What does it mean when my wife says she needs to upgrade

When was the last time you upgraded your washing machine? Is it even connected to the Internet, or does it at least have a DVD drive to install new software? If not, how can it possibly answer your needs? Our computers are constantly being upgraded. Even if you haven’t installed any software in the last few months, the Windows operating system is constantly receiving updates to fix internal but significant problems. My android device is constantly announcing upgrades to a whole list of apps, some of which I rarely use and should probably be removed altogether.

I must say that I find this a quite fascinating question. Our washers and dryers and microwaves and ovens all seem to function just fine even though they may have been purchased over 10 years ago. On the other hand, if I were using a 10-year-old computer [even if it was a Mac], I could not do most of the things that I take for granted.

You could argue that a computer needs to be upgraded and because it is performing very complicated tasks. Cooking the turkey so that it comes out tender but not raw is by no means simple. A master chef collects a whole range of specific kitchen items that allow him or her to produce the best possible food. Contrarily, how often does my Windows clock have to be upgraded, when all it is doing is telling the time. Worse, how can it be that such a simple program can crash and force me to restart my machine?

“It must be a virus”. I believe that these five words are uttered far more often than “I love you”. In fact, I am sure that the phrase “I love you even though your computer has a virus” is also very frequently said. Considering that Skynet was ultimately a computer virus, I would argue that all of our computers have already been irreversibly infected and that it is only a matter of time until the machines decide to take over. Considering how well and extensively viruses seem to have infiltrated every part of our lives, we might not even notice when the architect declares “resistance is futile”.

Deciding on whether to upgrade or not is by no means a minor issue. In companies with tens of thousands of stations, a “simple” upgrade of a standard piece of software could easily cost millions of dollars. And if the upgrade causes any difficulties, then the cost in lost productivity could be many many more millions of dollars. Someone might ask the annoyingly intelligent question, “everything is working. Why do we need to upgrade?”.

A friend of mine was a lead technical consultant on a major project for a teaching institution. In his own words, the institution had agreed to upgrade to the latest version of his company’s management software, not because they needed to but because my friend’s colleague who was a very adept sales person, succeeded in convincing the institution’s management that they would do far better with the updated version of the system they were presently using.

As it turns out, despite this being an upgrade, the new version of the software lacked certain critical features that the present version had. The many users within the institution were going to wake up to a very unpleasant new reality where they would have to learn a whole new way of working, despite the fact that the “old way” worked just fine. I wish I could say that this scenario was rare. But if a company does not have an internal person who can truly assess the needs and the value of upgrading a system, then it is just a matter of time until a company or an institution lose millions of dollars to a good sales pitch.

In the medical world, technology plays a huge role and is fundamental to certain specialties. Radiologists are heavily dependent on extremely complex and expensive imaging systems that allow them to peek into our body’s secrets. When CTs first came out, they were revolutionary. But version 2 of the CT was clearly better and faster than its predecessor. Today, a CT can scan an entire body in a few seconds. The CT happens so quickly that many patients question whether the test was even done. MRIs still take many minutes and sometimes tens of minutes to complete an imaging study. But that will also change with time.  At some point in the future, an MRI will be as fast as present-day CTs. Of course, by that point in the future, there may be a whole new type of imaging that has even replaced both CT and MRI.

Let’s go back to the CT. If the new CT comes out that can scan a person in one second versus the present day 3 to 5 seconds, is the upgrade to the new CT necessary. In children or agitated individuals, trying to get them to lie still for even a single second can be extremely difficult. So one could argue that the difference in study time still justifies the upgrade. So let’s say that the hospital agrees to upgrade to the one second CT. What then? Should the hospital upgrade when CTs can do the same study in a 10th of a second? Will this make a practical difference in the day-to-day imaging work that is being done?

Of late, the question of radiation dose from CTs has become a major topic in the radiological world. So new CTs that can deliver the same quality image but with much less radiation would be legitimately desired by the medical staff. But when the radiation dose is eventually reduced to such a point that it is equivalent to the background radiation that we all experience on a day-to-day basis, is an upgrade still necessary when the new version CT generates even less radiation during the study?

I recently read a series of articles talking about the “need” for the latest TVs that are curved and thus produce a much more enveloping experience. A couple of the reviewers literally tore this description apart. They claimed that any 50 inch TV with high quality DVD resolution produces the same visual effect. I personally have a widescreen TV at home, which replaced a nice but bulky TV, which failed to properly display certain widescreen movies. My TV upgrade definitely improved my viewing enjoyment. These days, as much as I drool over the images of the latest superpowered TV sets, I simply can’t bring myself to spend my child’s college fund on a new screen that would not be perceptually better. My satisfaction with my present TV makes me the scourge of many high-tech companies. If I am not willing to spend money just to say that I have the best and latest <insert device here>, then how will Samsung and Sony and Apple and Microsoft and all the others afford to give their workers a Christmas bonus.

Budgets in hospitals are always limited. Nevertheless, I know of cases where a hospital has spent a ridiculous amount of money for a product, solely because it was well advertised as being the best. I can honestly say that had I been the CIO in such a company, I would have fought tooth and nail against such a purchase. It is not evidence of being overly cheap when a CIO and CFO demand some proof of the added value from a new purchase or an upgrade of an existing system.

The problem is that doctors can effectively always claim that the upgraded device will provide for better healthcare. Unless the CIO and/or CFO have training in healthcare, it is extremely difficult for them to challenge such a statement by the hospitals’ physicians. I am incredibly fortunate in that I am well read in many technological fields, as well as being a practicing physician. On more than one occasion, I have explained how purchasing decisions should be made. I wish I had the ear of the CIOs and CFOs of many large medical institutions. I truly believe that even a short discussion could dramatically help them to make better decisions regarding new and upgraded systems.

Companies that sell technology will always succeed in arguing in favor of an upgrade or new purchase of equipment, whether medical or other. Hospitals and major insurance companies as well as countrywide health funds must have on staff someone who can challenge the salespeople who frequent the heads of the healthcare institutions’ departments. The point is to educate everyone within the healthcare service so that they understand why it is or is not appropriate to spend money on the particular item being pushed by the salesperson. The more that the decision-makers are educated, the more that the salespeople will truly have to prove the value of their products. Ultimately, this will be for the better, both in financial terms and more importantly in terms of the delivered healthcare.

On a personal note, I didn’t upgrade to Windows 8.1. I’m not sure I will upgrade to Windows 10, at least during the first year that it is out. I have a marvelous Windows 7-based system at home that does everything I need to my satisfaction. And more often than not, no one needs to upgrade when their present system is doing just fine. As the rabbis of old declared, “one who is satisfied with what he has, is wealthy”. I guess we could upgrade this statement and say “one whose system does not crash, need not update”. Who knew that 2000-year-old rabbis would predict the whole issue of upgrading systems.

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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