Upgrade or Die?

Anyone who’s been in computers or information technology for any length of time has heard the mantra, “upgrade or die”. It refers in part to the speed with which the computing industry developed from the late 1980’s through the beginning of this millenium, an axiom referred to as “Moore’s Law”.
While Moore’s Law refers specifically to the ability to cram increasingly more electrical circuits into the same amount of space, and the ability to use them to perform computational analyses, what it means in “real life, you and me” terms is this:

Everything you own that depends on a computer interface will be obsolete within two, or maybe three years.

It actually will be out of production much sooner than that – but given the cost of replacing equipment (even though that has been dropping) and how long it takes to learn new systems, most people put off getting new stuff until the old stuff is either completely-worn-out-and-not-working, or until the company who made the equipment has all their support staff helping people on the new systems only. At that point, the end-user has two options: to replace (upgrade) the old equipment with newer equipment, or to do completely without.

Figuratively speaking, “upgrade or die”.

While refusing to upgrade or delaying an upgrade can work for general business technology – as long as you can find someone who still knows how to work the program, or fix the equipment, and as long as you can find or make spare parts – it doesn’t bode nearly as well for medical equipment and supplies. While glucometers are (figuratively speaking) a dime a dozen, what would happen if your pacemaker, your insulin pump, or any other bioelectromechanical device upon which your life depends… should fail?

  • Karen Doering recently started a discussion on her meter manufacturer's lack of support for the model she has been using for five years, and for which she still has a significant inventory of supplies. Not only is she faced with the possibility of having to change meters, but also the expense of getting a completely new set of strips.
  • On Your Diabetes May Vary, Bennet complained that some of the pump companies disincentivize customer loyalty by charging for upgrades on a scale that steepens the longer one has been a customer.

In the computer-technology world, as in the automotive world, there are always third parties who understand the hardware and the software enough to assist both with repairing non-functioning equipment (until replacement becomes either physically necessary or economically feasible). There are computer experts who specialize in assisting customers with transitions to new software and new equipment. In addition to failure-warranties, there are upgrade warranties (such as automobile leasing, and the “New Every Two” option for many cellphones). The automobile economic model pays for itself with high end-of-lease costs and the high resale value of low-mileage late-model, certified-pre-owned cars. The cellphone economic model pays for the new phone in the cost of the service contract. The computer upgrade warranty may include in its cost the estimated cost of the new equipment, and the old equipment can be refurbished and resold (albeit at great discount).

The closest analogy I can find in the diabetes world is the “free meter deal”, where, like the cellphone, the capital cost of the meter is covered by the cost of the ongoing service (in our case, consumable test strips and lancets). I’ve read in several blogs that a bad pump will be expeditiously replaced by cross-shipment (as have been those of my meters that have gone bad, or a bad inkjet printer). Very often, current-model devices can be repaired or refurbished and either returned to the customer, or recertified and used as replacements for other failed devices of the same class.

The problems arise when a medical device goes off warranty, or is no longer supported.

Microsoft announces to the world at large, in many places, when it is ending support for an older version of Windows. Automobile companies suggest the end of official support by the length of the warranties on the vehicles overall, and on specific parts of the vehicles. Computer hardware and peripherals companies will generally suggest the end of support for a computer or peripheral by its disappearance from the line of current models, or by the announcement of replacement models.

Obviously, there are many cases where an older medical device should be replaced – pre-emptively, if a wear-related failure could be serious or fatal. In the case of home medical devices – at least, those which depend on microcircuitry – replacing (and/or upgrading) the equipment provides a greater level of reliability than refurbishment or repair. The issues I’ve seen this week appear to be those of alerting medical consumers to sunsetting (end-of-support) timelines in order to prepare them for the upgrade, finding ways of financing the upgrade in a timely fashion, and providing the training and data transfer necessary to make as seamless and as successful a transition as possible.

Failing that, the old IT saw may become fatal medical reality.