Archive for January, 2002

There's No Screen

Sunday, January 6th, 2002

Techno-futurists are full of it. Technology doesn’t cause anything. It amplifies, distorts, leverages, and attenuates but it does not determine the direction of things. It neither creates flattened organizations nor hierarchical ones. It is neither the cause of centralization nor decentralization. Technology, in general and, information technology in particular, is neutral in both a geographic and organizational sense.

This was the guts of my Ph.D dissertation almost twenty years ago. Like most dissertation writers I was so sick of it when I finished that I didn’t want to look at it again, let alone publish it or talk about it with anyone. So, I was delighted when a friend passed along to me The Social Life of Information by John Seely Brown and Paul Duguid of Xerox PARC fame (Harvard Business School Press, 2000). The guts of their argument is more wide ranging, more scholarly, better written and more readable than my dissertation, but the stance is the same. Futurists and technologists invest too much faith in technological determinism and not enough in the importance of the social context of technological change.

Becoming digital in healthcare will require much more than computers and bandwidth. It will require the correct social, political, and economic context and the organizational and personal transformation to bring out the best in the machines. And the transformation needs to make healthcare truly better not just appease the technologists.

In just one day, today I was reminded of how far we have to go. At 7.00 am I was on the phone with the CEO of a data-mining company, who has successfully applied sophisticated data-mining and pattern recognition technology to the oil exploration business. The CEO, a cancer survivor, wants to: “apply the (data-mining) technology to healthcare, so that doctors could have a synthesis of all the best information available to them on the screen, as they treat the patient”. “What screen?” I asked. “There’s no screen. No books even. ” I said. “Doctors don’t think like that, they like to make it up as they go along. It’s hypothetico-deductive reasoning at best, not calculus.” He was a scientist and that got him.

Fast forward an hour. I am going for a second opinion about whether I need neck surgery for a herniated disk. A week ago, the head of Neurosurgery at Stanford University told me I need it, and I believed him, but hey I’m supposed to be an informed consumer, so I’m at the high-priced sports medicine guys who don’t do surgery to see a non interventionist neurologist. Fancy office buildings, beautiful art, smart staff, yet the same opening ritual at reception as in all American healthcare: they took a xerox copy of my insurance card. (Wouldn’t it seem sensible to make the cards a swipe card or something?). I get ushered into an exam room, give the nurse the history, and after a bit of a wait, the neurologist bounds in. He does a lot of touchy feely exams, he asks me questions, he goes into trance like reflections at times. He hits me with a little rubber hammer all over the place, including between the eyes. There’s no screen.

I came to him hoping to be told that I didn’t need surgery. He told me I did, and immediately. I don’t need the screen. I trust him.

A couple of hours later after I cancel all my obligations for the next few weeks, I’m on another conference call. This time it’s with senior officers of the American Heart Association, the NIH, and the US Public Health Service talking about a conference they are organizing next year on cardiovascular health. The goal of the conference is help a wide range of practitioners and public health folks discuss ways to reach the healthy 2010 goals set by the Surgeon General. Among the wide range of problems we discussed, one was clear: the lack of compliance by patients and physicians with the existing knowledge about cardio-vascular health and management of disease. An eminent cardiologist on the call, who is also head of a large group practice, explained how in his practice, the cardiovascular care guidelines pop up on the screen to remind the doctor at discharge about the appropriate follow-up care. The American Heart Association is making these guidelines widely available on the screens of all physicians who want them.

There are screens, and doctors are increasingly using them. But the screens must enhance the science and magic of medicine. They must help not hinder the connection between physician and patient, and medicine can be even better as a result.

Ian Morrison is an author, consultant and futurist based in Menlo Park, California. A shorter version of this editorial was published in the January/February 2002 Issue of the Health Forum Journal.