Flow like a river but be strong like a mountain

Every time a new technology is introduced, people speak of its dependency on finding a killer app that will transform this technology into a universal necessity. Just this morning, I was reading an article about the problems with Microsoft’s approach, and the fact that they lack an ecosystem when it comes to their client-side software like Windows.

What is an ecosystem? I will explain by example. I use android devices, and I use Google services on my Windows desktop. I can access my Gmail from my desktop or tablet or phone. I can move unhindered from one device in one location to another, automatically always having access to all of my data sitting on my Google Drive. This free flow of my work environment which effectively eliminates the issue of the physical device I am using, effectively creates a virtual world which follows me everywhere.

Microsoft products are tremendously well-developed on the backend. Microsoft provides a wide-based set of server software and specialized server services. Microsoft now has a fully developed cloud-based world that provides users and developers with universal access to endless CPU cycles and memory. However, Microsoft is lagging in terms of the environment that it provides to the user. While Windows is still by far the most widely installed client environment, I really can’t easily move amongst my various systems, unless I am using a Windows phone or tablet. Windows phones are hopefully going to take a huge positive step forward with the release of Windows 10, which will effectively provide a standardized and universal environment that works on desktops, tablets, phones, TVs and other devices as they come along. But at the moment, a Google or Apple-based ecosystem is far more fluid.

It struck me this morning that the killer application in the medical field is not an application. There is no single program that will draw all of the doctors towards a particular software environment. Doctors, like most users, don’t want to know how their devices work. They just want them to work. For doctors specifically, it is critical that they should be able to move from patient to patient, conference to conference, clinical meeting to clinical meeting without any hindrance.

A doctor wants to be able to sit by a patient’s bedside and have immediate access to all information about that patient. With nothing more than a flick of a wrist or a few words spoken into a microphone, that same doctor should be able to request a consultation from another specialist or order a particular test. Doctors want to actually experience an environment where every single tool they use is one part of a much larger organism. Doctors don’t want to ever have to email themselves to move information from one location to another. Doctors want to be able to flow from one situation to another knowing that they are constantly surrounded by an ecosystem that always delivers exactly what they need, when they need it, wherever they need it.

I’ve spoken recently about a fundamental change in the big EMR companies in the United States. Just a year ago, I watched a conference video where representatives of these companies admitted that they needed to do far more work to integrate into some type of universal environment. Today, every major EMR has either already installed or is desperately working on a front-end that is clinically comfortable for physicians. This did not exist even a year ago. More so, every EMR company is creating a platform that will allow developers to create add-on modules, that may even be capable of plugging into multiple major EMRs. This single capability, of being able to develop universal plug-ins, was unthinkable two years ago, and maybe as recently as one year ago. That is how quickly things are changing.

In a few years from now, perhaps by 2020, I can easily now envision the free flow of secured patient information  from any device/company/EMR to any other device/company/EMR. The security will have to be rock solid, and all of the systems will have to be incredibly robust, and reliable. The worst thing that could happen is for a doctor to have to reboot a device because of a failure of communication or corruption of data. The killer application in medicine is an ecosystem which will allow doctors to almost forget that the data they need is flowing so easily throughout the work environment. When the day comes that doctors no longer sit in front of a screen waiting for a program to respond, and more so, doctors can interact with the ecosystem in any way they like [speech, gestures, handwriting, blinking, etc.], these doctors will truly embrace the digital medical world.

Given this new reality, it is difficult to imagine a company trying to develop an entire EMR from scratch and then competing with the mega companies that presently share the medical market. Instead, smaller developer companies will focus on the writing of the plug-in modules that will add any and all functionality that is considered necessary for an EMR to provide customized needs to various customers. This is actually a win-win situation for all those involved. And such an approach will continue to support a universal shared environment that will maintain the free flow of information.

Microsoft recently introduced an entirely new interface called Hololens. This is a totally immersive augmented reality system, that will allow doctors to see x-rays floating in front of their eyes as they sit at the bedside of a patient. Such an environment will support all of the means of communication I mentioned above. Every doctor will know and internalize the fact that they will no longer ever have to look for information. Efficiency will increase. Errors will decrease. Once again, this will be a win-win situation. And once again, I think this is achievable even by 2020.

To quote one of the villains in the Marvel comic universe, this is “the age of miracles”. And as Jewish law states, one should never count on a miracle, but it’s all right to appreciate it when it does happen.

Thanks for listening

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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