The Skeptical Convert 2/20/13

Angry Birds vs. The Fruit Altimeter

A man’s reach should exceed his grasp, or what’s a metaphor? Marshall McLuhan

I love a good metaphor as much as the next wetware-based concept processor, and Jonathan Bush’s labeling of Epocrates as “Angry Birds for healthcare” was a particularly clever one. But is it a useful one?

I was an early adopter of Epocrates on my Palm III (now bricked, and yes, there I go) and it quickly became indispensable in my everyday professional activities. For decades before, the only way to look up a drug information you didn’t have memorized was to haul up your giant copy of Physician’s Desk Reference and tediously turn pages. 

What you got there was a small-print version of the complete prescribing information, with every lawyer-generated factoid laid out horizontally. Useful things like the, uh, dose were hidden deep inside somewhere. So yes, I get the metaphorical point — quick, intuitive, easy to use, everything you need right there.  

The difference between Epocrates and Angry Birds, though, gets to the fundamental reasons for their popularity. The actually better comparator for the avian slingshot game would be Windows Solitaire. Because in both cases, new operating system technology required the use of new tools and/or techniques for on-screen manipulation, and both applications made learning of these techniques fun, although in both cases, unfortunately, time-wastingly addictive. Nobody sits for hours mesmerized by ePocrates. But that’s because Epocrates wasn’t about technique, it was about information.  

Which gets to that other metaphor you hear so much, the one about the tree with the fruit on it. We speak of “going after the low-hanging fruit” as an opportunity to get or accomplish something worthwhile and/or profitable with a relatively low level of effort. In this context, I suppose you can argue for applying that metaphor to Epocrates.

For the practitioner, drug information was well up in the middle of the tree, not difficult to understand per se, but difficult to reach. Epocrates put that information in your pocket and organized it the way a doctor thinks. Most drugs you prescribe are not new to you, but you need to check the dose quickly, or the pregnancy warnings, or answer a question about side effects. They organized perfectly for that, with categories that were clear and logical for us. At a basic mechanical level, they made it lower-hanging fruit for the doctor, which made it worth so much to Mr. Bush.

But there’s another side to this.  I doubt that the fruit was hanging quite so low for the developers. I’m sure designing the program, writing the code, and debugging it took a lot of work. I don’t know how much effort it was to take existing data and put it into a format that could be used by the new app. But the information had been digitized already, and to the practitioner it seemed like everyone else had digital access to it and was using it against you — the outside pharmacist telling you you wrote it wrong, the hospital pharmacist telling you it wasn’t on the formulary, the benefits person saying it wasn’t covered. Endless pages. They were throwing the fruit at you. At least if you could grab some and fire it back, you had more of a fighting chance.

With a slingshot motion, I guess?  OK, the fruit’s fermenting and I’m getting dizzy.  But I often wonder why the argument for improved control over already-digitized processes isn’t used more to motivate doctors to embrace CPOE. I’ll work on that one when the fire department comes to get me out of this tree.  

Robert D. Lafsky, MD is a gastroenterologist and internist in Lansdowne, VA.