2015 in review

The WordPress.com stats helper monkeys prepared a 2015 annual report for this blog.

Here’s an excerpt:

A New York City subway train holds 1,200 people. This blog was viewed about 4,700 times in 2015. If it were a NYC subway train, it would take about 4 trips to carry that many people.

Click here to see the complete report.

In My Mother’s Memory: The Usability of Digital Health Solutions

She died on a Tuesday. While my mother’s passing this summer was expected given her illness, I was still unprepared for the range of emotions that I have experienced.  Tuesday will never be the same.

As the oldest child and the family member most comfortable speaking in front of a crowd, I was asked to prepare and deliver my mother’s eulogy.  I found the main theme for this tribute in the words of Maria Shriver, a former First Lady of California and an American journalist:

Our mothers give us so many gifts. They give us the precious gift of life, of course, but they also leave treasured lessons that can guide us along our journeys even when they are no longer with us.”

My mother left me with many treasured lessons.  Her observations on nursing and the use of digital health solutions have shaped my views and influenced my digital health advocacy work.

My mother was a dedicated and caring nurse for whom nursing was as much a calling as it was a career.   She always referred to the people to whom she provided care as “her” patients.  Whenever we spoke about digital health solutions, she reminded me, often in subtle ways, to consider the needs of the people who use these solutions.

Although my mother was, at best, a computer novice, she saw the value in digitizing healthcare.  She bemoaned, however, what she referred to as the “well meaning” attempts to digitize the world in which she worked.  She often remarked that it was as if the people developing these systems “never walked the floor.”

Even though my mother retired nearly a decade ago, recent feedback from healthcare professionals regarding digital health solutions echoes my mother’s sentiments.

Earlier this year I worked with AmericanEHR Partners to analyze data from the annual AmericanEHR Survey on Physician Use of EHR Systems.  Among the various topics explored in this survey were respondents’ views regarding the ease of use of their EHR systems.

When asked whether they were satisfied with the ease of use of their EHR system, just over half (53%) of the survey respondents reported that their EHR system was difficult or very difficult to use.  Slightly more than one-third (35%) reported that their EHR system was easy or very easy to use.

One of the more striking variations in the survey data became apparent when respondents were grouped based on whether they were satisfied with their EHR system.

A significant majority (89%) of those who indicated that they were satisfied or very satisfied with their EHR system also reported that they found their EHR system was easy or very easy to use.

Conversely, for those respondents who indicated that they were dissatisfied with their EHR system, a significant majority (90%) also reported that they found their EHR system was difficult or very difficult to use.

In a New York Times commentary, Robert M. Watcher, author of “The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age”, writes:

“Our iPhones and their digital brethren have made computerization look easy, which makes our experience with health care technology doubly disappointing.”

Why do digital solutions like the iPhone or Google’s Gmail have higher user satisfaction ratings than most digital health solutions?  Many experts suggest that an intense focus on usability and user experience is one reason for this difference.

Bennett Lauber, Chief Experience officer for The Usability People, LLC, and an active member of the U.S. Office of the National Coordinator for Health IT (ONC) Policy Committee’s Implementation, Usability, and Safety Workgroup, observes:

“Usability in healthcare can be difficult to achieve … A useable healthcare system must be designed to match the mental models and workflow of its users.  A usable EHR needs to work (effective), work well (efficient), and not cause any unnecessary frustration (satisfying).”

The ONC appears to agree with the need for a greater focus on usability and the use of tools that contribute to it. Their 2014 certification criteria for electronic health record solutions includes a requirement that vendors attest to using user centered design processes as well as report on the results of their usability testing.

Unfortunately, according to a report from the National Center for Human Factors in Healthcare, many of the 50 electronic health record (EHR) solution vendors serving the highest number of healthcare providers did not meet the ONC’s usability requirements.

Using data submitted by the vendors to the ONC as part of the certification process, researchers at the National Center for Human Factors in Healthcare found that 34% of these vendors had not met the ONC certification requirement of stating their user-centered design process.

Perhaps more concerning, 63% of these same vendors used less than the standard of 15 participants during the usability tests of their EHRs while only only 22% used at least 15 participants with clinical backgrounds.  Nearly one in five (17%) vendors used no physician participants and 5% used their own employees when conducting usability testing.

Researchers commented in the report that “the lack of adherence to usability testing may be a major factor contributing to the poor usability experienced by clinicians.”

So, what happens when digital health solutions are as usable and as useful as other digital solutions? When asked by Robert Watcher what the equivalent of the “Jeopardy!” victory would be in healthcare, Eric Brown, lead engineer of the Watson Health team at IBM replied: “It’ll be when we have a technology that physicians suddenly can’t live without.”

