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Adopting The Obvious, Part 2

August 20, 2010
by Joe Bormel
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Shortening the Gap from Awareness, Jokes, and Threats to Common Use of Emerging Technologies

Everyday, I interact with clients, prospects, external and internal stakeholders, multiple, large and capable installed vendor systems, and plenty of real visionaries.

We’re often arguing over dated device strategy issues. We’re walking away from adopting new approaches to usability, even when their costs are comparable to the alternative status quo methods. And we’re basing our thinking on existing workflows, rather than becoming committed to discovering better ones. Better ones, like the GPS and phone examples in Part 1 of this post that do more, simply, with fewer steps.

There’s a humorous way of looking at the emergence of new technologies. Often, we become only vaguely aware of them, possibly through science fiction. They defy norms, the laws of physics and the practices of economics. Then, they’re socially evolved into a joke, " What idiot would want to ride in one of those awkward Model T Fords when we have these ubiquitous horse and buggies." Those who associate themselves with the vision are considered not credible, untrustworthy, and laughable oddballs. Next, the new technology is perceived as a huge threat. It will lead to horrible things for society, including reduced employment, shifts in power, erosion of economic investments. And, by definition, these new technologies are unproven and incomplete.

Lastly, as they mature and prove themselves, the new technologies are deemed as obvious improvements and steps forward. They sell in record numbers in short periods of time, replacing the prevailing paradigm, or supplementing it.

This is what’s happening with HCIT devices, usability and workflows. The rates of change and adoption have accelerated from 4-to-10 years per cycle, down to 9-to-36 month cycles. They are fueled by consumerism (lower costs and rising demands), rising expectations from buyers and payers, and the powerful governmental policy changes to reform healthcare.

My Advice?

1. Consider what might be obvious as you never have before. Get experience with the emerging Smartphone and Tablet technologies. Get a smart-device that’s less than a year old. Don’t just make phone calls. Share your calendar with your family. Discover and use some location-aware apps that have real potential for you. Take and send photos and high def video. Experiment with letting your friends know where you are (link to Google Latitude ). Routinely use video conferencing from your office, kitchen and anywhere it might make sense. Notice where it speeds you up and where it slows you down. And perhaps as importantly, notice where it energizes you and where it depletes you.

2. At home: Aggressively move to paperless approaches to your current work and transactions that are supported on low-cost, consumer grade mobile platforms. I have had good luck with NeatReceipts over the last two years; there are many alternatives.

3. At work: Start looking at the basics of HCIT: patient lists (rounding, sign out, other tasks), and patient-level work, such as chart review, ordering, documentation and decision support. Ask yourself and your colleagues, “ What are the obvious next steps for us?” I’ve participated in three advisory boards in recent weeks. That’s exactly what we’re doing. Surprisingly, tighter and tighter integration is becoming the dominant theme. Just wrapping information and services together through portals or adding drill-down buttons is now being viewed as intolerable. Until recently, those actions were seen as logical next steps.

4. Think twice before being dismissive when a friend, colleague or spouse wants to show you something "interesting." By all means, don't fall into the trap (that we all have at one time or another) of condescendingly telling them that you're disinterested but you're "glad their enjoying their little iPhone, Droid, or other new toy." These innocently intended behaviors are energy-depleting and slow the progress toward better, faster, and cheaper solutions.

A Recent Example of Consumer Functionality Destined for Common HCIT Use:





A good follow-on to your first post on this subject. And the two comments posted thus far are food for thought, too.

Joseph Goldberger makes a point concerning youth, but I contend that the push against adopting new technology, when it comes to clinicians, is due more to ego than age. Although healthcare has been criticized for being at least a decade behind most industries when it comes to the use of information systems, this is primarily due to the lack of viable clinical system implementation. Finance and HIM departments, for instance, have long embraced and effectively used HCIT to accomplish their respective goals. Only government mandates and taxpayer funded "MU bribes" to healthcare institutions are forcing clinicians to accept technology or forego reimbursement for their services. The "don't tread on me" attitude of far too many clinicians and their respective professional organizations (until recently) have, to a great degree, stymied not only system implementation but the enhancement and refinement of such systems by vendors.

Insightful wrote that it should take about two years to "adopt the obvious." I think two or three years is about right due to MU requirements. After all, why should clinicians have mobile devices if there's no EMR to review? Play games perhaps? Send a message that would be more concise and arrive in a timelier manner by phone?

Of course, clinicians must have confidence that the electronic record they review, and to which they issue orders, is complete and correct. Estimates indicate that less than 20 percent of hospitals have performed a comprehensive MPI cleanup and implemented a dependable EMPI system. Therefore, if the general consensus is correct, an average of 10 percent of patient medical records, approximately 50,000 in the average hospital that has not adopted such a program, are duplicates or incomplete. In their defense, why should a clinician risk his or her reputation, much less their financial well being, by trusting a potentially invalid database?

It may seem as though I've gone somewhat off topic here. But just stop and think for a moment. If you accept a wonderful new technology to simplify and enhance your professional life, but the information you seek to do so is unavailable, incomplete or erroneous, the new tech is literally useless. You're just playing games . . . with yourself. And placing yourself at considerable risk.


