Looking for the Future in the Past

I don't get smartwatches.

Yes, I know; they're all the rage.  Apple unveiled its Apple Watch earlier this month, to generally good if not entirely ecstatic reviews.  Not to be outdone, Google announced a collaboration with TAG Heuer and Intel for a "Swiss Smartwatch."   Samsung and Sony are close behind with their own versions, and new players like Pebble Time are also throwing their hats -- or, rather, their watches -- into the ring.

Poor Fitbit, which held the early lead in wrist wearables, is now desperately trying to broaden its product line, including the new Surge.  They must feel a little like Garmin or Nikon did when mobile phones began to incorporate GPS tracking and digital phones, respectively, especially after Apple kicked them out of is stores.   Then again, Fitbit snubbed Apple's Healthkit first.

I have to wonder why the focus on the wrist.  It isn't the ideal place to track, say, your heartbeat, your sleep, or your steps, and as a result fitness trackers have been faulted about their accuracy.  Cramming features into a smartphone makes some sense, because they have become so ubiquitous, but I'm not sure who is clamoring to add more features to a watch.  Weren't they supposed to be on their way out just a couple years ago, especially among the younger generation?

The idea goes back to at least Dick Tracy's watch, which was already old when I was young (and that was a long time ago...).  Heck, they're making/remaking movies out of about every comic book hero, but I don't see any call for a new Dick Tracy movie.  Supposedly just for his watch.

We spent the first few generations of cell phones trying to make them smaller, and in the past few years have been reversing that trend, to the point where the distinction between a large mobile phone and a small tablet have become trivial.  Now we're trying to put more information on watches whose faces are even smaller than cell phone screens used to be?  This is progress?

In an so-to-be era of The Internet of Things, in which virtually anything can be a sensor or even a computer, are watches the best device to be either?  It's as if Timex and Casio, not to mention TAG Heuer, are conspiring to create a demand so that they don't go the way of Kodak.

Now, I have to admit, when mobile phones first included cameras, I was skeptical, so perhaps I'm similarly just missing the wow of the smartwatch.

It's not that I think they are a bad idea.  If you want to wear one, more power to you, and I hope it helps you with your health goals.  My problem with them is that I think they are an example of our trying to create the future by looking in the past.  PCs, laptops, and tablets are other examples.  They're very sophisticated and grow ever more powerful, but have we seen any ideas for them that Alan Kay or Doug Engelbart didn't propose over forty years ago?  Or, to use a more familiar example: I know Star Trek: The Next Generation was set in the 24th century, but it was filmed in the 1980's, and its fans are  convinced the iPad borrowed a lot of features from STNG's tablets (just as the 1990's flip phones supposedly were inspired by the communicators of the original Star Trek).

Shouldn't we be developing truly new technologies and uses for them?

I can't help but think about EHRs in this context.  Health care providers insisted on being subsidized for what would be normal business process improvement investments for any other industry, and settled for technologies that weren't what they really needed.  What we got for all the federal spending were products that physicians don't really like, that more often hinder than help with patient care, that patients rarely have access to, and that can't easily share data.  They, and especially their interoperability, were supposed to lead to better patient care and reduced costs, but those promises haven't been realized.

A new study in the Journal of the American Medical Informatics Association  suggests that, at least when it comes to PCMHs, we may be working from the wrong health IT toolbox.  We need tools that are more collaborative, more interactive, and more proactive.  Our provider-centered EHRs aren't cutting it.

Congress is already starting to ask what it has gotten for its $35b HITECH investment, even holding hearings to demand answers.  Yes, sure, some of this is partisan bickering, a way for Republicans to take potshots at an Administration-led initiative, but EHRs used to have bipartisan support and now have fairly bipartisan disappointment.

We don't even have an agreed upon way to figure out if providers have the same patient, much less share their data about that patient.  CHIME just put out a $1 million prize to someone who can solve this problem.  The financial services industry solved similar customer-identification problems decades ago, without prizes or government mandates.  They did it because it made business sense.

Not so in health care; not yet, anyway.

In theory, that kind of change will happen once we make that big move to "value-based" care, but as long as our baseline is our current level of spending, I'm skeptical.  We need approaches that attempt not just to reduce increases in spending but that aim to take big chunks out of spending.  There's no shortage of waste, duplication and unnecessary care that could be eliminated, not to mention the huge saving opportunities in keeping people healthier in the first place.

Smartwatches, EHRs, or proton beam therapy, to name a few examples, are not likely to help accomplish that.

Readers of previous posts may remember that I am fascinated by virtual reality, holograms, and artificial intelligence (yes, I realize that they, like tablets, also were featured in various Star Trek series; what can I say; I'm a sci-fi geek).  I want to see those kinds of new technologies in health care, not a smartwatch.  Technologies that help change how we think about "health" and how we treat problems with it.  I challenge health care technology gurus: show us something not just that we haven't seen before; show us something we hadn't even thought of before

As Alan Kay famously said: "The best way to predict the future is to invent it."