- Max Planck
The Philosophy of Physics, 1936

Much has been said in the short time since the much-hyped launch of Apple’s new iPad. Most of the analysis from the Geek-aratti seems to suggest disappointment and underwhelmed comments such as “it’s nothing new” & “Apple has failed to deliver on the hype”. From jokes linking it’s name to feminine hygiene products to rants about it’s lack of features being an Apple-led planned obsolescence conspiracy.

Of all the criticisms, the one that perplexes me the most is the one claiming that because the iPad is purely an oversized iPod touch it has nothing new to offer.

However, in the healthcare setting, and no doubt numerous other settings also, those added inches make a significant difference. With a larger screen the ease of use and stylish user interface previously associated with the iPhone will pave the way to long awaited change in the use of such devices in healthcare settings. Previous iterations have failed for various reasons, including cost, weight and poor interoperability.

The indicative cost of the iPad at less than $1000 will address some cost issues. It’s typically Apple-elegant form and weight of less than a kilo should overcome the bulkiness and clunkiness objections.

Without question, iPad apps accompanying the myriad of iphone apps will quickly come out of the woodwork over the next 6-12 months. Many of these apps will no doubt service the healthcare sector.

Accompanying these predictions of software apps should also spawn a whole range of hardware modifications, new accessories and devices for the conduct of all manner of investigations, assessments and communications either plugged directly into the iPad or via bluetooth.

In view of the sorts of healthcare environments these devices will find themselves I certainly hope robust protective casings that can be easily sanitised will be developed as well as harnesses or adaptor kits that will allow easy portability, accessibility and use of both hands to type.

For change to occur and mass adoption to take place, timing is everything and with e-Health being on the forefront of many health reform agendas globally you can’t help but think the iPad (despite it’s flaws) is positioned perfectly to act as a timely change agent in an industry that has never fully embraced tablet technology before.

This final point is the most important reason why I believe the iPad is such an important development for the healthcare sector. It is this point which appears to be under-recognised or missing in most commentary I have seen thus far.

Tablet computing in healthcare will happen, it’s a matter of whether the iPad will be the device to herald in a new era of adoption of the technology or whether it will be another more fully featured device. One can only hope that Google’s undoubted response won’t be called the “Paddle One”.

- Star Trek Voyager

The advent of technology has created efficiencies and remarkable tools allowing us to diagnose and treat all manner of health problems like never before.

Human nature and the reductionist agenda of efficiency-driven health bureaucrats and capitalists will always look to automation to improve productivity, reduce errors and costs. So is there a place for doctors in the brave new world of technology driven health care?

If science fiction is any indication we will either be looked after in the future of healthcare by robots or computer-generated holograms.

If the role of doctors is merely to process informational inputs and communicating and executing algorithmic outputs then I suspect it is game over. In the early days of chess playing computers, Grand Masters boasted that computers would never defeat the best human opponents and for the best part of three decades they were proved correct. The first crack emerged however, in 1996 when IBM’s Deep Blue computer defeated the then reigning World Champion Garry Kasparov.

The “gestalt” or gut feel so highly prized by human physicians born out of the human brain’s incredible ability for pattern recognition is still a function of complex and numerous neural connections. So it is only a matter of time that the complex diagnostic algorithms and numerous evidenced-based guidelines associated with healthcare will be mastered by technology.

Our ability to execute treatments has already been met by robot-driven surgery and there has been much talk of nanotechnology bots being used for targeted therapy. So in light of all this, what then, if any, will be the role of human doctors?

I believe that the future of human doctors will be to act as the soft, user interface of technologically driven tools. You see the answer to our question lies not in the potential of the technology but rather the preferences of the patient. For the same reason people hate automated telephone systems when they have a problem or complaint there is still something comforting in dealing with another human being. In times when the medical odds are stacked against us we are looking for discretion and not rigid protocols. We want warmth, compassion, hope and optimism; qualities not currently widely associated with “technology” or at least not yet anyway!

At the end of the day human beings are a social species and in times of distress, dis-ease and dis-comfort no one wants to feel alone even if you have access to the best technology can offer.

The potential for many health innovations seem tremendous, yet why has there been such a reluctance and slowness to adopt them. The long awaited movie Avatar serves as a fitting metaphor for the health innovation agenda in many countries.

By all accounts Avatar’s director, James Cameron, had a vision of a cinematic masterpiece which by any standard was ambitious and risky. Making this project the more difficult was the missing technology and know-how to make it happen. It says a lot about the individuals involved in any long-term endeavour to stay the course in the face of uncertainty and adversity. Never more true is this of health innovation, which in the case of eHealth and biotechnology innovations involve significant capital investment and long development and validation times.

It takes vision, leadership and the willingness to commit to the process in the firm belief that something tremendous and worthwhile is being created. The question is whether some of these innovations are really worth the wait. Is the hype justified? Certainly for projects such as the movie Avatar the end result has been a triumph of the “unreasonable man”.

The conservatism in health care to embrace change and progress is well documented. It is almost as if progress happens inspite of the medical establishment. I believe the hammering of medical students and doctors in general to follow guidelines and well-worn algorithms under the guise of “evidence-based medicine” has its limitations when it comes to innovation. It never ceases to amaze me how we often choose the brightest and the best of the education system to enter medical schools around the world only to turn these bright minds into unthinking, uncreative automatons.

Of course no one wants a maverick clinician. However, once in awhile it is exactly these “maverick” clinicians that whilst taking fire from colleagues for years eventually discover a Nobel Prize winning breakthrough or continue to save lives when others have given up. Let’s not be naïve, not all “mavericks” are altruistic and misunderstood geniuses. However, not all of them are crackpots or dangerous rogues either. The question is how do we separate the “unreasonable man” from the “maverick”?

I believe the answer to this question in part lies in changing the culture. By encouraging all clinicians to undertake more teaching roles and engaging in research, creates a cultural norm of inquiry and valuing innovation. It is well known that groups lauded for their innovation, like Google and 3M, allow their employees time, resources and latitude to explore personal ideas. Why shouldn’t we do the same at the coalface of clinical medical practice?

Most clinicians are so bogged down in seeing the tsunami of patients and completing the ensuing paperwork that little time is devoted to reflection or creative pursuits. Building teaching and research into professional development is an ideal method of doing exactly this. I’m not talking about research in the esoteric, navel gazing sense as is sometimes associated with certain academia. I’m talking about formalised think-tanks of grassroots clinicians, within medicine and inter-professionally, grappling collectively with clinical conundrums, big picture challenges and having the latitude to explore potential solutions without being pilloried as misfits or worse still, criminals.

We need visionaries, we need leadership and we need courage to negotiate our way through this brave new world of health progress, never forgetting the centrality of the patient’s welfare in all that we do. However, let’s not ignore or forget the critically under-developed and under-appreciated resource of “unreasonable” people forming the “grassroots” of the healthcare industry. We will get more innovation and less angst if more was invested in nurturing this vastly untapped resource.