It was all going so well.

My fears of spending eight hours on a budget airline from Ottawa to Nice were quickly subsiding.

The plane was half-full. No one was sitting next to me. I could spread my things out. More importantly I could get to the loo at will. Most of my fellow passengers seemed to be smiling, well-behaved, holidaying septuagenarians and octogenarians on their way to the South of France. Even the plane seemed in pretty good shape as we climbed out of Canadian airspace. Which is always a good sign.

Then the flight attendants brought out tablets. No, not a trolley load of medicines. But mini-iPads.

On this particular airline, in-flight entertainment consisted of everyone being given a mini-iPad for the duration of the flight on which they could play films, tv shows and music. Normally in-flight entertainment causes a plane full of passengers to settle into a quasi-like trance – well, that and the food and drink. However, the introduction of state-of-the-art technology did not go down well with this group of airborne senior Canadian citizens; and being in a (highly) pressurised environment 30,000ft above the ocean did not help. What unfolded was nothing short of digital pandemonium.

For the first 30 minutes or so the cabin echoed to the sound of a succession of tablets failing to the floor as people tried to fix their tablets to the back of the seat in front of then. Then, as people tried to master the subtleties of touch-screen technology there followed increasingly frustrated and desparate cries of ‘Where did it go?’, ‘How do you..?’ and ‘How did I do that? I don’t know how I did that? Jean. Jean!’

Chosen films swished off the screen into the ether. Other things – ‘strange things’ – appeared on screen from nowhere.  Flight attendant call-buttons pinged non-stop as if there was a pin-ball machine at the back of the aircraft. The young stewardesses criss-crossed the cabin trying to serve food with one hand and carry out IT tutorials with the other. They raised their eyebrows. The smiles of my nice ‘genarians’ were replaced by scowls. Before long most had taken to reading a book or snoozing instead.

Ensconced in my seat I weighed up the pros and cons of turning facilitator, mid-Atlantic.  Of conducting an impromptu workshop to take people through the basic functions of these infernal machines that were spoiling their customer experience. After all, it was a captive audience if you get my meaning. But I thought better of it. I also pondered whether Air Canada Rouge might have thought about including an iPad ‘briefing’ to follow the safety briefing that we have all become used to. Something along the lines of ‘If for some reason the iPad fails….’

I told a few friends this story and it was also uppermost in my mind as I sat in the audience at last week’s Ann Sowerby eHealth Symposium organised by Imperial College Health Partners. I could only attend a few of the panel sessions. These were excellent. More pragmatic and grounded than the evangelist Twitter headlines coming from the conference before I arrived. Things like: ‘Digital is the only game in town when it comes to health system transformation.’

(Let’s hope not, is all I can say.)

Or the one that really gets to me which is when people talk about a ‘Paperless NHS.’  As if paper is the enemy.

The first time I heard someone make this an aim for their organisation was in 1995. I have it written in a work diary. 22 years later this organisation still uses a heck of a lot of paper. Not because they are bad at being digital – quite the contrary. No, because as a goal it is wrong. I think what they really meant then and now is they want to use digital technology to improve, to become more efficient. As the Wachter Review of NHS technology said: 

“We believe that the target of ‘paperless by 2020’ should be discarded as unrealistic. The goal is not paperless – it is improvement, facilitated by having information where it’s needed, when it’s needed.”

I love the vision and ambition that lies behind ‘evandigitalism’ as I like to call it.  Truly I do. No one is a bigger fan of digital than I. But unless we adopt a healthy pragmatism, unless we are grounded in our approach to applying and adopting digital technology, we will cause more problems than solutions for those we want to help. This was certainly the case for my Canadian friends. For them it meant being given only one choice, no help, a poor user experience and less value for money.

This morning I thought Derek Stewart wrote an important blog with some good questions we should ask ourselves when thinking about digital in health research: principled pragmatism which puts an understanding of the context within which digital will operate at its heart.

Funnily enough I was on another flight a few days ago. This time to Spain. I noticed that Tim Harford, the Financial Times journalist and presenter of the BBC series ‘Fifty Things That Made the Modern Economy’ has an article in the British Airways Business Life Magazine about what history can tell us about the future of technology. In the article he reminds us that the discovery of paper was a bigger invention than that of the printing press because of its cheapness and the ease with which it can be produced at scale.  He finishes his article by saying:

‘I am as clueless about the future of technology as anyone – but I’ve learnt three lessons by looking at its past. One: don’t be dazzled by the fancy stuff. Two: humble inventions can change the world if they are cheap enough. Three: always ask: ‘To use this invention well, what else needs to change.’

Let’s stop playing ‘Paper, scissors, ipad’ in digital health, for the patient’s sake.

Doors to manual.