Digital Charisma — A Concept for Healthcare

Aside from a small car fire I’m under the illusion, like most males, that I actually an above average -no-a superior driver. After all driving isn’t that hard…as Jeremy Clarkson says you can drive and talk and eat at the same time-how hard could it be. So, take a moment to visualize a dark and stormy night in May 2016 when a woman driving in an unfamiliar canadian town faithfully followed her car’s satellite navigation system straight into…wait for it…the ocean. Luckily she was able to quickly open her window and dog paddle to safety in 40 degree F water.

The reason why this poor woman inadvertently took her first unofficial SCUBA lesson was that the voice of GPS systems are amazingly engaging. A trusted, tireless human ready to guide us to our destination. And let’s not even count the number of fights resulting from us trusting our sat nav’s guidance over that of our friends and family?

Don’t be so smug. It could happen to you too. As Ben Collins, Top Gear’s previous Stig remarked in his book How to Drive about car navigation systems — they take away all forward planning. Can you remember the last time you actually looked at a road atlas to plan your route? Yeah, me neither. It’s much easier to rely on the mysterious, charismatic, and confident voice of your sat nav.

Satellite navigation systems aren’t just another piece of technology —they are trusted navigators. The combination of voice and visual guidance in our cars, with which we already have an emotional attachment, imparts a sense of personality and results in a personal, pseudo-human connection. That’s my car, talking to me in particular. They’re trustworthy and non-threatening. You can change the “voice” on most satellite navigation systems, my car let’s me choose from Veronica, Jessica, and some boring bloke. I stick with Veronica. Why go with unknown people — check out how the Waze navigation app offers upgraded celebrity and fictional character voices for their system. Including Arnold Schwarzenegger and Morgan Freeman. They tell us what to do and we pay attention. And we love it.

Morgan Freeman and Waze

We’re becoming more and more familiar with technology using voices and personas. And, in many ways these interactions are becoming vital to basic tasks of daily life. Just think about a standard IVR system or ATM machine.

If you want people to pay attention to your technology then ensure that they interact with it in way similar to how they interact with other humans. We usually call this trait Charisma. Charisma goes a long way in western society — we’ll pay attention, date, give millions of dollars to, and vote for people with who’ve got more charisma than substance. The concept of personality and charisma embedded within technology is not new. Fighter pilots and commercial airline pilots have been yelled at by a digital voice representative of their airplanes termed “bitching betty” instructing them to make sure they don’t land without lowering their “landing gear” and to “pull up” before crashing into the ground. You’ve probably heard this voice if you’ve ever during a cockpit science in a movie or documentary. Eurofighter Typhoon designers insisted on making this voice female as they think their mostly male pilots will respond better to a female telling them what to do. i’m not sure about that…..there’s concern about something called “Jetnag.” I did not make this up…

It’s not surprising that science fiction got here first. Just look at transformers, the robot maid in the jetsons, the smarmy emergency medical hologram from Star Trek, the robots from Interstellar, or the super happy doors from imbued with “Genuine People Personalities” from Douglas Adam’s masterpiece The Hitchhiker’s Guide to the Galaxy to understand how the future of technology interaction is supposed to be.

Two Robots from Interstellar

I call the concept of embedding technology with human — like personality traits Digital Charisma.

Digital charisma is the purposeful injection of human like personality traits into interaction design of technology. The purpose of these features are to increase overall engagement and specifically evoke specific emotions and/or drive specific behaviors. I you start looking, you’ll start noticing it everywhere. Digital charisma is changing how we interact with technology, interpret information, how we feel, and how we behave. An obvious driver is an ecosystem of ubiquitous, powerful, connected devices. IOT, phones, etc..

Perhaps a more important, and less obvious driver is a significantly better scientific understanding of human behavior via positive psychology, neuroscience, design thinking, and behavioral economics. Don’t forget the rapidly evolving field of affective computing which promises to use sensors to extract human emotional states from facial expressions, speech patterns, and movement. Companies such as Beyond Verbal, Emotient (acquired by Apple), and Affectiva are already doing this. Please use for good and not evil.

Fundamentally, people are consumers of personality just as much as data.