You have hit the nail on the head. Expanding our view and perspective, embracing new and exciting ways of doing things is the real key to moving civilization forward, let alone healthcare.
This is often a generational phenomenon, whereby the young, unfettered mind can adopt and adapt at a much faster pace. The trick is to be willing to let them teach you rather than taking the traditional approach. In healthcare, wisdom can come from experience, but the technology that will drive the future requires a willingness to release oneself from the usual hierarchy of society and partner with the younger more technosavy youth!

Thanks for your comments. You did a great job of balancing out a discussion that might have been getting a little too visionary, too nerdy, or too focused on the easier aspects of planning a revolution. And, of course, the Beatle would agree with you in their lyrics to Revolution.
Beatles' RevolutionYou say you want a revolution
Well, you know
We all want to change the world
You tell me that it's evolution
Well, you know
We all want to change the world
But when you talk about destruction
Don't you know that you can count me out
Don't you know it's gonna be all right
all right, all right

You say you got a real solution
Well, you know
We'd all love to see the plan
You ask me for a contribution
Well, you know
We're doing what we can
But when you want money
for people with minds that hate
All I can tell is brother you have to wait
Don't you know it's gonna be all right
all right, all right ...
Your perspective on age versus ego were relevant.  I like to remind non-physicians who can be annoyed, at times, by what they see as professional grandstading of this:  We, as a society, choose and groomed physicians to have a healthy skepticism for unproven methods. [The same is definitely true for pharamacists, and probably many other professions.]  So, we shouldn't be surprised at all when they raise concerns about EMRs, process changes, remodeling of healthcare finance, or integrity of any system.
The style and grace of raising objections varies dramatically with all adult professionals.  Some physicians are absolutely elegant in respectfully helping a team or group (like a board of directors) address the clinically important concerns.  Others, not so much.  There's historically not much organizational development training in the medical school curiculum.  In my experience, the sophisticated physicians have been trained elsewhere (prior careers, religious or child raising such as scouts, and family experience.)  I'm not comfortable chalking up poor style to ego!  It's better to approach as ignorance and go from there, in my experience.
With that as a backdrop, you raise an excellent point that EMRs need to be adequately reliable, and ideally, highly reliable.  Starting with patient identification.  Many knowledgable HCIT executives have detailed and published on challenging reliability problems and predicaments.  These include patient identification (EMPI, CMPI, etc), clinical assessment and codification challenges, planning, ordering, scheduling, ordering, performance, documentation, and billing short-comings that far from solved issues with EMRs specifically and HCIT in general.  So, to your point, we all need to be appropriately sober in HCIT when we talk about adoption, be it obvious or otherwise.
To quote (paraphrase) my brilliant friend, Jacob Reider, our efforts are directed at improving patient safety, and by extension, quality.  We are self-aware and modest enough to appreciate that this is complex work, and only somewhat perfectable at best. 

Thanks Joe, both for the validation and reminding us all to embrace those in other generations in our work.

We've been graced with a twenty-something student from South Africa, living with us for the last four years. A few years back, I told her of the vision my generation had in our twenties for artificial intelligence. It was popularized by the computer on Star Trek and the movie 2001, the HAL-9000. One could verbally ask the these AI-enabled computers any question and they would immediately respond with what we were told was the correct answer. Aside from looking up information, there were Chess games, complex abstract thinking and, of course, computation.
Our student was about nineteen at that time. In my head, I was thinking that we never got that AI; it didn't work out that way.  There were show-stopping problems at multiple turns. Perhaps it was too grandiose of a vision.  [Pictured here, Dave unplugging HAL, after an argument.]

I was shocked when she, matter of factly, said "yep, and, of course we have all of that now!" I'm thinking "Huh?" She said, Google [search] pretty much does all of that today, including the voice input if you want.

The younger generations clearly have that faster, unfettered mind, when it comes to recognizing and exploiting the new.   New ways of doing things.  New technologies.  And, new expectations.

IA, Thanks for the link to the article on trying to build an eco-friendly house and pointing out it's relevance (Barriers to rapid adoption):

- reasonable time and budget possible?
- finding a capable architect
- availability of materials
- approval of planning commission
- finding a capable builder
- no experience with hazards (earthquakes, hurricanes, termites, etc.)
- finding a building engineer
- forecasting/estimating resulting energy bills
- achieving reasonable aesthetics (socially acceptable?)
- solving the right problem (is 90+% of the benefit from window and roof design?)
- collateral orders (redesign the lawn? pebbles?)
- economic payback ? (15 years for solar panels?)
- rational / irrational psychology ( joy of an electric meter running backwards! )
- mundane considerations ( attic fans and whole house fans, which are different )

This example makes it clear, at least for the example of building a green home, that adopting the obvious benefits is not so simple, and clearly not a fast and reliable thing to plan.

Thanks again.

Joe, Interesting post. Regarding your closing question, "How long will it take to adopt the obvious?", I'd like to call your attention to a article in yesterday's Wall Street Journal, by Scott Adams (The Saturday Essay, August 21, 2010).

How I (Almost) Saved the Earth
No one said it would be easy to build the greenest house on the block. Scott Adams on perplexing energy bills, ugly lawns and the true meaning of 'green'

Scott Adams pointed out that early adopters are generally necessary to drive down the costs and risks.
The entire essay is funny, relevant and worth a look.
If that's true for healthcare IT as it is with other technologies like going green, then the concrete answer to your rhetorical question is: It takes no less than about 2 years to adopt the obvious.

[ Dilbert Characters Copyright Scott Adams, Inc]