Earlier this year, we learned that one of the most anticipated technologies ever to be offered to consumers would soon be available. It would revolutionize our lives, improve our connectivity with others, and manage complex information elegantly and error free. No, we're not talking about the personal health record. We're, of course, talking about the Apple iPhone.
With much hoopla and fanfare, the iPhone was unveiled at Macworld in January, lifting Apple's stock price by more than 10% and creating a flurry of tell-all blog entries and bootlegged video footage of the announcement. The slim, elegant device offers a unique touch screen navigation system with robust rich media display, in addition to Bluetooth and Internet connectivity.
Perhaps the most striking innovation of the iPhone is its unique user interface, Multi-Touch. The patented technology is able to discriminate accidental taps from intentional touches and press-button taps from list-scrolling sweeps. In developing this technology, Apple designers were able to do away with physical buttons, keyboard and stylus -- allowing for a new level of interaction between humans and technology.
Though it's still too early to see how the iPhone will perform in real-world situations, it's clear that Apple continues to push the frontiers of computer-human interaction design, allowing us to handle and process a growing array of information more efficiently. Certainly, we could benefit from some of those principles in electronic health record design.
However, it also raises some interesting questions about intuitive design and what it is we're trying to accomplish. Is the human-technology interface a potential long-term benefit, barrier or battleground for better managing information?
The Challenge of Design
The reality is that good design is deceptively difficult to achieve. Despite the designer's best intentions, design aesthetic, practical performance and economic feasibility all influence what can be accomplished in the marketplace.
Of all the challenges to good design, one of the more critical elements is developing intuitive computer-human interfaces. Despite advances in technology performance and cost, it is still rare to find applications that are as adaptive and easy-to-use as users would prefer them to be. Across most software and hardware applications in a variety of industries, intuitive computer-human interfaces are few and far between. Users often find themselves battling the technology rather than being enabled by it. Why is this the case?
Part of the answer lies in the underlying nature of the technology itself. Software applications and hardware devices inherently are constrained by electronic switches -- binary codes that drive the underlying logic behind any electronic application. Though this might make devices inherently more reliable and predictable, it also makes them less flexible and adaptable. Buttons and databases are relatively fixed, hardwired and rooted in the technical infrastructure.
Humans, to our credit, are much more nimble and rely more on probability in the way we process and act upon information. In many situations, a seemingly minor change in formatting can dramatically alter the meaning of the information for the user, such as from 12123434565 to 1 (212) 343-4565.
To make things even more complicated, not all individuals process information in the same manner. Some of us are more visual by nature, preferring to select options from a screen display. Others may be prefer auditory or list-view options.
This fundamental difference in the processing of information -- by humans vs. technology -- creates an enormous challenge for software and hardware designers. How do we design intuitive, fluid applications that can adapt to the environment while using rigid switches, fixed wires and static architecture? And how can we accommodate individually variable ways of processing information while maintaining the economics of mass production? This is the battleground that designers constantly manage when building effective human-technology interfaces.
Beyond Phones
As praiseworthy as the iPhone is, it is still, at many levels, just a phone -- a device used to manage personal contact information and connectivity between general consumers. How would such a device perform in the context of clinical care and secure, rapid information exchange? In all likelihood, not very well.
One of the key reasons is that health care information is much more complex and nuanced than data supporting personal contact management. The concepts of a phone number or last name are very clear and consistent to most individuals. In health care, however, even simple terms like "diabetes" can have highly variable meanings to different constituents. They also are often used in a wide array of contexts for different purposes.
In health care, the barriers to creating effective computer-human interfaces have likely hindered the adoption of many promising concepts ranging from EHRs to electronic prescribing. Though the barriers are most likely surmountable, the task is daunting for such a complex market -- both from a user-needs perspective as well as a pragmatic, economic perspective.
Beyond Barriers
Though user-interface barriers likely are hindering the adoption of desirable technologies today, it's also helpful to consider what would happen if the opposite extreme were to occur. Imagine a theoretical future when user interface and sophistication of technology progressed enough to dramatically lower those barriers to adoption. Humans would be able to send and receive any information on any device with effortless thought and navigation. Communication and transaction barriers would essentially diminish to nil. Would life be better, simpler and more efficient? Or would there be too few barriers to adoption, resulting in information overload only limited by the inefficiencies of our own minds?
In some ways, e-mail connectivity is already starting to feel a little too interactive for many today. In the U.S., e-mail volume is expected to double between 2003 and 2007 to more 2.7 trillion per year, and there appears to be no end in sight. Connectivity, usability and affordability all have fueled the growth, and with the exception of sheer human exhaustion, it's unclear if anything will slow it down. Once connected to technology, can we find a way to disconnect from it?
Over the next several years, the human-technology interface will be a key battleground for shaping the quality of life that we as humans will lead. How do we better achieve what we want with technology, while still preventing it from invading our lives? Yes, progressive and intuitive design still is sorely needed in health IT and many other arenas. However, as we continue to innovate down a path of intuitive automation without barriers, we should be prepared to manage the consequences of our success -- lest we allow ourselves to become transformed into Apple's next big release: the iRobot.
About the author:
Dr. Thomas Lee is a physician entrepreneur and consultant who builds software systems and medical organizations for physicians in practice. He can be reached at tlee@metropolitan.md.
The views expressed in this column are those of the author and do not represent the views of the California HealthCare Foundation or the Advisory Board Company.