Over the past decade, an astounding 34,000 iPhones have been sold on average, every hour of every day.5 Singlehandedly, the iPhone raised the once-moribund stock price of Apple from near bankruptcy levels and transformed the company into the world’s largest company, based on market capitalization.
There is a reason for our deep affinity for this device. It seamlessly connects us with everybody, everywhere. You can check your email, read the papers, deposit your checks, peruse your favorite medical journals, watch a video, snap a photo or text with your pals. The choices are endless. This is a textbook example of technology being optimally designed to maximize the user experience. The user is the center of the developers’ attention.
HITECH
But what happens when developers are agnostic to users’ needs? A couple of years following Steve Jobs’ introduction of the iPhone, Congress passed the Health Information Technology for Economic and Clinical Health (HITECH) Act to jumpstart the adoption of EHRs into clinical practice.6
For decades, many medical practices languished under the burden of paper charts, and the hope was that with sufficient financial incentive, doctors would leap at the opportunity to enter the digital age. Congress authorized spending $36 billion to encourage practices to transform their often illegible, messy collections of papers that masqueraded as medical records into digitized, legible packets that could be easily deciphered and distributed with a simple click to any authorized healthcare provider. These were worthy goals that aimed to radically transform the delivery of healthcare in America.
But there were many potholes along this path to digital nirvana. What doctors anticipated receiving and what was delivered were as different as expecting a smartphone and getting a cable television box delivered instead. Buyer beware!
Cable television systems offer far too many choices to the viewer. Ditto the EHR, with its busy screens packed with excessive data. System portability has never been the cable television standard; your device needs to be tethered by a cable to that hardwired box. Similarly, EHR systems function as closed loops. Unlike your iPhone that connects to your friend’s Samsung device regardless of service provider, EHR systems remain shut, gated communities, with restricted access. Don’t you want your Verizon phone to accept calls and text messages from AT&T customers? Just as it made economic sense for wireless carriers to develop universal standards that allowed their networks to interact with one another, there was a similar, though perverse economic rationale for EHR developers to shut their portals to other systems: They believed that if customers could purchase systems from their less costly competitors, they would be able to gain access at a cheaper price.
