Contemporary Issues in Medical Informatics: Good Health IT, Bad Health IT, and Common Examples of Healthcare IT Difficulties
Disrespect for the needs of clinicians: platform bias taken to an extreme

Disrespect for the needs of clinicians: platform bias taken to an extreme

An informaticist who was consulting with a large east coast hospital was called by the Chairman of the Department of Medicine about a very frustrating problem that had been ongoing for about two years.

The Chairman was not knowledgeable about computers but had purchased a home Apple Macintosh computer several years before to perform useful tasks such as word processing and medical information searches. It was a PowerPC-based unit, which he thought was handsome and fit well with his home decor. (Perhaps even more importantly, it had obtained spousal approval.)

The MIS department of his hospital had adopted a strict "PC only" rule, however. All connections into the organization, whether to the mainframe or other GUI-based clinical applications, were via PC-based terminal emulator software or winframe applications.

The Chairman of Medicine liked the Mac at home and did not want to install a second computer, a PC, into his home for hospital connectivity. The MIS department "did not do Macs" and therefore would make no attempt to look for Macintosh applications or emulators that could allow this physician to connect to the hospital network. MIS leaders told senior executives that making the Chairman's Mac connect to the hospital network was impossible. They would not even touch the Macintosh. Stalemate.

The Chairman had, on his own, obtained a PC-on-a-board for the Macintosh from a well-established third-party vendor, Orange Micro, but did not have the experience to install it. The MIS department was adamant that this could not work, that any PC emulator would have bugs, that it could not reliably run the PC software used for hospital connections. They refused to assist the Chairman of Medicine install his purchase. This was certainly not good for intercultural relations between MIS and the clinical staff. The Chairman turned to the informaticist for assistance.

The informaticist, not being a platform religionist, was proficient with both the PC and Mac platforms and the third-party add-on. He explained to the MIS department leaders that the add-on board was a complete PC, with its own Intel CPU, memory, serial ports, etc. running native Windows. The Macintosh would just share the keyboard, disk drives, and cabinet, and that this board would turn the Mac into a true PC when it was operational (a "MacCharlie", to those who remember the mid-1980's). The add-on was an industry standard itself and would convert the Chairman's Macintosh into a 'PC living in the Mac box', he said, with a great chance of success in running the needed telecommuniations software.

The informaticist stated he was going to attempt to install the third-party board and wanted MIS support. The MIS personnel remained adamant. They felt such a contraption could never work, that a Mac would not be compatible, that even if it were a "PC in Mac clothing" it was not the Standard Vendor Brand PC they utilized exclusively, that they don't support Macs. MIS still refused to touch it, as if it was a heresy. In fact, they never researched the third-party add-on board, showing one basic difference between clinical and MIS culture. Clinicians are used to researching new potential clinical tools and treatments.

MIS somewhat sarcastically wished the informaticist luck, and hoped it "all worked out." Behind the scenes, as the informaticist discovered, the CIO ridiculed the informaticist to other senior executives, wondering aloud where the informaticist "gets the time" for such adventures. The informaticist could not fathom how assisting the Chairman of Medicine in such a basic need could be trivialized in such a manner and obviously felt such behavior highly inappropriate.

This behavior is symptomatic of irrational thinking. The Chairman of Internal Medicine is an absolutely key leader in the difficult cultural transition of a hospital's physicians to electronic medical records, computerized order-entry, etc. The undivided support of such key medical leaders is absolutely crucial. This CIO represented himself as a religiously-devout person who nonetheless took pride in admitting his work-world philosophy came from the ancient Chinese book "The Art of War", perhaps indicating an ability to rationalize that tragically exceeded by a wide margin the ability to think rationally.

The informaticist installed the new board into the Macintosh, installed MS-Windows, and had the communications software installed and operational in a few hours. The MacCharlie was now able, with a single keystroke, to appear as either a Macintosh or a fully-functional PC. Compatibility with the communications software was not an issue and the Chairman now "had his cake, and could eat it, too." So ended several years of frustration for the Chairman.

The only gratitude received by the informaticist was from the Chairman of Medicine, although other executives in the organization (acclimated to an MIS culture representing computers as mystical) thought of this trivial, teenager-level accomplishment as something of a miracle.