Scaling the Tower of Babel – The Slippery Slope of Scale

One of the first obstacles to a successful Google global health URL is language. I will refer to this obstacle as the “tower of Babel idea” (Adam Bosworth). All the stake holders speak different languages. This is one of the major reasons that the second-generation EMR applications are failing. In my opinion, this lack of communication is found at every intersection of computers and humans.

From applications within education to EMRs for private clinical practice, developers in general do not understand the interactions of the end-users with the interfaces they design. Add in the languages of consumers, administrators, fiscal managers, nurses, medical researchers, radiologists, psychiatrists, HIPAA, and vendors, and we now have an insane tower of Babel.

I spend most of my days trying to scale this slippery tower by translating between stakeholders. I go into meetings, I try to learn as much of the alphabet soup that I can for each stakeholder, then I try to map one language into another to all at the table are referring to the same constructs.

To illustrate, I will describe a small unrepresentative sampling study. Several family members, friends, medical doctors, psychologists and office staff members were asked what the word SCALE means, that is, how would they describe scale to someone:

Who They Are	“What they Said”
Mother, 73	Something you stand on to weigh yourself
Son, 22	I do not know what you mean. Do you mean conveying the information to … (no answer, playing PSP)
MD#1	Something you use to measure something
MD#2	Something used to measure a concept
Friend, 15	Climbing up the side of something - to climb
Me, Ph.D.	A unidimensional set of items used to measure a defined concept
Developer	To allow an application to work with small or large amounts of information. Go from development to large-scale dissemination