Health IT and the Limits to Analogies

Many who write and talk about health IT, including myself, are fond of using analogies. One of the most common analogies that we use is that of the banking industry. I have noted that I can insert my Wells Fargo ATM card into just about any ATM in the world and receive out local currency. This is all made possible by a standard adopted worldwide by the banking industry. Of course, there is another reason for banking interoperability that does not exist in healthcare, which is that the financial incentives are all aligned. Each time we make an ATM transaction, a fee goes to both the bank that owns the ATM and (if the machine is owned by a bank different from our own) our bank. While most of us grumble about ATM fees, we usually pay them, not only because we have to, but also because of the convenience.

Another common analogy we use for how health IT could be better is to discuss the aviation industry. There is no question that healthcare could learn more from not only the IT of the aviation industry, but also the relationships between all the players who insure that planes take off and land safely [1]. With regards to the IT of aviation, there is definitely more human factors and usability analysis that go into the design of cockpit displays for flying these complex machines than is done in healthcare.

An addition to the analogy list I hear with increasing frequency is the smartphone. In particular, many ask, why can’t the electronic health record (EHR) be as simple as a smartphone? Again, there is much to learn from the simplicity and ease of use of smartphones, especially their organization as allowing “substitutable” apps on top of a common data store and set of features, such as GPS [2]. However, there are also limitations to the smartphone analogy. First, the uses of the EHR are much more complex than most smartphone apps. There is a much larger quantity and diversity of data in the patient’s record. Second, the functions of viewing results, placing orders, and other actions are much more complex than our interactions with simple apps.

I look at my own smartphone usage and note that I spend a great deal of time (probably too much) using it. But there are many things I do with my laptop that I cannot do with my smartphone. For example, my phone is fine for reading email and typing simple replies. However, composing longer replies or working with attachments is not feasible, at least for me, on my phone. Likewise, writing documents, creating presentations, and carrying out other work requiring more than a small screen is also not possible on my phone with its limited screen, keyboard, and file storage capabilities.

While a key challenge of informatics is to make the EHR simpler and easier to use, it will never approach the simplicity of a highly focused smartphone app. Analogies can be helpful in elucidating problems, but we also must recognize their limitations.

References

1. Pronovost, PJ, Goeschel, CA, et al. (2009). Reducing health care hazards: lessons from the commercial aviation safety team. Health Affairs. 28: w479-w489.
2. Mandl, KD, Mandel, JC, et al. (2012). The SMART Platform: early experience enabling substitutable applications for electronic health records. Journal of the American Medical Informatics Association. 19: 597-603.