How do you rate the usability of the digital health solutions that you use?  Are there solutions that you or your user community can’t live without?  Please share your thoughts by commenting on this blog post.



Apple Watch: 5 Second Rule

For the better part of the last two years, I have written and spoken about the Apple Watch and the related HealthKit ecosystem. A little over a month ago, in what might be best described as an overwhelming desire to “walk the talk” (or, perhaps, to put my money where my mouth is), I purchased an Apple Watch. While it is still, in many ways, an expensive tech gadget that suffers from the limitations inherent in any first-generation device, the Apple Watch offers a compelling glimpse of a future in which computers are worn as well as carried.

Check out the remainder of this article here.


Apple Watch: Transformative Technology or Passing Fad?

The following article recently appeared in Healthcare Information Management & Communications Canada, the journal of COACH, the association for Canadian health informatics professionals:

Earlier this spring (though it was to tell from the snow still on the ground) I had dinner with several stakeholders from a project on which I am currently working. One of my dining companions, it turns out, reads my columns and blog posts.

“So, what new gadget are you planning to buy next?”, he asked between the appetizers and the main course.

“The Apple Watch,” I replied without hesitation.

My dining companions did not share my enthusiasm for Apple’s latest product. Indeed, I am, at least among my friends and family, the only person with any interest in the Apple Watch.

The results of my informal poll are consistent with the results of a recent Reuters/Ipsos survey that found only 6% of U.S. adults plan to buy an Apple Watch. This same survey revealed that an additional 18% of respondents were “very” or “somewhat” interested in buying an Apple Watch while just over three quarters (76%) expressed no interest at all.

In the Reuters article in which the survey results were published, Van Baker, an analyst with information technology research and advisory firm Gartner, notes that “many potential buyers will end up holding off until the second version of the watch, likely to appear next year.”

Among my circle of friends and professional acquaintances, price and questionable value proposition were cited as major reasons for not considering purchase of an Apple Watch.

Steve Ranger, the UK editor-in-chief of ZDNet and TechRepublic, notes in a recent ZDnet article that many of these same people who see little value in the Apple Watch also stated five years ago that “they would never buy a smartphone” for similar reasons. They are, he sarcastically quips, “the spiritual descendants of the people who thought the world would only ever need five computers.”

Mr. Ranger suggests that “just as the smartphone created new needs and fulfilled them, so will smartwatches.” They are not, he contends “just a smartphone shrunk down and strapped to your wrist” but “something new and different.”

So, what is the Apple Watch’s raison d’être? According to a Wired article entitled “iPhone Killer: The secret history of the Apple Watch”, smartphone users “are subject to the tyranny of the buzz – the constant checking, the long list of nagging notifications.” Kevin Lynch, Apple’s Vice-President of Technology, states in this article that the Apple Watch is intended to provide this level of engagement in “a way that’s a little more human, a little more in the moment when you’re with somebody.”

Technology columnist Farhood Manjoo offers a similar perspective in a New York Times article in which he reviews his recently acquired Apple Watch. “By notifying me of digital events as soon as they happened, and letting me act on them instantly, without having to fumble for my phone, the Watch became something like a natural extension of my body – a direct link, in a way that I’ve never felt before, from the digital world to my brain.”

After using the Apple Watch for a week, Mr. Manjoo notes that it has the potential to “address some of the social angst wrought by smartphones.” He predicts that the Apple Watch “could usher in the transformation of social norms just as profound as those we saw with its brother, the smartphone, except, amazingly, in reverse.”

A key ingredient in the transformative potential of the Apple Watch is the manner in which Apple’s Watch interacts with the wearer. While most computers to date, including smartphones, rely primarily on two senses – sight and sound – to convey information, Apple created what it calls a “taptic engine” for the Apple Watch to deliver physical sensations to the wearer’s wrist.

Haptics, the underlying technology on which Apple’s taptic engine is based, have seen limited use in consumer devices, mainly video game controllers. Brian Hall, a writer specializing in technology and culture, offers a succinct summary of haptic technology in a recent Macworld article:

Haptic technology—haptics—uses force upon the skin to deliver real-time tactile feedback. These physical sensations are created by tiny motors called actuators. Done right, haptics can mimic the feeling of a pin prick by a wearable that tracks your blood sugar, simulate the plucking of virtual guitar strings on a tablet screen, or re-create the physical recoil of a phaser from your favorite game controller.

In this same article, Mr. Hall suggests that haptics “may prove most useful, possibly revolutionary”. He contends that Apple, “with surprisingly little fanfare” has “embraced a new user interface” based on touch.

