By Bill Cooney  

April 23, 2012 | eCliniqua | Guest Commentary | The untimely passing of Steve Jobs led to extensive media coverage and a best-selling biography examining his life and legacy. Jobs was both a passionate visionary and an eccentric renegade, and his many successes rose from a set of principles and practices that changed how we develop, use, and think about technology. The Jobs legacy pertains equally to consumer devices and business applications such as eClinical systems, so let’s pause and consider “What would Steve say about eClinical?" 

End-to-End Control  

Steve Jobs was fanatical about producing technology that is “amazing” and “insanely great.” He believed in controlling every aspect of the product and user experience. Jobs felt it was imperative for Apple to produce—or tightly control—the processors, hardware, operating system, and application software for his products. Later in his career, he expanded the notion of control to include product distribution (the Apple Store) and digital content (iTunes and the App Store.) Apple’s unprecedented end-to-end business model has produced a series of extraordinary products; Jobs also guided Pixar to innovate computer-generated animation and movies such as Toy Story. These are among the most ingenious and iconic products of our time. Or as Steve would say, “insanely great!”  

Apple’s integrated approach stands in sharp contrast to Microsoft’s open-system approach, which encourages third-party companies to manufacture hardware and develop software compatible with the MS Windows operating system. For most of the past 30 years, Microsoft’s products have been commercially dominant, if not “amazing.”  Over the past decade, Apple has reversed the balance of power, challenging Microsoft’s hegemony in desktops and notebooks, and clearly surpassing Microsoft in mobile devices.   

The ascendancy of Apple’s integrated model has important implications for eClinical technology. To date, open system approaches have prevailed, with most eClinical vendors touting the advantages of platforms that are interoperable with other systems. Notably, the clinical research industry has largely lined up behind CDISC, whose mission is develop interoperable data standards to improve medical research.  

What would Steve Jobs say about open eClinical systems and CDISC? He said the issue is not “open versus closed,” but rather “integrated versus fragmented.” Jobs believed that open systems are inherently more variable, unstable, and confusing. He felt that open environments, especially those created by consortiums such as CDISC, require too many compromises, leading to dysfunctional standards and mediocre platforms. Jobs insisted that integrated systems, if developed correctly, would lead to significantly superior end products.   

Despite the ascent of Apple, open systems are far from dead, and Google’s Android serves as a recent successful example of the open system approach. But if Jobs is right, and open systems are too unstable and compromised, the eClinical industry may have a difficult time achieving true interoperability among open systems. CDISC may serve as an e-standard for data exchange, but fall short of serving as a basis for integrated systems that seamlessly combine and streamline major areas of clinical operations.   

The App  

The App is a Jobs innovation largely taken for granted due to its simplicity. Prior to the App, standard-setters such as Microsoft exerted little control over the software that third parties ultimately shipped for MS Windows. Apps, by contrast, must not only be developed according to Apple standards, but approved by Apple and distributed through Apple’s online service. Thus the App ingeniously combines Jobs’ penchant for control with an open channel for third-party developers. This approach has been a stunning success, yielding over 500,000 iPhone and iPad Apps, and over 5 million App downloads every day.   

The App demonstrates that success can come from hybrid approaches that borrow elements from both open and integrated design. Steve Jobs’ App may serve as an instructional case-in-point to eClinical developers, namely, that eClinical systems should be open to other systems, but only if there is strong control over the efficiency, quality and user experience of interoperable systems.   

Designing for Users  

Steve Jobs took the customer-centered business model to the next level, setting forth empathy, “an intimate connection with the feelings of the customer,” as the first business principle of Apple. He stated that Apple will succeed because, “We will truly understand their needs better than any other company.” Jobs felt it was important to develop an intuitive sense of user preferences, and to view every aspect of product design in terms of user experience. Surprisingly, Jobs did not believe in market research to determine user needs, and famously said, “Customers don’t know what they want until we’ve shown them.” Jobs had an uncanny ability to envision products from the user perspective, and this resulted in an unprecedented series of blockbuster products.   

The Apple principle of empathy has important implications for eClinical technology. Whereas Microsoft products have long been preferred by corporate IT managers, Apple products have always been the favorite among consumers. The rise of Apple may signal the democratization of the technology marketplace, in which the needs of end users win-out over the demands of IT technocrats. If that’s so, the eClinical industry needs to change; its platforms have traditionally been developed following the waterfall model of sequential design, with study sponsors and IT professionals setting the design goals. This has tended to produce platforms that meet the data, quality, and reporting requirements of management and IT, but have rarely produced a great user experience.   

