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Friday, June 19, 2015

Remember When?

Remember how almost nobody had a PC, and now everyone does?  Remember how nobody had a word processor or spreadsheet, and now everyone does?

How many of you remember what it took to install an interface card in an IBM PC or compatible system?  You remember jumpers, IRQ settings, port addresses?  Do you remember configuring drivers?  And then the various changes to the technology came along, and after a few years, we just plugged it in and it worked.  Well, mostly.  Some cards didn't live up to the standards.  Some had some configuration jumpers for different features anyway.  And some pairs of cards just wouldn't work together anyway.

Do you remember what it was like in the days of setting up printers with your favorite word processor?  Especially when it needed a custom driver?  And then, when Windows came along, we no longer had to configure every application, but now we needed to install a driver from the manufacturer for our printer when we hooked it up?

And then Windows 95 came along and got rid of all of that with Plug and Play.  Well most of it.  OK, some if it.  And it got better over time.

And cables? Remember having to build serial cables?  Or getting long parallel cables.  Now we have USB, or even WiFi and BlueTooth.

So, now, you can just plug something into your PC, and it works, mostly.  Drivers are automatically installed, downloaded or even updated over the Internet.  How long did that take?

Let's take a look why don't we:

The IBM PC was Announced in 1981
Windows 3.0 was Announced in 1990
Plug and Play came with Windows 95
USB 1.0 was announced in 1996 but didn't reach general adoption until USB 1.1 in 1998
WiFi came out as 802.11a in 1997, but it took 801.11b in 1999 before it became widely adopted, and then the WiFi Alliance was born.
BlueTooth showed up at the turn of the century.

These days, nearly 35 years later, you just plug it in, and it works. Well, mostly.  Sometimes you still need to deal with those crap consumer driver disks that the manufacturers like to give you for home use products.  And sometimes it still doesn't work.

Some of you reading this blog never had to deal with this OLD stuff, it was simply before your time. But for those folks in DC that think major technology advances happen in 3-5 year increments, I wish they'd think back to the days before the Internet, and remember how long ago that was.  It didn't happen overnight.  A baby born on the day the IBM PC was announced is barely old enough to hold office in congress, but still isn't old enough to run for President.

Yes, we've all got a long way to go for Interoperability in healthcare.  But at the same time, we also aren't in the enviable position of having only two or three vendors near monopolies on the applications and platforms to choose from (and get to adopt the standards). No, it's more like two or three thousand vendors, and the standards that I'm referencing are about 3-4 layers higher up on a stack of standards that got us where we are today plugging in a printer.

When's the last time someone just connected major infrastructure components in any business's enterprise with the expectations that some have put forth in Healthcare?  Never. Think about it. What other industries technology infrastructure has received so much attention?  Forget banking.  Anything that requires nothing more than a 2400 baud modem to communication a single transaction isn't on the same footing as healthcare.  If you have to ask why this is so, you probably aren't qualified to be making major decisions about technology infrastructure.

So, do me a favor Senators, get out of my way and let me work.  I get the need, and unlike many, I actually know what to do about it.

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      Agreed that most technological changes have a popular reputation as happening much faster than they really do. Social and cultural changes take about a generation _regardless_ of how whiz-bang-ariffic the hardware is. Notice that teenagers and other youngsters have been fleeing facebook for years. Not simply a parallel to the myspace collapse, but they'd rather live lives worth posting about, an then not bother posting. Google's attempt to create an interoperable records system has clearly flopped, but the reportage on the process is ... of a crappily low sort of quality vis-a-vis depth and incisiveness. Raising the question, though: are superbly well-integrated database records of valuable information anything other, in the end, than gold nugget hacker bait? Computer Security shouldn't be political either, in re your lament above regarding healthcare records infrastructure, but it is as well. Add to that the inherent difficulties theoretical (the math), practical (writing secure software), and pragmatic (making people act right and install and use the stuff).

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