA, USA. Copyright 2010 ACM 1-58113-000-0/00/0010…$10.00.