Why healthcare and technology are still not speaking the same language

9:53 am by | 5 Comments

Imagine two people carrying on a very pleasant and cordial conversation. As you pass by you note that they’re nodding heads in agreement and smiling. You then listen a bit more and realize that they are each speaking different languages and, in all probability, don’t really know what each is saying.

I’ve been to a number of meetings lately where technology and health professionals have been trying to explore how the amazing promise that breakthroughs in technology are making can be used to advance health and healthcare. Intuitively, it seems that the two would go perfect together. Trends in moving services away from traditional clinical settings, the need to be more patient centric and the advances in technologies related to mHealth provide fertile ground for this collaboration. However, I’m beginning to worry that there are some profound disconnects that threaten what should be a remarkable partnership. There’s a lot of nodding but I’m not sure that there’s that much understanding. There are clearly substantative differences in research methods but there seem to be disconnects in what are viewed as solutions.

The first disconnect is based on different understandings. Technologists hear problems based upon the technology they know. There’s much to be said about the phrase: “To someone with a hammer, every problem is a nail.” But it’s more than that. Even when we start with a common understand a problem solutions tend to drift toward functions implicit in the technology. This can cause a drift toward solving a different problem than the one in question or refining an attribute that is less relevant to the original problem.


The second problem is that there is an inherent beauty in pure technology. It is easy to become focused on making a technology as “perfect” as it can be. Often in health, the existing standards of care can be quite low so “good enough” can be transformative. Working toward an elusive ideal may make sense from a theoretical framework but it may only delay interventions that are needed now.

Third, there is a mistaken assumption of symmetry in the relationship between technologists and health professional. The problem space comes from health and healthcare and is based upon a very practical framework. The health professional knows these and this reality must guide the collaboration. The solution space is likely to be technical but it must fit the reality. The technologist needs to communicate the solution in such a way as it is truly actionable. She also needs to listen carefully to the language that is actually being spoken. It’s difficult to bend reality to fit a theory not well based on the facts on the ground.

On top of this, one needs to align the very practical real world to this system. Collaboration between technology and health is complex and takes time and there are far easier realms to apply technology. But the potential payoff in making the world healthier should transcend the complexity.

Of course, all of this is based upon a belief that there is value in the solution and value is a very complex combination of evidence, design and execution.

[Photo courtesy of Flickr user ilamont]

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Albert Shar

By Albert Shar

Albert Shar, PhD, is a vice president and program officer for the Pioneer Portfolio at the Robert Wood Johnson Foundation (RWJF). He is also a principal at QERT, a technology consultancy focused on strategy, implementation and value in health where he will be full time in January, 2013. Shar was RWJF's first vice president for information technology and previously worked as director for Information Technology Research and Architecture at the R.W. Johnson Pharmaceutical Institute, a Johnson & Johnson company. He has also served as director of technology services at the University of Pennsylvania Health System, and CIO at the University of Pennsylvania’s School of Medicine. He has held faculty positions at the University of Pennsylvania, the University of New Hampshire, Swiss Polytechnic Institute (ETH) and the University of Colorado. Shar holds a patent in medical imaging and is author of more than 50 scholarly articles.
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@hakmalVC @gnayyar @medcitynews @spulim Agreed but its the brightest one on industry's radar. Perception is everything.


@hakmalvc Excellent point, very true. @SPulim Great article, thanks for sharing!


@hakmalVC @dlschermd has a great post about how FDA would potentially be involved http://t.co/V76zmDGM @gnayyar @medcitynews

Carolyn Thomas
Carolyn Thomas

Thanks for these three well-fleshed out perspectives on the chasm between health care professionals and technology.  I'd break down "health care" even further, however. There are the users who are providers, and there are users who are patients.  And not the "worried well" who like to self-track because they can, but real live patients living with debilitating and chronic illness.


It wasn't until I survived a heart attack that I realized the enormity of the chasm possible between health care providers and their patients. And it wasn't until I attended Stanford University's Medicine X conference and got to rub shoulders with health tech startups and committed Quantified Selfers that I realized the chasm between technology and patients.


In short, I wondered if any of these young tech-savvy startups ever bothered to spend time with real live patients?  According to Pew Internet stats, for example, only 13% of people >age 65 own smartphones. This is the same demographic most likely to be struggling with multiple chronic illness diagnoses - and least likely to be embracing mobile self-tracking to manage these diagnoses - no matter what groundbreaking utility is promised by the over-excited "hype-meisters" (as David Whelan at Forbes referred to these startups recently).  Much of mobile health technology is geared towards the worried well, as Whelan writes:  “It’s true that you can point a finger at health care and say it lacks technology. But it’s not because the tech doesn’t exist. It may be that technology doesn’t really fit.”  More on this at: http://myheartsisters.org/2012/10/10/no-smartphone/