Some interesting observations near the end of Kevin Kelly's book. apropos, I am reminded of my December 2015 post setting forth "Margalit's Lament."
Are structured data now the enemy of health care quality?
Margalit apparently thinks so. Per my last post, which was an annotated analytical cross-post of Margalit Gur-Arie's provocative post "Bingo Medicine," which was itself first cross-posted at THCB.
the one foundational problem plaguing current EHR designs – the draconian enforcement of structured data elements as means of human endeavor...
People don’t think in codified vocabularies. We don’t express ourselves in structured data fields...
Furthermore, when your note taking is template driven, most of your cognitive effort goes towards fishing for content that fits the template (like playing Bingo), instead of just listening to whatever the patient has to say..."Draconian enforcement." Gotta love that.
So, is digital health IT is inimical to clinical acumen, and consequently, patient outcomes?
More Kevin Kelly:
The space of knowledge in ancient times was a dynamic oral tradition. By the grammar of rhetoric, knowledge was structured as poetry and dialogue—subject to interruption, questioning, and parenthetical diversions. The space of early writing was likewise flexible. Texts were ongoing affairs, amended by readers, revised by disciples; a forum for discussions. When scripts moved to the printed page, the ideas they represented became monumental and fixed. Gone was the role of the reader in forming the text. The unalterable progression of ideas across pages in a book gave the work an impressive authority—“authority” and “author” deriving from a common root. As Bolter notes, “When ancient, medieval, or even Renaissance texts are prepared for modern readers, it is not only the words that are translated: the text itself is translated into the space of the modern printed book.”
A few authors in the printed past tried to explore expanded writing and thinking spaces, attempting to move away from the closed linearity of print and into the nonsequential experience of hypertext. James Joyce wrote Ulysses and Finnegan’s Wake as a network of ideas colliding, cross-referencing, and shifting upon each reading. Borges wrote in a traditional linear fashion, but he wrote of writing spaces: books about books, texts with endlessly branching plots, strangely looping self-referential books, texts of infinite permutations, and the libraries of possibilities. Bolter writes: “Borges can imagine such a fiction, but he cannot produce it....Borges himself never had available to him an electronic space, in which the text can comprise a network of diverging, converging, and parallel times.”
A new thinking space
I live on computer networks. The network of networks—the Internet—links several millions of personal computers around the world. No one knows exactly how many millions are connected, or even how many intermediate nodes there are. The Internet Society made an educated guess in August 1993 that the Net was made up of 1.7 million host computers and 17 million users. No one controls the Net, no one is in charge. The U.S. government, which indirectly subsidizes the Net, woke up one day to find that a Net had spun itself, without much administration or oversight, among the terminals of the techno-elite. The Internet is, as its users are proud to boast, the largest functioning anarchy in the world. Every day hundreds of millions of messages are passed between its members, without the benefit of a central authority. I personally receive or send about 50 messages per day. In addition to the vast flow in individual letters, there exist between its wires that disembodied cyberspace where messages interact, a shared space of written public conversations. Every day authors all over the word add millions of words to an uncountable number of overlapping conversations. They daily build an immense distributed document, one that is under eternal construction, constant flux, and fleeting permanence. “Elements in the electronic writing space are not simply chaotic,” Bolter wrote, “they are instead in a perpetual state of reorganization...”
The total summation we call knowledge or science is a web of ideas pointing to, and reciprocally educating each other. Hypertext and electronic writing accelerate that reciprocity. Networks rearrange the writing space of the printed book into a writing space many orders larger and many ways more complex than of ink on paper. The entire instrumentation of our lives can be seen as part of that “writing space.” As data from weather sensors, demographic surveys, traffic recorders, cash registers, and all the millions of electronic information generators pour their “words” or representation into the Net, they enlarge the writing space. Their information becomes part of what we know, part of what we talk about, part of our meaning."Shards." Yeah. As in "Shards of health care. Fragmentation." A lot of us are not finding those shards very useful or comforting. Are we gonna get to true "interoperability" in the health care space anytime soon? Or will we remain mired in digital silo fragmentation and "Interoperababble" owing to continuing/increasing industry "fragmentation" wrought by powerful incumbent market forces?
At the same time the very shape of this network space shapes us. It is no coincidence that the postmodernists arose in tandem as the space of networks formed. In the last half-century a uniform mass market—the result of the industrial thrust—has collapsed into a network of small niches—the result of the information tide. An aggregation of fragments is the only kind of whole we now have. The fragmentation of business markets, of social mores, of spiritual beliefs, of ethnicity, and of truth itself into tinier and tinier shards is the hallmark of this era. Our society is a working pandemonium of fragments... [Kevin Kelly, Out of Control, illustrated edition, pp 387-391]
Reflections on "ways of thinking" here at KHIT focus as a priority on clinical cognition and judgment, and on the workflow realities that may negatively impact them (much of which have little to nothing to do with infotech -- digital or analog -- per se).
"Out of Control" was published 22 years ago, in 1994 (and is a great read; I bought the hefty Amazon oversized softcover edition). It will be interesting to see what his thoughts are in his upcoming release "Inevitable." See my prior post "Anything that CAN be tracked WILL be tracked." Inevitable Tech Forces That Will Shape Our Future.
Interesting quick post over at Medium:
mo’ data mo’ problems?Yeah. My comment:
Think about it.
Your phone carrier knows who you are talking to. Uber knows where you are going. Facebook knows who your friends are. Amazon knows your purchase habits. Fitbit knows how much you exercise. etc. etc. etc.
Your entire life is producing data. You are the product.
Is this a good thing? Well, the short answer is it depends...
“When you use a free online service, you’re not the customer, you’re the PRODUCT.” From my latest riff on my KHIT.org blog (I think I was quoting either Dan Lyons or Douglas Rushkoff at that point).__
Much more to come on that topic shortly. Kevin Kelly asserts that “whatever CAN be tracked WILL be tracked.” But, not withstanding its ostensible inevitability, the propriety of that, as you note, will depend on who’s doing the tracking, and for what purpose. Who benefits, and who is put at risk?
I recently covered a medical infotech conference amid which one presenter showed his fatuous “app” that purports to calculate an AI-enabled machine-learning social media based adaptive “health score,” sort of akin to a FICO credit score (all totally unregulated, of course). What could possibly go wrong there? Similarly, would you like to have, say, Facebook calculating (and sharing with the Feds), without your knowledge or consent, your “Terrorism Risk Score?”
BTW, COMING UP
Link here. They approved my press pass again. I covered it last year, in Dallas. It was fabulous.
More on tech and "The Future of Medicine"
Dr. Bertalan Meskó. I cited his book here.
More to come...