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.

iPadurday

The iPad is here! The line at the

Apple Store was impressive, and the Apple Store clerks handed out Smart water, coffee, and muffins. The line moved briskly and there was a festive atmosphere and a fellowship of similarly minded futurists. And I believe that this device is a portal to the future of mobile computing. It untethers you from the desk in a way that laptops never could because laptops were still all about creating a desk.

It is an enabling technology much

in the way that literacy and human language enabled humans to be unfettered by genes and instinct. You may hate Apple and all that it makes, but you will be turning away from the next big thing, if that is important to you.

On opening, the device, like the iPod, wants to be connected to iTunes to be activated. Once set up, the device is beyond words in terms of fit, finish, and smooooothness.

iPadurday Eve Diorama

The day is nearly nigh! In celebration of iPadurday Eve, I constructed this diorama of Steven Jobs bestowing upon humanity the iPad (as modeled by the iPhone which is now technically the iPad Mini) all underneath an actual Apple Tree.

The Man in Brown will drive by and deliver our iPad tomorrow. If by some twist of evil fate he is held up, I will drop by the Apple Store (of earthly delights) to pick up my reserved iPad (to sell on eBay?).

So happy iPadurday to All!

The netbook

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Acer One netbook

The netbook, the smart phone, and the future of personal computing

 

The netbook is a new category of laptop computer that is really a refreshing of an old category. Starting with the ASUS eeePC introduced in 2007, several major laptop manufacturers have joined the fray, and the category has exploded. The current set of netbooks are a re-entry into what is a very old category centered around mobility. What the current set includes is connectivity. 

The first ultraportable of note was the Radioshack TRS-80 Model 100.

Radio Shack TRS 80 Model 100

Radio Shack TRS 80 Model 100

It was portable and had a full keyboard. It featured a wordprocessor and Microsoft Basic. The Atari Portfolio and the HP95LX brought computing into the coat pocket, and the culmination of this was the Psion Series 5 which was tiny but touch typable. I used it to write my consult notes during residency and maintained a database of frequent fliers. The hospital had HP printers with infrared ports allowing me to print out my notes wirelessly. 

 

 

Atari Portfolio

Atari Portfolio

Psion went on to create the Psion netbook and holds copyright over the name. It is a shame that they gave up the personal computer business after developing the most stable portable operating system (EPOC) and software set ever created. For example, their spreadsheet program, part of an Office compatible suite, took up 22k of memory. My Psion could run over twenty programs concurrently without crashing. EPOC became Symbian which powers Nokia and Sony-Ericksson phones. Having given up the business, they are now chasing the netbook ghost by filing cease and desist letters to websites and businesses that use the word netbook.

HP 200LX

HP 200LX

 

 

I used to own a Psion netbook and it was fantastic to type on with incredible keyboard feel. It was fast, and had instant on -booting up was instantaneous like a cell phone, not like a computer with the minute of bootup time typical for a Windows computer. The EPOC office suite was integrated and allowed cutting and pasting of graphs into documents that would update with changes in the data -this was rock stable and again, took up only a few hundred kilobytes (not megabytes) of memory.

Psion Series 5

Psion Series 5

With AA batteries, the Series 5 would run up to 40 hours. The netbook had a PC card slot for a WiFi card giving it wireless internet back in 1999.

 

 

I believe Microsoft killed the portable computer industry for about ten years with their Windows CE operating system. Microsoft powered clamshell computers were popular for a while but were difficult to use and crashed frequently. I owned a fairly advanced PocketPC clamshell, the NEC 790, but was frustrated by its instability, it’s tendency to freeze and crash, and worst of all lose data, but the full keyboard and instant on capability were enough of a plus to keep me interested for a while. 

 

The salient features of portability, keyboard for human hands, instant on, long battery life, full resolution landscape screen, and wireless internet with full capability -Flash, Quicktime, WMV and other multimedia features, are the killer features of the modern netbook. None of the currently available netbooks (Acer, HP, Dell, MSI, ASUS, and now Sony) fit the bill.

