Contemporary Issues in Medical Informatics: Good Health IT, Bad Health IT, and Common Examples of Healthcare IT Difficulties
New technology under tinkerers: how one person can impair progress for entire organizations

New technology under tinkerers: how one person can impair progress for entire organizations

This story comes from a major U.S. academic institution. The informatics director, a tinkerer and bully with major political connections, usually got his way at a major academic teaching hospital. The director believed himself an expert on all aspects of computing and communications.

The director was asked to perform a demonstration to V.I.P.'s of voice and visual communication for telemedicine applications over the campus computer network. This person knew there were experts on staff in telecommunications and in this area in particular, including an informaticist on his own staff with significant amateur radio expertise, including slow-scan and fast-scan television.

Rather then engage these individuals and share the spotlight, this director created a demonstration without such expert assistance. Small cameras were hooked to two computers, one in the campus library where the demo was to be performed, another in an office across campus. Simple communications software was installed. Minimal testing was done since "unless the network was down, nothing could go wrong."

At the demo, the software was started while a dozen or so senior leaders in the organization observed. The first few moments went well, with the director in the library talking to his wife in the office across the campus. However, the demo was performed in the early afternoon, during a time of peak network traffic. Network delays started to cause pauses in transmission and reception. When it appeared one party had finished speaking, the other party would begin, only to be interrupted by the completion of the first party's transmission.

These "packet collisions" continued for several minutes and made meaningful communication of even simple information difficult and frustrating. The assembled V.I.P.'s got a very bad first impression of this technology, and first impressions are very, very important (especially with non-technical people who are responsible for funding of new technologies).

At the wrap-up discussion of this demonstration, the embarrassed director-tinkerer concluded that the technology was immature and may not yet be ready for fruitful use until higher network speeds were available. This discouraged those in the audience who hoped this would be a good technology for medically-underserved areas in the poorer rural communities of this state.

The informaticist amateur radio expert in the audience begged to disagree and stated that a simple communications protocol could suffice to facilitate use of the technology, even under heavy traffic situations. He explained that a mutually-agreed upon protocol of saying "over" (or similar acknowledgment) to signal the end of a statement would be a foolproof mechanism to prevent collisions.

The director responded in a sarcastic manner that this was a 'ridiculous idea', that he would never say things like 'roger, over', and that others would feel the same way in the age of fast communications. The amateur radio enthusiast replied that this was not the case. He pointed out that radio operators had been using such protocols for almost a hundred years, especially with Morse Code or any form of half-duplex communication such as radioteletype or voice. A senior member in the audience, the medical school educational computing director, agreed with the radio expert about this, himself knowing a bit about telecommunications, but the audience still left the demonstration quite disappointed.

Unfortunately, the amateur radio expert was to learn the problems with challenging someone politically well-connected, and not surprisingly no longer works for that organization.