Not everyone is enthusiastic about the potential of haptics, particularly as a notification technology. Fellow Canadian blogger Tim Wilson states in a recent blog post that “the Apple Watch sounds more like invasive nag” than a useful tool and seriously questions whether it is the “game-changer” that many people contend it will be.

Technology columnist Farhood Manjoo suggests that the Apple Watch, unlike the iPod or the iPhone, is not “suited for tech novices.” Instead, he suggests that “it is designed for people who are inundated with notifications coming in through their phones, and for those who care to think about, and want to try to manage, the way the digital world intrudes on their lives.”

Will I buy an Apple Watch? Yes, I have the same feeling about the Apple Watch as I did about the iPad when it was first announced. I think the Apple Watch is one of those devices that once you use it and integrate it into your daily activities, you will wonder how you did without it.

Are you considering purchase of an Apple Watch? Do you think that the Apple Watch is a transformative technology or a passing fad? Please share your thoughts by posting a comment


COACH Board of Directors Candidate – Shiran Isaacksz

I have posted several articles recently related COACH,  Canada’s Health Informatics Association, including one promoting the annual eHealth conference co-hosted by COACH.  In this post I’d like to draw COACH members’ attention to the upcoming board of directors elections.

As the governing body for COACH, the board of directors sets the long term vision and provides strategic direction.   Six highly qualified individuals are standing for election for three positions.    I urge all COACH members to take a few minutes to check out each of the candidates’ profiles on the COACH website and, equally important, to cast your votes before April 15th.

I’d like to introduce one of these candidates, Shiran Isaacksz.  I asked Shiran to provide a brief overview of his background and qualifications for the COACH board.  His response follows.

Shiran Isaacksz has been actively involved as the Senior Director at University Health Network for the Regional/Provincial Portfolio.  In this role, he has led the ConnectingGTA (cGTA) Program and the GTA West Diagnostic Imaging Repository Program over the past 6 years. Shiran has shown strong leadership and effective stakeholder engagement, as he leads two very complex, regional initiatives.

At the local level, he is also the Senior Director responsible for the Resource Matching and Referral initiative in the Toronto Central LHIN and he is a member of the Senior Management team at the Toronto Central Community Care Access Centre, overseeing the organization’s IM Strategic Plan.

He is known for his broad system’s thinking and pragmatic approach to move complex projects forward.  Shiran has been very collaborative in his manner dealing with many health service provides across the continuum of care, eHealth Ontario, the Ministry of Health and Canada Health Infoway.

To better understand the unique experiences, passion and commitment that he will bring as a member of the COACH Board, please visit his candidate profile on the COACH website:  http://www.coachorg.com/en/membership/Shiran-Isaacksz-2015.asp


Why I attend the Canadian eHealth Conference

As winter ever so slowly releases its icy grip, my thoughts turn not only to spring and warmer weather but also to the approaching e-Health Conference. Since attending my first e-Health Conference in 2004, this event has become a tradition that I eagerly await with nearly the same anticipation I feel for major holidays. What is it about this Conference that makes it such a “must attend” event for me?

Check out the rest of the article on the eHealth conference blog … click here


An interview with Mike Barron of COACH: A president’s prespective

This blog post contains an article that was originally published in the March 2015 print edition of Canadian Healthcare Technology magazine:


The Canadian Organization for the Advancement of Computers in Health is celebrating its 40th anniversary this year. More commonly referred to as COACH, this stalwart of the Canadian health IT sector has consistently championed the cause of digital health and advocated on behalf of the health informatics professionals who make it possible.   What does the future hold for COACH? Why should someone join COACH? I put these and other questions to Mike Barron, the current COACH president, in an interview just prior to the Christmas holidays.

Introducing Mike Barron

Ordinarily I would refer to the subject of an article by their last name; e.g. Mr. Barron. However, in this case, doing so simply doesn’t suit the personality of the man. He is one of the most affable and down to earth executives I know.   He pulls no punches yet manages not to offend, no matter how blunt his comments might be.   Mr. Barron just seems too formal and stuffy for such an approachable and friendly man. Instead, I will his first name.

I asked Mike how he ended up working healthcare. Mike explained that his first “main job” was with the Royal Commission on Hospital and Nursing Home Costs in the mid 1980’s.   Two years later, he moved to the General Hospital Corporation in St. John’s to take on the Director of Information Systems. This role, he explained, introduced to him to the “complexities of healthcare.” It was, in Mike’s words, a “rewarding yet challenging” assignment.

