Why Keyboards Matter and Why They Must Go Away

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Tablets are often denigrated as being merely consumption devices, and there is some truth to it. For actual work -or what we call work in this latter day, we do need keyboards, but that is because of the infancy of touch UI, and its likely successor, the voice UI (Siri). In healthcare, not having keyboards is a big deal -the ones in hospital hallways are generally filthy, but accessing Windows via Citrix on a tablet is not fun -just not set up for touch. Being able to talk to a device like it was your ever-present first assistant -like a caddy but less bulky, would be ideal.

“Give me Mrs. Jones vitals for today. What is her potassium level? Order a bolus of saline, CBC, Chem 7 in morning labs, and schedule for surgery on Friday -what? oh..an exploration with possible resection.”

One day. until then, watching The New Girl on Hulu rocks.

Intersection of Healing and Technology

So much has been written in the short time since Steve Job’s death, that I will refrain from expressing my personal grief at his passing. I just finished his biography by Walter Isaacson. I read between cases and into the night. The most recent memory I have of Steve (he is now all of ours to refer to personally) is watching his introduction of the iPad2, which I watched on-line this past spring. The final image was what stuck with me –the intersection of the liberal arts and technology. That is why Apple products are so wonderful –they liberate the individual to perform insanely great things with computers that were frankly difficult or impossible before. It has also inspired me to think about health care’s relationship to technology.

Modern health care is about delivering technology. I can now repair an abdominal aortic aneurysm with stent grafts delivered via two small incisions smaller than the width of my pinky where traditionally, I had to make a long incision on the belly. These patients go home the next day. Small computers embedded in pacemakers can sense arrhythmias, correct them, and send reports to physicians by internet. Drugs can be tailored to the genetic makeup of tumors. You can have your genome scanned for disease risk.

But in the practice, on the back end, health care is very analog, very dependent on paper and pen, dictation, and text. The best medical notes read like compelling tone poems but can only be composed by direct speech or penmanship. The notes generated with the assistance of computers end up formatted for other computers and insurance companies. I generally skip to the human generated summary section and plan of care, yet even here, most EMRs (electronic medical records) try to parse meaning by stuffing what is analog into digital cubbies. Electronic medical records are ripe for reimagining.

When I want to know the temperature in Orlando, where my father lives, I can ask my smartphone, “What is the weather in Orlando, Florida?” and the temperature pops up along with weather forecast for today, this week, and so on. My email, my contacts, my friends are instantly available. When it comes to my patients, it is an entirely different story.

The problem is that hospital information services serve many needs and therefore devolve into the least common denominator in order to be used in an infinite variety of scenarios. Often, during the course of decades, legacy systems and databases serving different aspects of patient care create an alphabet soup of programs, each with their own security needs and access methods.

For example, in most hospitals, to look up blood tests, you have to log into the computer, then log into several layers of programs then look up the patient, select the correct admission, then select the laboratories -all the while remembering multiple long and complex passwords which you are not allowed to write down. You repeat the process to look up x-ray images, and chart notes from other physicians if they happened to have been scanned in. I can find out the location of every Starbucks in Manhattan and have them mapped out, but checking patient information is a trip back to 1985 in terms of technology. On top of all of this, hospital computer programs are simply ugly. Steve would not approve.

Steve’s philosophy of vertical integration -of creating the software, hardware, store, and services, created simplicity for the end user. It made the technology work magic by being carefully thought out from top to bottom. Simple takes a great deal of effort, but the returns are clear. What a great day it would be if I could just ask my smartphone, “What is Mrs. Smith’s potassium over the past week?” and get an answer.

The answer, of course, is to begin the work needed to get to that point. And that is the great lesson in Steve Job’s life -not fortune, nor influence, but that beautiful simplicity takes a great deal of focus and effort. Thank you Steve for showing us how.