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For Healthcare, Windows Picks a Bad Time for a Facelift

 |  By smace@healthleadersmedia.com  
   June 05, 2012

By my calculations, 2013 will be one of the trickiest years in tech since Y2K.

Why? Not because of EHRs, HIEs, or the other technology acronyms so familiar to healthcare executives. The biggest reason is the release of Windows 8, Microsoft's most radical rethink of Windows since Windows 95.

Windows remains the dominant OS in healthcare institutions, as at most organizations. The new interface-lift is expected as early as fall 2012, to be followed by a long period of upgrades and retraining. Gone will be the familiar overlapping windows and pull-down menus so familiar to Windows users since way, way back. (I used Windows 3.0 back in 1990, so I'm a longtime menu puller-downer.)

Replacing this will be the radically new Metro user interface, where applications are tiled but not overlapping, where menus and mouse movements give way largely to gestures and touch-driven commands to make applications maximize, minimize, and do cool stuff.

It's all very inspired by the success of the iPad, itself a radical rethink on the old Macintosh user interface. Apple doesn't officially support the iPad with a mouse, although at the recent American Telemedicine Conference, I saw a variety of iPads paired with third-party keyboards and even a few mice to recreate that PC experience.

Metro still retains the mouse when running on desktops, but it's the "Windows 8" name that will cause healthcare (and many users in general) the most grief. As of last Saturday, purchasers of systems with the current Windows 7 installed are eligible to upgrade to Windows 8 for less than $15.

Generally these upgrades are a headache for all of IT. It's usually better to start with a fresh system. I wish Microsoft would dispense with the whole idea of upgrading from one OS to another. There's a history of bad experiences.

However you get Windows 8, if you're used to the Windows you know and love/hate, you're in for a disruptive transition. Windows 8 removes the "start" button in the lower-left corner, replacing it with a Charm Bar that's invisible until you drag your pointer via mouse or touch to the top or bottom of the screen (or press Control-C if you're a real geek).

I understand why aesthetically Microsoft has to remove the Start button, but this is going to cause no end of grief when it comes to retraining users comfortable with Windows 7 or earlier versions. Now couple this with the trend permitting healthcare staff to bring their own devices to work, a trend accelerated by the iPad. More and more of those devices in 2013 will be running Windows 8, as Microsoft starts leaning on computer makers to ship Windows 8 as the default operating system. Based on a marketing blitz, those BYODers who don't get Windows 8 will start mailing in those $15 coupons for the upgrade.

It gets worse. There will be a version of Windows 8 for tablet computers running the ARM processor. But those tablets will only run new-style Metro applications. Older Win32 pull-down-menu applications won't even run on those tablets, but they will run on tablets powered by Intel processors. I'm not saying those applications will look good or run well on tablets, but some will and some won't. Did I mention that all these different operating systems are called "Windows"? Are you confused yet?

It's all good news for the iPad, in my opinion. At HealthLeaders Media, our coverage of the iPad in healthcare attracts huge readership numbers. But there are so many Windows users out there, and so many devices running Windows, that there is bound to be some grassroots adoption of Windows 8 in healthcare.

Of course healthcare EMR vendors will be developing Windows 8 front-ends to their systems throughout this year and especially next, and I don't envy their job. Certain ways of using EMRs will have to change, just as they have with iPad versions of those systems. This complicates training, as it won't be practical or even necessarily possible for a healthcare provider to suddenly swap out desktop and laptop deployments for touch-based ones. The new user interfaces look promising, but they are a radical rethink.

In a year when so many providers will be struggling to complete their first year of Meaningful Use implementation, those Windows 8 systems trickling in will seem like a very unwelcome annoyance. But some of those Windows 8 users are bound to be in executive suites. Good luck convincing your Windows-loving CEO that he can't have his Windows anymore or that his executive dashboard can't be made to work with Windows 8.

I should say here that Microsoft is to be commended for trying to modernize the Windows user interface. The company just picked the absolute worst time to do it as far as healthcare is concerned. But with the continuing revolutions in healthcare tech, maybe there would never be a best time.

One irony of the greatest success in private EHR implementation, at Kaiser Permanente, is that all those systems are running Windows XP, a long-obsolete version of Windows.

Extended support for Windows XP is due to conclude on April 8, 2014—less than two years away. I would bet that security patches for XP will continue to be provided for several years after that. Meanwhile, the automatic Windows Update service, whose familiar, unwanted reminders pop up everywhere from PowerPoint presentations to billboards, will be cajoling XP users (and Vista users, and Windows 7 users) to upgrade version components stat. As more and more healthcare providers turn their screens around so patients can follow along with their EMRs during consults, those pop-ups won't inspire confidence in healthcare's digital future.

Our healthcare systems are becoming so sensitive to technological considerations that Microsoft might be well advised to stage a formal clinical trial of Windows 8. The good news is, as with all clinical trials, years would be needed to complete to prove its safety and efficacy. By then, we'd almost be ready for it.

Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

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