A few years ago, I spoke at a conference at the Mayo Clinic and, afterward, shared a ride to the airport with John Hockenberry, the host of The Takeaway on NPR. Back in 1976, while he was hitchhiking in Pennsylvania, he was involved in a car crash that left him paralyzed from the waist down. He now lives in Red Hook, Brooklyn, one of the most remote parts of NYC in terms of public transportation, with his wife and 5 kids. For the most part, he takes public transportation wherever he goes. So I asked him which app he uses to get around NYC’s subway system in his wheelchair. He responded “I don’t use an app.” I was surprised to hear that because not all 468 subway stops in NYC support wheelchair access.

“How do you know where you can get on and off and where you can’t? Why don’t you use an app?”

“Because I have not found an app that shows real-time updates on wheelchair accessibility. And the first time I used an app that purported to show this information, it was wrong because they were doing construction that day blocking the exit I needed for my stop. So I had to go to the end of the line and hope that the wheelchair exit was functional. Luckily it was functional but it took two hours that day for me to go to the end of the line and back just to get out of the subway system. And my time is so precious that I can’t afford to make those kinds of mistakes. So I’ve just learned the stops that are redundant and are safe for me to enter and exit and I just use those. I mean, when an app is 90% or 95% accurate, but the consequences of the inaccuracies are so large, you just can’t trust them.”

That last statement hit me hard and it’s really shaped how I design Sherpaa’s apps.

Trust is everything— in love and in apps. If one of our doctors sees information within our app, and it’s not accurate once, they’ll let it slide. But if it’s not accurate twice, they’ll break up with it. The consequences can literally be life or death in not knowing a critical piece of your medical history when diagnosing, say, a blood clot in your lungs. For example, say your online profile you created 9 months ago upon signing up for Sherpaa says you weren’t taking a birth control pill, a significant risk factor for blood clots. But 6 months ago, you started taking one. Five months ago, you started smoking. Today, you contact our doctors complaining of some shortness of breath. And what if our doctors simply looked at your online profile and trusted that, since you forgot to update it with your new medication and also didn’t mention that you smoke cigarettes, they just assumed you weren’t taking one and you were a non-smoker? These huge parts of the story that could point our doctors toward something very serious were simply missing and inaccurate.

Online Personal Health Records were all the rage about 8 years ago. Even Google got into the game and created Google Health. This was the place you could go online and create a list of medications you take, diseases you’ve had in the past and currently have, etc. What a great idea right? We even built one into our app. But over time, we’ve found that an online personal health profile is ignored by both our doctors and our patients. It’s ignored by our patients because it’s static and boring. And it’s ignored by our doctors because it’s ignored by our patients. Therefore, it can’t be trusted by our doctors. From a user’s perspective, this had to be the most boring concept healthcare people could invent. It’s static information that you must maintain on an irregular basis when any kind of change in your health happened. It’s about as exciting and helpful as watching paint dry. Following the healthcare pack was the wrong move for us. The right move is asking pointed questions during today’s interaction to get real-time up-to-date information that’s relevant and trustworthy.

No wonder Google shut down Google Health. No wonder Personal Health Records never took off and never will take off. They suffer from a lack of trust, with potentially horrible consequences. Trust is the foundation of relationships with not just your lover but also, your apps. Trust is built over time with accurate and consistent data and behavior. If they’re bipolar, you gotta dump them.