What if hospitals were run by Apple

The experience of presenting to the Apple Store Genius Bar might carry some important lessons for hospital workflows. Martin Seneviratne explains why.

I recently had a technical problem with my Mac computer. It had been gradually slowing down and then one day it simply refused to turn on. The little spinning wheel just kept spinning ad infinitum. I consider myself to be reasonably tech savvy, so it was with a hint of defeat that I paid a visit to the Apple store.

After booking the appointment online, I arrived to be greeted by the iPad-wielding store managers, who directed me to a back desk where I would be seen by one of the Apple Geniuses. Meanwhile, they logged the serial number from underneath my computer to get a full record of exactly where that computer was sold, when it had been repaired, what Apple user IDs were associated with it. All of which appeared on my Genius? iPad when he arrived to help us.

The Genius turned out to be quite an eminent diagnostician. He took a history of the problem, asked about any previous issues I had experienced with the computer, and then began a very methodical series of investigations. He ran a script to check the integrity of the hardware, used an algorithm to detect logic errors in the software, checked the most recent internal error logs. The conclusion - a fatal software problem requiring a full reboot of the operating system.

At each step, he documented his findings in an electronic pro-forma built into an iPad app, which in the end generated a full report of the encounter for upload to Apple?s international database. Before he rebooted the system, I had to sign (with my finger on the iPad) an automatically-generated consent form. And when I left, with a software-refurbished Mac convalescing under my arm, I was emailed a complete summary.

At each step, he documented his findings in an electronic pro-forma built into an iPad app, which in the end generated a full report of the encounter for upload to Apple?s international database.

It struck me afterwards how medical this whole experience had been. My computer had basically come in GCS 3 on a background of chronic dementia with an acute deterioration. There was triage, investigations, diagnosis, intervention. And finally the computer was discharged. Yet it was all done with a level of slick technological efficiency that I had never seen in a hospital before. So the question naturally occurred - what if a hospital was run like an Apple store?

There are three aspects in particular of the Apple model that would be interesting to imagine in a healthcare context:

  1. Bedside technology: In most hospitals, the average morning ward round could benefit significantly from some technological support. Currently so much time is wasted juggling different charts, deciphering illegible handwriting, running to check information on the computer. What we need is an iPad app with centralised patient information and a pro-forma interface for formulaic tasks like recording vitals, reporting examination findings and charting medications. This is precisely what Apple has already developed for computer maintenance.

  2. Electronic records: Apple gives us aglimpse of what centralized e-health records might one day be. It has a global database where both devices and consumers are tracked with unique IDs, and information is synchronised across every Apple store internationally. That being said,concerns have been raised about the quantity of personal information held by Apple and the privacy regulations protecting it.

  3. Staff training: Apple can monitor the time and outcome of each Genius consult and thus track the performance of each employee. This may seem overly intrusive, but imagine the potential efficiency gain if medical consults were electronically tracked and collectively analysed.

Of course, we cannot model our entire healthcare system on an Apple store. There would not be very good patient follow-up, no personalised healthcare, and we would only treat people if they were still under warranty. And the hospital gift shop would have to expand considerably.

However, by leveraging technology to streamline routine tasks, Apple have designed an amazingly efficient ?computer healthcare? system from which the medical world can learn some valuable lessons.

The old mantra an apple a day keeps the doctor away almost implies a rivalry between doctors and apples. In fact, there should probably be more crosstalk.