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Educating and empowering seniors about fall risk while improving communication and collaboration with their care-team[5/25: Readability]

A software platform designed to assess fall risk and exercises to reduce fall risk and improve balance

Photo of Chris Ashford

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Who is your idea designed for and how does it enable older adults to live their best possible life by preventing falls?

Health in Motion is designed for older adults & their care teams, as well as providers and payors, looking for an edge in pursuit of the Healthcare Triple Aim. The platform educates and engages users to reduce their fall risk, while connecting the outcomes with their provider and payors. By providing objective and standardized fall risk status, healthcare providers can make clinical recommendations well before a fall occurs. Payors can customize services and provide choice to their members.


Health in Motion is an evidence-based Fall Risk Assessment and Fall Prevention Program, which is designed to improve balance, reduce falls, improve population health, and lower the cost of care.

Blue Marble received numerous highly competitive, peer-reviewed, federally funded grants from NIH-NIA and NIH-NIDCD to develop Health in Motion. The assessments and activities are based on the CDC’s STEADI (Stopping Elderly Accidents, Deaths & Injuries) program, OTAGO Fall Prevention Program, and Tai Chi.

  • Fall Risk screening & intervention tool 
  • Used at home, clinic, physician office, or senior center 
  • Shared data informs the clinical decision-making process

Falls are preventable but the current process is expensive 

Clinically proven, evidence-based, fall prevention programs such as Matter of Balance, Stepping On, Falls Talk/FallsScape are costly to implement because they require an instructor to teach, are limited to eight weeks of instruction and do not track participant progress after class.

Each program requires an instructor to receive coaching and training on the principles of the course. The instructor bears the cost of their instruction and passes it on to their customers.  Depending on the environment, instructors charge $300+ per one hour class. Health in Motion uses Nancy the avatar-instructor, to teach fall risk assessment and OTAGO + Tai Chi fall prevention exercises. She does not have to drive anywhere nor set up equipment. She is always available, even during inclement weather.

Nancy demonstrating Tai Chi "Holding the Ball" 

For those over 65, fall prevention is a way of life. Regular movement and exercise is key to a fall-free life. Group based fall prevention programs meet only once per week for eight weeks, leaving participants to fend for themselves the rest of the time. Health in Motion allows the user to self-assess their fall risk and perform fall prevention exercises when and where they want, anytime.  Users can use the default exercise routines or design their own which helps with motivation.

Creating customized routines keeps users engaged

Probably the biggest drawback of group based fall prevention programs is the lack of trackable data once the class completes. Users are sent home with photocopied instructions and information.  Health in Motion is always with the user. They have access to the latest information and fall prevention exercises. The sponsoring organization has access to the user's fall risk assessment outcomes and exercise results for as long as the participant stays active.  Furthermore, the standardized and objective data can be used to leverage funding from local and national sources. When combined with additional Blue Marble Health add-ons, sponsoring organizations can track fall risk and cognitive health, key criteria of the healthcare triple aim.

Screenshot of simulated data from Health in Motion


Unlike more expensive sensor-based platforms, Health in Motion takes up less space, can be stored when not in use and is mobile. It can be used anywhere the user takes it. Many of the seniors in our study were on fixed incomes and expressed doubts that they would purchase a sensor for use after the study ended. Moreover, our studies found that older adults do not have or want to dedicate space to support a sensor. The minimum requirement of one sensor, the Mircosoft's Kinect camera is 6 feet.  While 6 feet is the minimum, the exercises also require space for a chair, space to move forward and back and side to side during exercising. Current pilots utilize our sensor-less version of Health in Motion. One senior center loaded it on their pool of computers in the computer lab. In the first month, they had over 12 new users. Some participants racked up over 10 hours of exercise twice as much as the instructor led classes going on in parallel.


Users with RED are at higher risk of falling for their age and gender

Most platforms available on the market today require real-time interaction with the patient by a therapist or physician. Our observations indicate healthcare providers have little time nor the appetite to learn new technology. Who can blame them, as licensed healthcare workers are being asked to produce more with the same resources? While Health in Motion in the hands of any licensed healthcare professional is a powerful tool, Health in Motion (FDA approved for use) is designed to be prescribed by the provider and used by the patient. The application teaches the user the exercises and tracks their use autonomously. Health in Motion's server-side has built-in reports that make population management a breeze. An administrator can oversee thousands of users and, based on protocol, can choose which patients to engage and which patients to monitor. Filters make sorting the most urgent cases easy. Email notifications enable management by exception the norm thereby helping to enhance work-flow and improve inefficiencies.

Administrators can see at a glance the status of their population


Laura H - ACO Geriatrician
he sees 8+ older adults a day. She is looking for tools to inform her clinical decision-making workflow and allow more time for discussion with the patient. Fall risk assessment needs to become part of obtaining a patient's vital signs. "We would like a kiosk our patients can use in the waiting room before they meet with me.  It would be even better if they could do it at home."  
Response: Health in Motion is ready to deploy in your network as a light-weight SaaS addition to your IT Network or as an embedded service on your patient portal.

Wendy H - ACO Office Manager
She is responsible for the office workflow. "Health in Motion is easy and straight forward to use. It would be nice if I could navigate around Nancy talking and get right to the questionnaire."
Response: We are working on a "clinician mode" where clinicians can navigate directly to the tests they need. Currently, the assessment process takes 7-8 minutes. We foresee less than 5 minute assessment times as very possible.

Jeff H - Home Healthcare PT
"We saw Dr. Flynn's presentation and the demonstration of Health in Motion at this year's physical therapy conference [CSM]. We are ready to Pilot Health in Motion as soon as it is available on iOS. Our whole team uses iPads."
Response: We await production cycles to port to iOS and Android.

