What can cell phones teach us about health care?

It just worked. The iPhone from Apple. You've seen the ads and they're all true. It's cool and it works. It just simply works. When I wanted to make a call, I made a call. Emails? Flawless Exchange integration with my company's server and no IT professionals were hurt in the making of that movie. Surfing the web? Sure, all the time. When I was traveling with my son through the American West early in this past summer, I clicked on the free application (you do understand that there are thousands upon thousands of apps available right on your phone; most are useful and most are free) to locate the nearest restaurants of the exact type we desired. Last Spring, as my family and I were rushing from the Starbucks near Central Park to the venue where "Wicked" was playing, we used the built in GPS function to chart our progress on the avenues as we navigated toward the theater. Text messaging? Sure. Fun games? Occasionally. Everything fit together like a glove. It just worked.

Fast forward to two weeks ago and my new position required a move to Verizon. Verizon does not (yet) have the iPhone so I became acquainted with the Windows Mobile 6.1 smartphone, smartly entitled the HTC Touch Pro 2. Windows Mobile was originally built for a stylus (remember those?), though Microsoft has made some, repeat some, progress toward implementing a touch interface. Apparently everyone has seen the iPhone commercials showing all the neat acrobatics you can accomplish with just your index finger and so all the competitors are moving in that direction. HTC clearly does not think that Microsoft has moved fast enough, and so it has introduced something they call the Touch Flo interface, which sits squarely atop Windows Mobile (aka WinMo). Because the wireless functionality of this combination is sorely lacking, my company has rightly selected a third party service called Good, which I can confidently state is anything but. Here's the problem. WinMo, Touch Flo and Good all have their specific roles. All are capable, slick bits of software code all hoisted upon the Touch Pro 2 frame. But, sometimes these particular kids don't like sitting together in the back seat of the car, and so they fight.

When I need to make a call, sometimes Touch Flo wins by making me use its visually appealing tuxedo black skin, which my index finger is happy to be acquainted with. But, and I'm not sure precisely why or when, WinMo's avocado green interface wins out, forcing me to try to use my finger, but the tiny dialogues and buttons work only if my finger was the width of a pencil tip. Enter the stylus. WinMo's core applications, which are always left standing at the altar by the favored Good applications, try so hard to get the job done. Touch Flo, thinking that WinMo is in charge, features those apps on its home page. But, that's of no use as the Good apps (requiring a completely separate and mind numbingly time consuming launch in order to access) are the only ones that synchronize with the servers at work. Oh, and web surfing? Right. Talking on the phone? Make sure your cheek doesn't rub against the phone as you'll most assuredly accidentally make the phone do something you don't want it to do. And the notifications. Yes, the notifications. Something angry pops up on the screen (regardless of whether you're actually using that screen for another purpose) constantly telling you that you're hovering near somebody's wireless network. Do you want to join? Do you? Do you? Click me. Now. Ugh.

The individual applications are all decent. In fact, they're more than decent. But it's the connection between them that is the problem. And the fact that this works for our company is testimony to the capabilities of our IT staff... who, by the way, are beginning to move us in a different direction as we speak.

***

I met Margaret in the waiting room of the cancer center where I worked. Margaret didn't mind sharing her story and I didn't mind hearing it. Margaret has had a number of health problems through the years, but none as concerning as the one she was now facing. Previously, she experienced diabetes, an irregular heart rate requiring ablation procedures, and a dizzying array of prescription medications which Margaret was increasingly having a hard time keeping straight.

Six months earlier, when she experienced a cough that wouldn't quit, Margaret was sent for some tests and ultimately the spot on her x-ray proved to be cancer. It's been a tough six months for Margaret. Two surgeries, yet more prescriptions, radiation therapy and now chemo. She has seen more doctors in six months than she had seen over the course of her earlier nearly 70 years. And it was all bewildering to her and to her family. The cancer treatments were causing dietary problems which impacted the diabetes. A new medication lowered her heart rate, causing blood pressure woes. Given her irregular heart rate, Margaret needed to see her cardiologist, though unfortunately he had recently moved to the West Coast and she wasn't as fond of her new doctor. She did love her radiation oncologist, though, describing her as "caring and very organized." Margaret's eyes watered when she told me that she brought all of her health issues to this doctor even though she fully understood that the oncologist was only prepared to deal with the tumor. "I find this all so confusing. I wish the doctors would talk to each other once in a while."

Margaret's profile and experience demonstrates the complicated nature of medical care today. Highly specialized systems of care have emerged to contend with an exponentially expanding body of knowledge about medical conditions and treatment possibilities. Unlike the local doctors who visited our parents in their homes and who could be counted on to deal with any and all situations as they arose (however superficially), today's medical response is fragmented and the various elements do not always "talk to each other"... making patients, such as Margaret, feel as they are experiencing what Dr. Gary Gibbons, Quincy Medical Center CEO, describes as "conveyer belt medicine."

You'll no doubt see that I'm drawing a parallel between today's health care system and the Windows Mobile-Good-Touch Flo saga I described above. Can an iPhone equivalent be possible here?

Well, we're getting there. Health reform will probably move us toward "accountable care organizations" designed to better coordinate the entire package of services across a wide array of providers for patients such as Margaret. The movement to global capitation will (yet again) attempt to do the same thing. Electronic health records, long the Holy Grail of health care, will also push us in that direction.

The local larger systems are working hard on this very quest. Atrius Health and its Epic system is probably closest but the Partners system is far from conceding this race. There is much talk about investing in electronic health record technology in the current reform debate and opportunities will exist for providers, technology vendors and payers to collaborate to move us closer still. But, as long as the separate parts continue to look and act like separate parts, we'll get no closer to eliminating conveyer belt medicine.

Someone will come up with the iPhone equivalent in health care. And whomever that is... will win.