Steve Jobs undoubtedly would have taken eClinical developers to task over user experience. He would reject systems that require extensive user training, arguing instead for intuitive user interfaces that need no training. Jobs would recognize that the greatest challenge facing eClinical is acceptance by study sites across diverse global locations, languages, cultures, clinical settings, and technology infrastructure, and he wouldn’t be surprised that global study sites have resisted use of many eClinical platforms.  He would say that the only way to gain user acceptance is to deploy platforms that are streamlined, intuitive, and clearly rewarding to end users. And he would insist that they only way to achieve that is to design systems not based on management and IT goals, but rather on the end user needs.  

Mobile Platforms  

If not for the vision of Steve Jobs, the world of mobile devices would not exist as we know it. Jobs always envisioned mobile devices as an alternative to computers; he articulated plans to develop a tablet computer more than a decade before the iPad. Today it’s easy to discern that the line is blurring between tablet devices and ultra-light notebook computers, and that mobile devices are being empowered by advances in broadband wireless service.   

Jobs certainly would predict that tablets and mobile computers will continue to converge and rival conventional computer hardware. Jobs would expect mobile devices to become prevalent in medical settings, and indeed we can already observe that many clinicians are using the iPad as their primary tool for connecting to digital networks. The implications for eClinical are clear: it’s becoming imperative to deploy platforms that work equally well for conventional computers and for mobile devices, especially the iPad.  

Apple DNA  

In the end, Steve Jobs’ passion was to build an enduring company that would continue to produce great products “at the intersection of artistry and technology.” In his final years, he sought to infuse Apple with cultural DNA it could carry into the future. He viewed this as a more important legacy than his products, and although Jobs built the most valuable company on earth, he always cared more about making great products than making profits. eClinical developers can also benefit from the DNA that Jobs has infused at Apple.  

Jobs was passionate about design and viewed technology as an art form. He believed that “simplicity is the ultimate sophistication” and constantly strove to eliminate complication and to reduce the user interface to only the most essential elements. He was obsessed with the tiniest details of every new product, unwilling to compromise product goals, and relentlessly sought perfection.   

An undeniable aspect of the Jobs legacy is that he was brutally honest about products in development, trumping personal feelings. He was quick-tempered and often humiliated his colleagues, but he was also energetic and inspirational. His personal style is not something others can easily—or would want to—copy, but his commitment to great products will always inspire.  

Focus was a founding principle of Apple. Although Jobs believed in informal “skunkworks” projects, he forcefully focused Apple on a small number of the most promising projects, shutting down many others. To deliver great end-to-end solutions, Jobs avoided typical corporate divisions, and instead organized Apple into multi-functional teams that spanned hardware, operating systems, and applications. He believed that entire teams, and indeed the entire company, should work in close proximity to foster frequent, informal exchanges.  

Jobs enjoyed marketing and respected finance, but felt that “product people” from among designers and engineers must lead Apple and constitute its essence. He encouraged his developers to be pirates, both in the sense of renegade creativity and also in aggressively borrowing great ideas. “Think Different” was Jobs’ rejoinder to IBM’s “Think.” He not only invented new products, but re-invented both Apple and himself in a career that spanned as many downs as ups. He believed that to survive, Apple must evolve, and he considered being fired from Apple in 1985 as a critical step in transforming both himself and the company that he returned to in 1997.  

Jobs, like Isaac Newton before him, credited his achievements to “standing on the shoulders of giants” who preceded him in Silicon Valley. He unabashedly borrowed from the ideas and inventions of his contemporaries, including such rivals as Xerox, IBM and Microsoft. Now it’s our turn to stand on the shoulders of Steve Jobs and borrow from his ideas and the Apple approach. Jobs was outspoken about what constitutes great technology, and if we listen carefully, we can still hear “What Steve would say” about eClinical technology.   

Bill Cooney is founder, CEO & President of MedPoint Digital, which he founded in 1990 in Evanston, Illinois. He has turned MedPoint into a leading provider of digital medical communications and information services. For more on MedPoint please visit www.medpt.com.