Lobster:
Imagine a far-sighted, maladroit physician with a portable computer. Can you design an application that he can easily use?

Met with Janine Buis yesterday of Nokia's Innovent arm. We're going to be sharing the podium at the Medical Record Institute's Mobile Healthcare Conference in San Diego this December. I will talk about BirdDog as a case study of the potential for mobile computing in the healthcare 'space.' The key concepts are 1) that mobile computing is not just running applications on portable devices; it's best thought of from the application layer up; 2) adoption of devices depends on the business value and usability of the tools more than a price point; 3) that application design should anticipate changing platforms and infrastructure support; 4) that devices that are aware of 'microcontexts' may have the best chance of serving the needs of mobile users; 5) that in healthcare specifically we are simultaneously heading toward a more transparent, shared, and distributed medical record at the same time that we are more than ever concerned with the security of protected health information (PHI).
I'd better elaborate on what I mean by 'microcontexts.' In emergency medicine, much work is done outside of a defined exam room, and as the medical record is essentially a datastream from electronic resources, the 'chart' may not be accessible at the bedside in the conventional sense. It may be difficult to have a private conversation, let alone do a decent examination without compromising the patients' privacy. Yet we may need to recruit them in decision making. Some portable devices may make this more possible since the information can be obfuscated in a way that shared workstations or COWs (computers on wheels) can't. A microcontext might also be thought of in terms of the temporal environment that encloses a decision point. E.g., 'should I order this medicine, here and now?' Because there will be new data incoming, this fleeting moment of opportunity may be best taken if there is a proximate device that allows an action. Lowering the threshold of access to information and the ability to act on that information is what mobile healthcare is about.

Johannes Ernst, encouraged me to start this blog. And it's not a bad idea, since most of my thoughts evaporate or get buried under a pile of other ones before they can germinate themselves or pollinate elsewhere. Johannes and I met last week to discuss BirdDog, the project on which we are collaborating at Kaiser. Adrian Blakey, the development manager in charge of the project, and Johannes are good about cataloguing the progress of our joint venture internally, but when we start thinking beyond the immediate parameters of BirdDog some good thoughts tend to get lost in the shuffle.
The part of that discussion that I want to elaborate has to do with the limitations of small form factor communication devices and computers. My opinion is that too much is expected on the user's part to accommodate to these little machines. Even if an individual gets really good at one of them, he may find that these skills aren't very transferrable to the successor devices. For example, text entry is a big challenge. I spent years getting good at Graffiti for Palm-based systems, but it's not natively supported on the new Treo phones. I'm getting better at thumb-keyboarding, but that skill is inhibiting my facility with touch-typing. (I was never very good at the latter.) This is a problem for clinical applications, since virtually all of them require lots of keying. So in designing new clinical applications, I am exploring the opportunities for very simple graphical interfaces. That led me to look at AJAX-powered web sites. (Thanks to Jory Bell of OQO for first mentioning AJAX a couple of weeks ago...I'm a little late in becoming aware of this next-gen web technology.) The more we can replicate the tasks that are required without having to type accurately, the more usable and efficient the application will likely be. So if you want to ask something of a database, rather than typing in SQL queries, it makes more sense to use a drop-down selection menu. That's old news. But what makes the new AJAX sites so cool is that they are quick, responsive, and seem to anticipate the needs of the user before the requests are invoked.
As I work through my clinical patient task list (inbox, whatever you want to call it) I am constantly toggling back and forth between disparate applications and re-entering credentials and medical record numbers. Even in a unified system, like Epic, there are so many tiles, tabs and buttons that it is still fairly cumbersome to navigate, even on a full screen. On a small display it might be unusable. How can we get the same functionality out of a mobile app? I think that if we start by designing for lobsters instead of touch typists we'll be on our way.