One-on-One with IBM Research Fellow and Johns Hopkins Professor Marion Ball, Ed.D.

KG: And this is where initiatives like TIGER come into play.

MB: Right, I'm a big advocate of the TIGER Initiative for technology. We need to have trained healthcare professionals who can effectively communicate with the well-meaning IT people and vendors. New training methods are needed in nursing schools, pharmacy schools and dental schools, where the young people already know about enabling technologies and can learn how to apply them.

KG: Ultimately, what does TIGER hope to accomplish, and what message would you like to send out to hospital leaders about the initiative?

MB: You can't do anything unless you recognize the problem. So the first thing is to realize that the medium is not the message. It's not about technology; it's about how do we change behavior and processes and thought flow to be able to transform the way we practice, and then use the enabling technologies to transform healthcare. That's what it's all about.

We need to be able to get involved with changing legislation. There is very little research, money and support for nursing, and yet nurses are the ones who are taking care of all the sick people, and we're all going to need them when we get older.

KG: And the goal is for this to happen before all of the money starts flowing in from the stimulus package?

MB: Absolutely. There's a wonderful quote from Albert Einstein that says, the definition of insanity is doing the same thing and expecting different outcomes. For the last 40 years, we've had 18 percent clinician adoption. If we think that because we're going to pour the ARRA money into what we've been doing, that it's going to be more successful, that makes us insane. It's just going to speed up chaos.

These are the kinds of questions we should be asking. Is it going to make any difference if we put more money into what we've been doing, or do we need to look at a whole disruptive innovation to seeing how we can use different ways to skin the cat, so to speak. And one way is to address the issue of what the clinician needs at the point of care.

How are we going to use enabling technologies as we move into the medical home concepts, using primary care physicians, using nurse practitioners, looking at how do we provide care - not only in the emergency rooms, but at Wal-Mart and at drug stores. These are all disruptive innovations, each of which will also need the information component and some enablement by technology. But it's 90 percent transforming and change management, and 10 percent technology. Changing behavior is more difficult than anyone ever wants to admit.

KG: So it all comes back to the idea that technology needs to adapt to users and not the other way around?

MB: Yes. But also, the technology and the vision that we have needs to be platform-independent, it's got to be ubiquitous access. When you look at a clinician, that person is a mobile individual. He or she is not in one place for more than one minute. And the systems they use were designed by brilliant computer scientists and information scientists who are sitting at their desks.

So the problem is, how do I get the information I need on my Blackberry? How do I get it on my tablet? How do I get it in my office when I'm on my PC? I'm going to three hospitals and each hospital has a different system - one is Cerner, one is McKesson, one is Epic. I want to be able to have my Blackberry or iPhone give me the same information so that when I walk into the hospital, I don't have to put in 20 or 30 passwords. And that can be done. I want to know who my patients are, I want to know who is most sick, and I want to know what the latest lab results are. So the whole idea is, give me less, but give me what's relevant to my practice. And that, I can assure you, we are not doing.