This post was originally featured on EMRandHIPAA.
Steve Jobs famously said that “laptops are like trucks. They’re going to be used by fewer and fewer people. This transition is going to make people uneasy.”
Are medical professionals truck drivers or bike riders?
We have witnessed truck drivers turn into bike riders in almost every computing context:
Big businesses used to buy mainframes. Then they replaced mainframes with mini computers. Then they replaced minicomputers with desktops and servers. Small businesses began adopting technology in meaningful ways once they could deploy a local server and clients at reasonable cost inside their businesses. As web technologies exploded and mobile devices became increasingly prevalent, large numbers of mobile professionals began traveling with laptops, tablets and smartphones. Over the past few years, many have even stopped traveling with laptops; now they travel with just a tablet and smartphone.
Consumers have been just as fickle, if not more so. They adopted build-it-yourself computers, then Apple IIs, then mid tower desktops, then laptops, then ultra-light laptops, and now smartphones and tablets.
Mobile is the most under-hyped trend in technology. Mobile devices – smartphones, tablets, and soon, wearables – are occupying an increasingly larger percentage of total computing time. Although mobile devices tend to have smaller screens and fewer robust input methods relative to traditional PCs (see why the keyboard and mouse are the most efficient input methods), mobile devices are often preferred because users value ease of use, mobility, and access more than raw efficiency.
The EMR is still widely conceived of as a desktop-app with a mobile add-on. A few EMR companies, such as Dr Chrono, are mobile-first. But even in 2014, the vast majority of EMR companies are not mobile-first. The legacy holdouts cite battery, screen size, and lack of a keyboard as reasons why mobile won’t eat healthcare. Let’s consider each of the primary constraints and the innovations happening along each front:
Battery – Unlike every other computing component, batteries are the only component that aren’t doubling in performance every 2-5 years. Battery density continues to improve at a measly 1-2% per year. The battery challenge will be overcome through a few means: huge breakthroughs in battery density, and increasing efficiency in all battery-hungry components: screens and CPUs. We are on the verge of the transition to OLED screens, which will drive an enormous improvement in energy efficiency in screens. Mobile CPUs are also about to undergo a shift as OEM’s values change: mobile CPUs have become good enough that the majority of future CPU improvements will emphasize battery performance rather than increased compute performance.
Lack of a keyboard – Virtual keyboards will never offer the speed of physical keyboards. The laggards miss the point that providers won’t have to type as much. NLP is finally allowing people to speak freely. The problem with keyboards aren’t the characteristics of the keyboard, but rather the existential presence of the keyboard itself. Through a combination of voice, natural-language-processing, and scribes, doctors will type less and yet document more than ever before. I’m friends with CEOs of at least half a dozen companies attempting to solve this problem across a number of dimensions. Given how challenging and fragmented the technology problem is, I suspect we won’t see a single winner, but a variety of solutions each with unique compromises.
Screen size – We are on the verge of foldable, bendable, and curved screens. These traits will help resolve the screen size problem on touch-based devices. As eyeware devices blossom, screen size will become increasingly trivial because eyeware devices have such an enormous canvas to work with. Devices such as the MetaPro and AtheerOne will face the opposite problem: data overload. These new user interfaces can present extremely large volumes of robust data across 3 dimensions. They will mandate a complete re-thinking of presentation and user interaction with information at the point of care.
I find it nearly impossible to believe that laptops have more than a decade of life left in clinical environments. They simply do not accommodate the ergonomics of care delivery. As mobile devices catch up to PCs in terms of efficiency and perceived screen size, medical professionals will abandon laptops in droves.
This begs the question: what is the right form factor for medical professionals at the point of care?
To tackle this question in 2014 – while we’re still in the nascent years of wearables and eyeware computing – I will address the question “what software experiences should the ideal form factor enable?”
The ideal hardware* form factor of the future is:
Transparent: The hardware should melt away and the seams between hardware and software should blur. Modern tablets are quite svelte and light. There isn’t much more value to be had by improving portability of modern tablets; users simply can’t perceive the difference between .7lb and .8lb tablets. However, there is enormous opportunity for improvements in portability and accessibility when devices go handsfree.
Omni-present, yet invisible: There is way too much friction separating medical professionals from the computers that they’re interacting with all day long: physical distance (even the pocket is too far) and passwords. The ideal device of the future is friction free. It’s always there and always authenticated. In order to always be there, it must appear as if it’s not there. It must be transparent. Although Glass isn’t there just yet, Google describes the desired paradox eloquently when describing Glass: “It’s there when you need it, and out of sight when you don’t.” Eyeware devices will trend this way.
Interactive: despite their efficiency, PC interfaces are remarkably un-interactive. Almost all interaction boils down to a click on a pixel location or a keyboard command. Interacting with healthcare information in the future will be diverse and rich: natural physical movements, subtle winks, voice, and vision will all play significant roles. Although these interactions will require some learning (and un-learning of bad behaviors) for existing staff, new staff will pick them up and never look back.
Robust: Mobile devices of the future must be able to keep up with medical professionals. The devices must have shift-long battery life and be able to display large volumes of complex information at a glance.
Secure: This is a given. But I’ll emphasize this is as physical security becomes increasingly important in light of the number of unencrypted hospital laptops being stolen or lost.
Support 3rd party communications: As medicine becomes increasingly complex, specialized, and team-based, medical professionals will share even more information with one another, patients, and their families. Medical professionals will need a device that supports sharing what they’re seeing and interacting with.
I’m fairly convinced (and to be fair, highly biased as CEO of a Glass-based company) that eyeware devices will define the future of computer interaction at the point of care. Eyeware devices have the potential to exceed tablets, smartphones, watches, jewelry, and laptops across every dimension above, except perhaps 3rd party communication. Eyeware devices are intrinsically personal, and don’t accommodate others’ prying eyes. If this turns out to be a major detriment, I suspect the problem will be solved through software to share what you’re seeing.
What do you think? What is the ideal form factor at the point of care?
*Software tends to dominate most health IT discussions; however, this blog post is focused on ergonomics of hardware form factors. As such, this list avoids software-centric traits such as context, intelligence, intuition, etc.