For optimal enjoyment, read the entire 63 page pdf ONC slide deck while listening to Weird Al's "Mission Statement."
and, also apropos of Health IT,
“This is a book about automation, about the use of computers and software to do things we used to do ourselves. It’s not about the technology or the economics of automation, nor is it about the future of robots and cyborgs and gadgetry, though all those things enter into the story. It’s about automation’s human consequences. Pilots have been out in front of a wave that is now engulfing us. We’re looking to computers to shoulder more of our work, on the job and off, and to guide us through more of our everyday routines. When we need to get something done today, more often than not we sit down in front of a monitor, or open a laptop, or pull out a smartphone, or strap a net-connected accessory to our forehead or wrist. We run apps. We consult screens. We take advice from digitally simulated voices. We defer to the wisdom of algorithms. Computer automation makes our lives easier, our chores less burdensome. We’re often able to accomplish more in less time— or to do things we simply couldn’t do before. But automation also has deeper, hidden effects. As aviators have learned, not all of them are beneficial. Automation can take a toll on our work, our talents, and our lives. It can narrow our perspectives and limit our choices. It can open us to surveillance and manipulation. As computers become our constant companions, our familiar, obliging helpmates, it seems wise to take a closer look at exactly how they’re changing what we do and who we are…”
Carr, Nicholas (2014-09-29). The Glass Cage: Automation and Us (Kindle Locations 43-54). W. W. Norton & Company. Kindle Edition.
“…A medical exam or consultation involves an extraordinarily intricate and intimate form of personal communication. It requires, on the doctor’s part, both an empathic sensitivity to words and body language and a coldly rational analysis of evidence. To decipher a complicated medical problem or complaint, a clinician has to listen carefully to a patient’s story while at the same time guiding and filtering that story through established diagnostic frameworks. The key is to strike the right balance between grasping the specifics of the patient’s situation and inferring general patterns and probabilities derived from reading and experience. Checklists and other decision guides can serve as valuable aids in this process. They bring order to complicated and sometimes chaotic circumstances. But as the surgeon and New Yorker writer Atul Gawande explained in his book The Checklist Manifesto, the “virtues of regimentation” don’t negate the need for “courage, wits, and improvisation.” The best clinicians will always be distinguished by their “expert audacity.” By requiring a doctor to follow templates and prompts too slavishly, computer automation can skew the dynamics of doctor-patient relations. It can streamline patient visits and bring useful information to bear, but it can also, as Lown writes, “narrow the scope of inquiry prematurely” and even, by provoking an automation bias that gives precedence to the screen over the patient, lead to misdiagnoses. Doctors can begin to display “‘screen-driven’ information-gathering behaviors, scrolling and asking questions as they appear on the computer rather than following the patient’s narrative thread.”
Being led by the screen rather than the patient is particularly perilous for young practitioners, Lown suggests, as it forecloses opportunities to learn the most subtle and human aspects of the art of medicine— the tacit knowledge that can’t be garnered from textbooks or software. It may also, in the long run, hinder doctors from developing the intuition that enables them to respond to emergencies and other unexpected events, when a patient’s fate can be sealed in a matter of minutes. At such moments, doctors can’t be methodical or deliberative; they can’t spend time gathering and analyzing information or working through templates. A computer is of little help. Doctors have to make near-instantaneous decisions about diagnosis and treatment. They have to act. Cognitive scientists who have studied physicians’ thought processes argue that expert clinicians don’t use conscious reasoning, or formal sets of rules, in emergencies. Drawing on their knowledge and experience, they simply “see” what’s wrong— oftentimes making a working diagnosis in a matter of seconds— and proceed to do what needs to be done. “The key cues to a patient’s condition,” explains Jerome Groopman in his book How Doctors Think, “coalesce into a pattern that the physician identifies as a specific disease or condition.” This is talent of a very high order, where, Groopman says, “thinking is inseparable from acting.” 26 Like other forms of mental automaticity, it develops only through continuing practice with direct, immediate feedback. Put a screen between doctor and patient, and you put distance between them. You make it much harder for automaticity and intuition to develop…” [Kindle Locations 1555-1581]A bracing read, this one.
More to come...