Blog | Thursday, November 10, 2011

What if Steve Jobs had taken on the HIT challenge?


I saw something that made me think of the difference between a "techy" and a "regular" doctor's approach to technology. We were installing an upgrade to a popular medical dictation software package. The upgrade was over the network and was to occur seamlessly overnight.

Unfortunately, in the morning when providers logged in, they saw a big message in the middle of their screens saying the software would now be installed and during this process, they would not be able to use various software, including MS Outlook. To make matters worse, this was a long install process and the message would stay on top of all other windows.

When the information technology (IT) person was told about the problem the response was, "What's the big deal? Just drag the message window down so it does not interfere with other windows, and use web Outlook. What if you can't dictate you notes for a while? Just use the keyboard!"

I am sure a number of docs had figured that out and went about their work. But many were complaining.

The world is made up of two kinds of people (simplistic view with lots of assumptions):
1) Those who love Linux because it is open and they can tinker with it and troubleshoot it and they get a thrill out of making a difficult thing work. Some of these same people would prefer a PC over a Mac because of similar reasons. They love messing with the hardware and drivers and they know how not to get viruses. They would hate a device where they cannot modify the OS or hardware! I would venture to suggest that these same people may also get a kick out of fixing their furnace and replacing a faucet. These might also be the folks in the IT industry.
2) Those who want to take a device out of the box and just have it work. They want to use the device to do what it is bought for without worrying about trouble shooting the device.

Fixing things and finding workarounds is fun and gives the person satisfaction from having solved a tough problem. But when time is short, when there is important work to be done, when the interface creates inefficiencies, it causes a lot of frustration. Having worked on both sides of the fence (clinical and IT) it is quite obvious that the two sides don't speak the same language, and are clearly not on the same page. Our current electronic health record (EHR) systems are a classic example.

Physicians probably don't know what exactly they want but they know what they have is not ideal. They want someone to figure out what their needs are and create something simple that works that actually helps them take better care of their patients in less time.

I really wonder if Steve Jobs ever got to see one of these EHR interfaces and workflows, saw the chaos of a clinician's day, the frustrations, the inefficiencies. An iPad is arguably the best media consumption device ever made. EHRs have a ton of data, and physicians need a device with the right form factor and data visualization to consume information about their patients as they walk from room to room.

Would he have taken on the challenge to fix it? Would he have made a difference in people's lives by improving care via better HIT products? Did we lose a huge opportunity in his untimely death?

Neil Mehta MBBS, MS, FACP, practices internal medicine at a large tertiary care hospital in Ohio. He is also the Director of Education Technology (Academic Computing) for his medical school and in charge of his hospital system's home grown Learning and Content Management System. He is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management. This post originally appeared at Technology in (Medical) Education.