The Meaning of Version 2.0

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Version 2.0 is a good thing. Except when it’s not.

Being 2.0 means embracing something brand new, something different, revolutionary, totally revamped from the old 1.0 that’s just not as good. It’s simple math, really. 2.0 is twice of 1.0.

The terminology we use for what software developers call a “major version release” is a popular way to address all things new and cool. For instance, in 2010, Justin Bieber released his My World 2.0 album, charming fans world-wide with the #1 hit Baby.

In health care, we also like new versions. Typically used to describe a move towards all-digital access, a post on The Health Care Blog describes the evolving wave of patient self-scheduling methods as “2.0.” An Academic Radiology paper describes radiology education using computing devices over paper as “Radiology Education 2.0.” Even an iTunes app providing a set of emergency radiology teaching cases calls itself Radiology 2.0 (incidentally, because the software is in its first release, the app is actually “Radiology 2.0 v1.0”).

In fact, versioning in health care is so popular that when The American College of Radiology decided to push a new approach to imaging, it decided to skip 2.0 and start with Imaging 3.0.

This approach to “versioning” in health care may appear inexplicable, particularly in the light of its receding popularity in the other industries. As early as 2009, the public began to notice that Google products were kept in beta for years, as the digital goliath moved away from major version releases for its web products. It slowly became obvious that Google simply keeps many of its products in beta so that improvements can be made continuously. Likewise, Facebook updates features incrementally without ever mentioning of a 2.0. After its initial public offering, Twitter underwent dramatic changes but never pausing for a revolutionary new major version. As the Bieber Fever raged across the popular music scene, the teenage pop star moved away from versioning his album five years ago (naming his next release Never Say Never).

The industry who pioneered the term “2.0” has moved away from the concept of versioning altogether, instead favoring the somewhat humbling concept of “always in beta,” or perpetual beta, the concept of achieving big-scale upgrades in a myriad of small but frequent updates instead of one big install. Therefore, in software engineering, “perpetual beta” also embraces the philosophy that your product is never as perfect as it could be, that there is always room for improvement. The software build on 3/26/2015 is mostly the same as build 3/25/2015 but just a little bit better.

The danger with 2.0 lies in its implicit recognition of a dramatic change, in the fact that you simply cannot call something 2.0 without first defining a 1.0 and then defining its shortcomings. The implication is that 1.0 can be fixed with an packaged solution. It makes a complex process that may otherwise require a gradual transition appear achievable with a simple technological update. Buy the v2.0 workstations, upgrade to v3.0 software, acquire a v4.0 CT scanner. That’s how you fix problems.

The reality is that, like cloud-based technology, health care doesn’t really have a true “2.0.” Care delivery is in perpetual beta testing, as new knowledge incrementally accumulates and changes practice patterns. Slowly, just as the acceptance of evidence-based medicine as a paradigm took decades to take root. In an industry where change can bring harm to a vulnerable population, it is no secret that clinics and hospitals always seek to improve care. The part that is less emphasized, though, is the importance that we do so in increments.

You may recognize the philosophy of perpetual beta as being remarkably similar to kaizen, a mainstay concept in the Toyota Production System for continuous improvement. Indeed, we have come a full circle that the newest way Silicon Valley upgrades its offerings is based on the half-century-old work ethic of making cars.

However, the two are not exactly mutually exclusive. Perhaps the major version releases in health care were never meant to be a specific product but more as a paradigm. ACR’s Imaging 3.0 pushes a patient-centered paradigm of practicing radiology moving forward. Patient self-scheduling 2.0 is not an actual product, or even a collection of products, but rather a movement towards better convenience for patients. Assigning a major release number to an otherwise amorphous health care movement has definite benefits. Specifically, it allows like-minded individuals to focus a wide array of efforts with the same goal in mind, like going into battle under the same banner.

The labels Imaging 3.0, Radiology Education 2.0, and Patient Self-Scheduling 2.0 have the power of rallying people behind the same cause.

So please, when you work towards the next major release in health care in the interest of our patients, remember that the 2.0 will not arrive guns-blazing to save the day. Instead, for a moment pretend that every equipment and every workflow around us is in “perpetual beta” and can use a few bug fixes. This is how health care upgrades to 2.0.

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