The Uncanny Valley

As the new calendar year begins, Serendipity Health and I wish you and your family a happy, healthy 2010. At the same time, we thank you for being a part of our growing community of professionals interested in learning more about how health information technology can be leveraged. 2010 promises to be another important year in advancing technology to improve our overall healthcare system, and we look forward to continuing this journey with you and providing all the vital information you need to know.


I had the opportunity to see what is dubbed the most expensive movie ever made; Avatar which takes you to a spectacular world beyond imagination. James Cameron first wrote the script over a decade ago and tried to make the movie in 1995. He found that the technology did not exist to do what he wanted. Therefore, he patiently waited a decade until 2005 when it appeared more promising. In 2005, he started to try again and even invented a new performance capture technology to cross what is called the uncanny valley. James Cameron needed to make sure that his new technology could cross the chasm, known in robotics and animation as the uncanny valley. James Cameron worked with the best animators in the world and the movie has now reached over a billion dollars in sales.


Over the past 19 years of my career, I have experienced similarities with our healthcare reform. As we begin a new year, and as we contemplate our resolutions for 2010, let’s take a look at a few predictions from the past that led to innovation.


• In 1876, American president Rutherford B. Hayes told Alexander Graham Bell: “The telephone is an amazing invention, but who would ever want to use one?”


• In 1873, Sir John Eric Erickson, the Surgeon-Extraordinary to Queen Victoria, said: “The abdomen, the chest, and the brain will forever be shut from the intrusion of the wise and humane surgeon.”


• In 1949, mathematician John von Neumann said: “It would appear that we have reached the limits of what is possible to achieve with computer technology.”


Many inventions have taken several centuries to develop into their modern forms and are rarely the product of a single inventor's efforts. Every breakthrough is a collective effort that combines and tweaks already existing ideas and technology in novel ways. As James Burke said; “The easier it is to communicate, the faster change happens.” In 1985, Burke produced a 10-part series The Day The Universe Changed. Burke worried that computing and communications would increasingly be in the hands of expert elite, in the closing scenes of The Day the Universe Changed he instead suggested that a forthcoming revolution in communication and computer technology would allow people all over the world to exchange ideas and opinions instantaneously. With the launch of Microsoft’s first version of Windows 1.0, on November 20, 1985 and other subsequent events, such as the rise of popular access to the Internet, suggest he had been correct.


Inventions only become successful when they are not only needed, but when mankind is so far advanced in intelligence as to appreciate and to express the necessity for them, and to at once make use of them. Each invention may be just one small step on the road to the ultimate goal. I feel we must take baby steps, always moving toward our goal of interoperable health care. I agree with James Burke that the easier it is to communicate, the faster change happens.


Our nation is at the forefront of aligning the stars with monetary incentives to stimulate the adoption and meaningful use of the Electronic Health Record (EHR). The Health Information Technology for Economic and Clinical Health (HITECH) Act provisions of the Recovery Act of 2009 create a historic opportunity to improve the health of Americans and the performance of the nation’s health system through an unprecedented investment in health information technology (HIT). This initiative will be an important part of health reform as health professionals and health care institutions, both public and private, will be enabled to harness the full potential of digital technology to prevent and treat illnesses and to improve our nation’s health. The HITECH grants are specifically designed to work together to provide the necessary assistance and technical support to providers, enable coordination and alignment within and among states, establish connectivity to the public health community in case of emergencies, and assure the workforce is properly trained and equipped to be meaningful users of EHRs.


Meaningful Use has been a long time in the making, as those who have been in this industry as long as I can recall. I remember being required to read the Institute of Medicine’s (IOM) report entitled Crossing the Quality Chasm: A New Health System for the 21st Century while working for a major EHR vendor in 2001. The report stated that Americans should be able to count on receiving care that meets their needs and is based on the best scientific knowledge. The formation of the Committee on the Quality of Health Care in America in June 1998 set our nation on the decade-long journey. They were charged with developing a strategy that would result in a substantial improvement in the quality of healthcare.


I know there are still gaps and obstacles ahead as not all stakeholders are incentivized to make the necessary changes to allow ubiquitous communication. A well respected friend and colleague of mine, Wes Rishel explained some of the pitfalls in his blog recently. I am hopeful that he is right in his statement that

“We expect that the incentive-bump will create a ripple of adoption of interoperable HIT. We hope the ripple will be a good-sized wave.”

Being an eternal optimist, I expect that this “good-sized wave” will carry us across the uncanny valley we are facing right now.


I continue to be inspired by ongoing work with members of Integrating the Healthcare Enterprise (IHE), who I have worked with for the past decade to profile many of the infrastructure standards to carry us along this wave. With the Healthcare Information Technology Standards Panel (HITSP) adoption of many of these standards, our nation now has a framework that will enable vendors and other stakeholders to start collaborating in new and innovative ways. I am further encouraged by those who are well on their way and will be showing meaningful use sooner rather than later as reference by another friend of mine John Halamka, in his blog this week. I am excited to see what innovations will come in the next decade of my career as I help stakeholders navigate the waters while riding the wave to help deploy connected healthcare with my friends and family close by.