“Waiting for Godot” or why Apple’s rumoured tablet won’t transform health care today

by Hans on 2010/01/26

In a little over 24 hours, the technology world will be dissecting the announcements made by Apple at its special event. While everyone is expecting a tablet computer that will upend … something, I’ve been trying to hold my expectations in check. In my reading, I was surprised to come across an article titled “The Healthcare System: An Apple Tablet’s Biggest Opportunity” from ReadWriteWeb that Apple’s tablet could “transform our care delivery system in a major way”. While I am hopeful for a great product from Apple, I am skeptical that any single product could transform health care right now.

Even though the author does present valid points about why a tablet could be a great catalyst for adoption of mobile technologies in health care, he seems to forget some significant structural issues that need to be addressed.

1. Data definitions
Much to everyone’s chagrin, there still remains considerable work on developing standard data definitions. For example, I worked on a small project to develop a data dictionary to allow organizations to share information about lab results. When we started looking at the issue, there were no standard definitions used by organizations (often even within the same organization). We had to strike a working group to collect an inventory of definitions and then try to reconcile and agree upon definitions – all before getting approval from the clinicians. As such, much work still needs to be done to standardize definitions and then work needs to be done to link the systems.

2. Access and integration
Once the data definition issue has been addressed, getting access to information and integrating the information from different sources is the next big structural barrier that needs to be overcome. While a tablet is a great way to have information accessible at the point of care, significant work is required to get the data to a point where it is understandable and meaningful. The current legislation surrounding health data privacy and security often prevents novel ways to use the information because people can’t get access to it as the penalties can be severe.

3. Workflow, workflow, workflow
As much as a new tablet would be great, any potential solution has to overcome the issue of workflow issues. Clinicians are generally hesitant to try a new solutions because it doesn’t impact how they work in meaningful ways. Yes, a tablet could go a long way in making information readily available, but that’s only when the foundational issues have been addressed. The other systems and business processes need to be redesigned.

I’m a bit proponent of changing and transforming health care. I’m also a big proponent of utilizing new technologies when appropriate, but we can’t forget some basic principles:

  • Technology is a tool. As a tool, IT only helps people do things faster and more easily – hopefully better. There are no magical qualities about a tablet that will solve the issues currently facing health care. When I was doing business process re-engineering work, my team had this principle of optimizing the existing system and then considering technological solutions to accelerate and magnify what was being done. This approach contradicted the CIO who once came in shouting “I have a solution! Now go find me a problem”.
  • We need good leadership. If technology is only a tool, then how we use technology is the most important issue. Good, strong leadership will help organizations and people use technology appropriately. Nicholas Carr has done considerable research on how IT (and technology in general) is not a strategic advantage but that leadership is. This research is supported by the American Hospital Association’s Most Wired surveys which consistently find that the top performing hospitals also use technology well. It is a reflection of good leadership.

Finally, I think the author forgets that technology is not a panacea that will auto-magically solve all of the challenges clinicians face. A tablet that functions and looks like something on Star Trek would be both amazing and absolutely delightful. However, we are likely to be “waiting for Godot” for a while longer as health care is not yet ready for a magical tablet. Perhaps tomorrow…

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MedInformaticsMD January 27, 2010 at 11:50 pm

I am quite tied of hearing about how IT will “transform, revolutionize, grandiose verb du jour” healthcare. This is marketing hype and irrational exuberance at best, and downright lying at worst.

I would welcome a return to sobriety about the capabilities of computers. See this link for a dose of reality: http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=2009

The bellicose grandiosity about “revolutions” must stop.

Hans January 28, 2010 at 12:18 am

Thanks for the comment – I totally agree that people subscribe to “technological determinism”. Technology is just a tool – it’s up to people to use the tool properly.

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