I get the concept

Sometimes, you will hear or see a presentation about a new idea that strikes you as absolutely brilliant. Time passes, and you expect to see that idea come to fruition. More often than not, though, more time passes and at best, you see poor implementations of that magnificent idea. And you wonder how it can be that a marketplace desperate for cutting-edge concepts, let’s a brilliant new idea pass away.

There are many stories about the early days of the major tech companies Apple and Microsoft. Over time, I realized that mythology can intertwine with modern stories just as much as it is a part of ancient lore. For example, I was under the impression that Apple created the mouse from scratch. After watching an excellent movie (“The Pirates of Silicon Valley”) about the origins of these companies [which in my opinion surpasses any of the recent movies about Steve Jobs], I suddenly realized that it was Xerox that created the mouse and the graphical user interface.

As history goes, Xerox failed to appreciate the power of the graphical environment and it was Apple that made the mouse and GUI worldwide successes. These kinds of stories beg the question – who really is the innovator? Is the innovator the one who comes up with the idea, or is the innovator the one who takes the idea and creates the first workable version of it? I don’t pretend to have any solid answers. What I can say though is that without workable solutions, ideas remain ethereal. What the world needs are new, better and more efficient, workable solutions to whatever problems are being faced.

A couple of blogs ago, I mentioned Microsoft’s introduction of a system called “continuum”. The idea is simple. We are all walking around with powerful computers in our pockets, often more powerful than the desktops, laptops or even tablets that we own. Nevertheless, because of the small screen and the difficulty with typing, these computing powerhouses in our pockets never get fully utilized. The concept behind continuum is to have a docking station that immediately links a phone to a screen [or set of screens], a mouse and keyboard. Over time, I suspect that this docking station will allow for far more types of input devices [such as musical instruments, and gaming devices] as well as output devices [such as 3-D projectors, enhanced audio equipment and so on]. The real innovation is in the fact that the user can simply take the phone out of the docking station and move it to any other docking station as needed. So, a user could take the phone from the music studio, where all types of complicated music blends have been made, and bring it home and dock it once again, in order to put the finishing touches on the musical piece.

The essence of such a system is the phone itself. Understandably, Microsoft is touting their own phones as the ideal centerpiece for the continuum environment. The problem is that the market share for Microsoft phones is relatively small. In many ways iPhones and Android phones are superior to the Microsoft smart phones. This doesn’t in any way diminish the power of the concept of mobile dockable phones. It does however limit the number of options when one wants to have such systems at home, workplace and more.

After seeing the demonstration of Continuum, I immediately went to the Internet and searched for equivalent systems for my android phones. Using Bluetooth connectivity, it is relatively easy to add a mouse and full keyboard to an Android phone. The piece that is missing is the screen or set of screens on which to view the output of the phone. As it turns out, finding a Bluetooth compatible set of screens is not straightforward. My hope is that either Microsoft will make the continuum environment supportive of at least android, or that a new market for Bluetooth screens will develop. In either case, it is absolutely clear that an excellent idea can fall flat because of the lack of implementation in a way that is comfortable and thus usable for the general public.

When I started developing my electronic health record system, that is presently in use by TEREM across its 12 clinics, it was immediately clear to me that there would be a need for a free flow of information between all of the hardware and software components of the system. From a single monitor, using a single piece of software, it was critical that users and managers alike should be able to access any data that was generated by any other component of the system. A classic example was the idea of incorporating  photographs of the patients [taken by the doctors] into the system.

I could have easily built a separate module that would have required a separate login, and then written an interface that would require entering search parameters before searching for the images. Instead, with my present system, once the physician has logged in once into the patient ‘s chart, any photographs that were attached to the case, were immediately viewable with a single click. This is the same concept as for radiological images and scanned information [such as old lab results from another location]. Complete integration is a foundation of the system I built. Based on my reading of various technology references, it took the general EMR market 10 years to catch up with this idea. And still, many EMRs do not have an interface that readily shares information between the EMR components.

Why can’t everybody just get along? Why is inter-connectivity, along with the intuitive and easy flow of information from one location to another, so difficult? Some of the reasons for this are technical and some of the reasons are political. In the end, it is both the patient and physician that suffer from the lack of the free flow of information. The idea is clear to everyone. But the implementation has been slow, painful and at times simply absent.

In time, solutions will be found to make the flow of medical information simple and readily available. But somebody has to pick up the gauntlet. Someone with enough clout and resources needs to say that the new standard is free flow of information via hardware and software solutions. It is very possible that the investment required  to make this a reality would cause many companies to falter. Nevertheless, someone has to take that leap of faith. Someone has to believe enough in the necessity of sharing information, so that all of the tools will be developed to make this possible.

At the very least, when companies are developing internal software, they should be focused on the maximal free flow of information. When such companies purchase outside software, they should ask about inter-connectivity and even demand it as part of the purchase package. Hopefully, this kind of trend will take hold and in a few years, no company will dare publish a package of software and hardware that does not champion inter-connectivity. From my own experience, I can only say that this idea needed to be a reality many years ago. Therefore, it cannot come too soon.

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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