NEC Mobilpro 790

NEC Mobilpro 790

 

Psion netbook - the original

Psion netbook - the original

 

 

 

All are based on the Intel Atom processor. This is a low voltage processor that integrates graphics which translates into slow -how slow? About a hair faster than Centrino Mobile (laptops circa 2005) when running Windows XP. It definitely won’t be lighting up the specs compared to dual core laptops, but it is “good enough,” especially compared to how we used to access the internet via dialup. 

Most of the netbooks come with Windows XP. The whole netbook category along with resistence to upgrading from the coporate side has kept Windows XP alive despite the presence of Vista. A few of the netbooks are presented with a scaled down version of Vista. Having stayed away from Vista like the plague, I can’t say first hand if it’s good or bad, but the word from people using the first generation HP netbooks which ran Vista on the slower VIA processor is that it is slow. This goes against the concept of a fast-boot, efficient, fast running machine. 

 

Apple Newton eMate 300

Apple Newton eMate 300

Linux was offered on the first generation of netbooks, but as they became popular, Microsoft made Windows XP licenses available for these netbooks, essentially killing off Linux on netbooks. This is unfortunate, because Linux starts up quicker and runs more efficiently on netbooks. OpenOffice, an office suite that is available for free, runs very well on Linux. The only downside is there is no iTunes for Linux, but the bulk of the needs are met through open source and usually free software. The great thing about Linux is that the computer are customizing the operating system for their product. The new HP Mini 1000 just presented at CES with a highly customized interface. We are all use to this with the Macintosh, but also with cell phones. In fact, this is a bit of a return to the days of yore, when computer makers created the box and the software. 

 

What does this mean? The netbook is in evolution. It is somewhere between a laptop and a smartphone. The laptop offers the larger screen, USB ports, and a keyboard. The smartphone offers instant on, extreme portability, omnipresent connectivity, long battery life, and great integration between software and hardware. The netbook is slowly moving toward this end, becoming less a commodity, and more a finely honed tool. 

 

HP MiniNote 2133

HP MiniNote 2133

Do I recommend a netbook? Depends. They are easier to carry than a laptop and offer the ability to work anywhere. My Acer One netbook cost less than $400, and has a battery life of over 6 hours, has a 160gB hard drive, and has Wifi. It runs Windows XP which has its faults, but it runs iTunes, turning my netbook into a large screen iPod where I can watch movies and TV shows. With Skype, I can have video chats with family and friends wherever WiFi is available. What is really neat is cloud computing being embraced by Google, Apple, and others. It moves the work onto the browser, and makes it platform agnostic. The problem is the current generation of netbooks are still just small, slightly slower Windows laptops. 

 

The future is the next generation of netbooks which will feature more solid state memory, customized Linux operating systems, and 3G or WiMax high speed internet that is integrated. The solid state memory or SSD (solid state disks) have no moving parts, are fast, and more energy efficient getting you closer to instant on. The customized operating system means that your hardware is more tightly integrated with the software, much like a cellphone. The 3G or WiMax type high speed internet means you can go anywhere untethered from a WiFi network. You can buy netbooks that feature 20Gb SSD’s (solid state disks) with Linux, but these basically disappeared after some muscling in by Microsoft. Windows 7 promises a smaller footprint to be able to run on netbook-like gear, but it completely misses the point. You don’t buy a car from BMW and run it on an engine from GM. You want the software to run seamlessly with the hardware, and this is much more difficult under Windows.

Apple is still digesting this arena. The Newton eMate 300 was an effort by Apple to create an instant on clamshell laptop, but was quickly killed by Steve Jobs upon his return along with the Newton OS and the great Newton 2100. MacBook Air has some netbook features, but fails in it basic concept as another, albeit beautiful, laptop. Ideally, iPhone/iPod Touch would be the platform for it’s netbook, but I don’t see it going that way because of Steve Job’s aversion to buttons. No, this category will be populated by manufacturers looking to capitalize on Apple’s deafness and blindness to this category. BTW, this blog entry was written entirely on my netbook running OpenOffice and uploaded via the Google Chrome browser.