John K - VP of Center Services - Senior Services Center
They serve of 18,000 seniors a year. They have three centers and multiple vehicles to serve meals and provide services to home-bound seniors. "We like that Health in Motion has play-by-do tutorials. Once seniors learned how to turn on the PC and login to Health in Motion, they were able to train on their own. We did not have to allocate any staff to facilitate instruction."

Fabiola T - Services Counselor - Senior Services Center
She is responsible for ensuring the installation of Health in Motion on their computers. "After the installation on our computers and letting the computer instructors know the software was there, the seniors took to it on their own. We ran into some issues with our non-native English speakers. Consider localization to Spanish and Korean."
Response: We are ready to localize, and with your order, we will pay the licensing fees and get it done immediately.

Marissa M - Development Manager - Senior Services Center
She is responsible for the grant writing process. "The reporting tools make presenting a story to potential funders easier. Funders are looking for data that demonstrates the effectiveness of our programs. Health in Motion data from 300 participants could make  a compelling case."
Response: Let us get started!


A common question we receive is about usability. "Do seniors find the app usable? Can seniors with minimal computer experience use it easily?" According to usability is defined as the "extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency and satisfaction in a specified context of use" (

Blue Marble uses user-centered design principles in the development of all of our products. We take specific care to engage with and obtain end-user feedback from the very beginning of the design process. We also focus extensively on testing usability by using the "System Usability Scale" (SUS), the measurement tool of choice developed by the Digital Equipment Corporation in 1986. This questionnaire contains ten questions that evaluate how well the product achieves the goals and how effortful or easy the product is to use. Blue Marble Research has found that Health in Motion usability is "very good" with scores exceeding the 69th percentile, scores that are tough to obtain in software.

What early, lightweight experiment might you try out in your own community to find out if the idea will meet your expectations?

Take to a local senior center and have them try it. 1) Confirm that it is easy for older adults to use. 2) Confirm that older adults will perform the exercises. 3) Review the data with the senior center - is it data that can be used to justify additional fall prevention resources. 4) Confirm with senior center that minimal resources were used to deploy Health in Motion. Pilot ongoing. Use cases confirmed. Additionally, users would like the platform localized to Spanish and Korean - [5/24]

What skills, input, or guidance from the OpenIDEO community would be most helpful in building out or refining your idea?

We would like to collaborate with healthcare industry partners who specialize in health trauma prevention, fall prevention, innovation, healthcare IT integration, reimbursement (Medicare and Medicaid), chronic care management, and population health. Nurses, especially those involved with fall prevention, as well as physicians and geriatricians will be particularly useful. We are specifically interested in new opportunities to demonstrate value, and introductions to early adopters.

How long has your idea existed?

  • Over 1 year

This idea emerged from

  • A group brainstorm
  • An Individual

Tell us about your work experience:

My background begins as a Navy aviator, during which time I experienced disruptive technology first hand. You see, my instrument panel was upgraded from analog to digital, causing me to quickly adapt my workflow. After the Navy, I applied this experience in telephony, digital music and healthcare.

How would you describe this idea while in an elevator with someone?

Health in Motion is a software platform that teaches older adults to self-assess their Fall Risk and empowers them to follow an evidence-based fall prevention program. Unlike traditional fall prevention programs, ours is mobile. Users can workout whenever they want. User outcomes can be ported to an EHR where the data can inform their care-team's clinical decision-making process.

How does your idea demonstrate our Criteria of Affordability?

We intend to make the client-side of Health in Motion free. Older adults can self-assess, exercise and print out their results as often as they wish. Organizations wanting to track or provide services for their users will pay for the ability through a SaaS payment model. Fees will be on a sliding scale. Blue Marble Health will work with grant funded organizations to seek reimbursement through Long Term Services and Support, Area Agency on Aging and other government-based institutions.

How does your idea demonstrate or plan to demonstrate scalability?

Our software platform deploys to most connected devices. The lightweight client is easy to use and does not require intervention from a licensed healthcare professional. Most seniors who can log in to a computer can use Health in Motion on their own. The server-side has built-in reports that make population management a breeze. An administrator can oversee thousands of end users. Filters make sorting the most urgent cases easy. Email notifications enable management by exception the norm.

How do you plan to measure the impact of your idea?

Health in Motion measures fall risk, exercise adherence, and the number/circumstances of falls, for each user. Upcoming pilots will measure the impact by comparing Health in Motion outcome measurements with readmission rates, fall-related ER visits and fall-related hip/knee surgery, joint surgery recovery times, and Chronic Care Management resource utilization.

What are your immediate next steps after the challenge?

After this challenge, we will continue with existing pilots while continuing to pursue additional collaborators and pilots. We seek further validation of our business model(s), use cases, value proposition and, work-flow efficiency. We are also seeking advice regarding integration of Health in Motion and strategic partner collaboration with senior organizations such as AARP Services Inc., and innovative payors like United Health.

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Photo of Nita Lakhani

Love this idea and its appeal from a gaming technology perspective. The addition of some sort of gaming was suggested to me to make our Falls Check in community pharmacies idea more appealing to users. Have you had any specific feedback on the gaming aspect of your idea from potential users?

Your idea could be integrated into health check stations to reach older adults that may not have a computer or tablet in their home, for the falls risk screening part. The exercise part would be trickier in a public setting.

Photo of Chris Ashford

Nita Lakhani - indeed engagement works. We have Health in Motion installed in a senior center. They use it more than the seniors who are enrolled in the Matter of Balance programs. Also, privacy isn't a big deal with the seniors - at least the ones we have worked with. Seniors do need follow up and incentive to keep moving forward. More seniors play Bingo when there are prizes than when there are none. We figured out early - having an application is nice. Having an application that connects to their provider is better at least as it pertains to US healthcare.

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