Saturday, June 30, 2018

Is Technology Ever the Problem?

Electronic Health Records (EHR) were originally introduced and subsidized to cut waste, eliminate red tape, reduce redundant medical tests, save billions of dollars and thousands of jobs, and save lives by reducing medical errors.

Instead, according to a study published at BMC Medical Informatics and Decision Making, the current approach “makes inconsistency and error the standard.” The very tool that was supposed to standardize care is reducing or eliminating quality and causing substandard care. Clinicians are led to believe that the computer knows medicine better than they do. In reality, while a computer can hold medical information, computer programmers are not trained in the practice of medicine. Researchers point out that “substitution of technology for people is a misunderstanding of both.”

Programmers are trained and hired to build systems that collect information and recreate representations of the real world in computerized data structures and then apply rules of logic. It is their natural tendency to blame inadequacies of their systems on inaccuracies of how well the data in the computer system matches reality in the health care system. Yet, it is this very requirement of attending to the information needs of the system that diminishes clinician attention to the patient that is causing medical problems.

To a technologist, the answer is always more technology.
  • If the computer terminal is located too far from the patient bedside, the answer is to go wireless and use tablets.
  • If the system is not accurately reflecting where the patient is in the hospital, the conclusion would be to implement RFID so the system knows where the patient is and clinicians are freed from entering that information.
  • If the problem is not enough eye contact with the patient, the answer is to find a way to put the display in the line of sight to the patient.
Little consideration is given to the ever-widening stream of unintended consequences or reactions.

The assumption is that for anything that can be done in the real world, technology can do it and do it better because computers do not make mistakes and just do as they are told. Directly or indirectly, we are told that technology is the answer to all the world’s problems and can bring us to the promise a perfect world. If technology has not yet brought us to the perfect world, then that must be because technology does not yet have enough data.

In reality, the data we are missing is on when these technologies fail because computers only did as they were told.

“The techology is being pushed, with no good scientific basis,” according to Dr. Scot Silverstein. A scientific basis would involve actual observation of a health care environment by health care IT developers.

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