At the turn of the century Mike joined the Newfoundland and Labrador Centre for Health Information (NLCHI) during what he referred to as their “early days.” In 2006, Mike was appointed NLCHI’s CEO.

Given his rather demanding job, I asked Mike why he devotes time to COACH. He explained that when he first joined NLCHI, Canada Health Infoway in its formative years and he was involved in various federal / provincial / territorial (FPT) committees. These committees gave him a “taste of national vision and leadership.”

Getting involved at the board level at COACH was a natural extension of his other national roles. According to Mike, it gave him “an opportunity to participate in an organization outside government” that involved both public and private sector organizations.

Mike has devoted his working career to working in the health sector. Healthcare, Mike observed, is “something that glues us together as Canadians besides hockey” and is subject about which he is unabashedly passionate. His involvement in COACH provides him another outlet besides NLCHI to feed this passion.

COACH’s Role

When asked how COACH fits into the complex Canadian digital health ecosystem, Mike replied that it is the “glue for the health informatics environment.” While COACH is not, in Mike’s words “a one stop shop”, he does feel that it is, “a place where people from different communities can gather.”

Some people with whom I have spoken wonder how COACH is different from HIMSS, an organization with Canadian chapters that is also focused on digital health. Mike pointed out that COACH “offers more accessibility and more meaningful engagement.” While HIMSS supports a “largely private sector constituency, COACH “brings together public sector necessity and private sector reality.”

Some people have suggested that there might be economies of scale to be gained by combining COACH and ITAC Health to create the Canadian equivalent of HIMSS. I asked Mike what he thought of this suggestion. While he did not rule out the possibility in the longer term, he felt that it was important to recognize that “in the current environment, we need to ensure that we don’t lose sight of the constituencies that these groups represent” as well as “the contributions that these associations offer today.”

Mike pointed out that many of the same benefits attributed to the merging of two organizations could also be achieved by partnering. He pointed to collaborative efforts with ITAC Health and CHIMA as examples. “As Canadians, we are not predatory in nature,” Mike noted. “Partnerships are often a preferred model.”


According to Mike, membership has remained stable between 1,400 and 1,800 members. HIMSS, by comparison boasts 52,000+ members. It never ceases to amaze me how many people in the Canadian digital health community have opted not to join COACH.

I asked Mike about COACH’s plans to grow membership, a stated objective in their 2014-2017 strategic plan. He replied, “You don’t need numbers to denote success.” Instead, COACH is striving to “balance quality and quantity.” He went on to say that COACH is looking for “engaged members” who can “carry the message into various areas of the health system.”

So, why should someone join COACH? Without hesitation Mike rattled off a number of reasons, all sharing two common themes. First, COACH is one of the most effective ways for anyone with an interest in digital health to broaden their horizons. COACH, Mike observed, offers “exposure at very low cost to an extensive knowledge base” and “provides information about and exposure to different areas of health informatics.”

Second, COACH offers an opportunity to become a more active participant in the healthcare system and to join, as Mike describes it, “a complete national network of very bright and experienced healthcare professionals.”

Annual eHealth Conference

For many people, the COACH brand is most closely associated with the annual eHealth conference co-hosted by COACH. Over the past few years both revenue and attendance have declined leading some people to question the conference’s relevancy. Mike acknowledged that there is a “need to make it more applicable and attractive” but also asserted “as a conference it will remain relevant by sheer nature that it is the only national conference.”

While there are factors such as travel restrictions over which COACH has little control, Mike was emphatic that the annual eHealth conference is an event to which COACH is committed. He spoke about a number of ideas for refreshing the annual eHealth conference, starting with a “need to embrace youth.” According to Mike, COACH and its partners are “concentrating on bringing value and entertainment” and striving to “make the conference a more diverse experience.”

On a Personal Note

I closed up my interview with Mike by asking about his personal goals for his two-year tenure as COACH president. He told me that he had two goals. First, he is “very much into strengthening COACH as a sustainable entity” which, he said, was a natural extension of his involvement in the business side of COACH for many years. His second goal is “to reach out to the youth element.” He wants to create a critical mass of members under 40 years old to “carry the torch” after he and other long-time members retire.

As we concluded the interview, we spoke briefly about his life outside work. I learned that his favourite movie is any of the The Godfather movies.   According to Mike, “you can always use a quote from the movie.”

In Summary

I always enjoying speaking with Mike and my interview was no exception. As a ten year COACH member I was more pumped and enthused about COACH than I have been in a long time.

Are you a COACH member? If so, why? If not, why not? Drop me a line at michael.martineau@avenant.ca comment on my blog posts on this topic at eHealthMusings.ca.