This is part of our addiction to storytelling, which, as some researchers are finding can capture human attention even when presented by virtual characters. In just one example, researchers at Honda found increased attention, as measured by human gaze, when listening to a story recited by their Asimo robot that was specifically programmed to gaze at the participants faces.

Examples are Everywhere

Here are some familiar areas where designers are working to add digital charisma to your life. Pull up google maps on your phone and for fun plot a route from malibu to laguna beach, a route that is surely to have significant traffic. Google’s message about traffic may say something like “the fastest way is xx freeway despite a 45 minute delay.” That’s the type of statement that would be uttered by your personal driver or navigator. The semantic choices are deliberate and designed to make this information about traffic, easier to understand, more palatable, and reinforce your trust in the app. This is subtle, but important, especially when you consider your limited exposure time to this app.

While you’ve got your smartphone handy activate your digital assistant. e. Fiendishly complicated, Apple’s Siri, Microsoft’s Cortana, and Amazon’s Alexa are now ubiquitous digital personalities are readily available and promise a conversational tone and can perform basic information gathering tasks. They’ve got attitude. They’ll tell you jokes. I know, the jokes aren’t that good. Why invest in that ability at all? To create trust of course. Apple wants you to trust and like Siri so that you’ll use Siri. And I’m assuming, Siri can use you too if it’s collecting data correctly. Trusting someone who cant take a joke is as hard as liking the two FBI agents from Die Hard. This is a human social interaction thing. The number of apps with dgital charisma is exploding. Do i need to mention virtual scheduling asssistants such as Amy from or Chatbots?

Digital Charisma in Healthcare

Digital Charisma represents a powerful toolset for perhaps the most challenging problem in healthcare — patient behavior change and motivation. An area, I should add, that digital health technology largely overlooks or provides only superficial solutions. Counting steps and making pretty graphs is flashy, fleeting, and right now doesn’t have any evidence for real, long term impact. We need to provide support far beyond that of just education — patients need effective health coaching. Good coaches use a variety of methods to analyze a patient’s trigger points as well as deploy timely effective motivational strategies at the right time. It’s not feasible for everybody to have flesh and blood health coaches follow them around and the telecoaching and app market here is growing with entrants such as Lark and Kaigo Health. Hopefully, the existing IOMT can be used to provide coaches or their algorithmic counterparts with relevant contextual information that can be used to motivate and nudge patient behavior.

This is where Digital Charisma comes in. Apps and service that use charismatic interaction strategies have the potential to vastly improve the odds of data resulting in the right behavior. For example sending a simple text message notification as a patient enters a McDonald’s that burgers have high calories and that they’ll exceed their caloric limit that day just isn’t as compelling as: “you wanted to lose weight and use less insulin. Don’t even think about going in. Be strong, I’m watching, You can do it.” or “You wanted to lose weight, let’s make sure you look good in that bridesmaids dress for that wedding on your calendar next month. Turn around now.”

You get what where I’m going.

Perhaps the best example of a digital charisma success story is the AED, whose confident voice has guided many unskilled bystanders to save the lives of people with out of the hospital cardiac arrests? Technology has to tap into the power of human behavior science to turn sensor data into real motivation and behavior change.

Individualized messaging will take an application of known motivation strategies, beyond just “social networking” and combine it with patient characteristics to produce the right message at the right time.

Of note, this is why I’m skeptical of clinical studies that use “text messaging” to drive improvement in chronic disease health outcomes. Not enough detail is provided about the type of messages that are used. Reminders aren’t enough. We need better, more persuasive, charismatic interactions. This is why the literature is full of trials and meta reviews that show mixed results in chronic disease management using these interventions. There are too many to list here.

As researchers from Stanford, UCSF, and Northwestern found patients are already using their smart personal assistants to ask about mental health, physical health, and interpersonal violence. Which is more surprising: that their smart assistants are providing real answers or that patients are trusting those answers? I should mention that virtual medical chatbots such as and are already live.

This is still a nascent area for healthcare. I’m optimistic that the that we can use digital charisma effectively in apps and other health technology designed to persuade, motivate, and drive patient health behaviors at scale.

Physician, Digital Health Entrepreneur, Troublemaker

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