"Google’s CEO Eric Schmidt doesn’t know why docs haven’t embraced databases to help them sort through medical information."
[Schmidt said] ... So when you show up at the doctor with some set of symptoms, in my ideal world what would happen is that the doctor would type in the symptoms he or she also observes, and it would be matched against the data in this repository
[such as DXplain? -- which we learn from a - er, um, Google search - was developed starting in the mid 1980's by medical informatics researchers who actually know this domain, and which offers this explanation and warning: "DXplain uses an interactive format to collect clinical information and makes use of a modified form of Bayesian logic to derive clinical interpretations ... DXplain does not offer definitive medical consultation and should not be used as a substitute for physician diagnostic decision making"? - ed.]
... Then this knowledge engine would use best practices, and all the knowledge in the world to give physicians some sort of standardized guidance. This is a generalized form of the checklists that you’re talking about …
As computer scientists, this is a platform database problem, and we do these very, very well, as a general rule. And it befuddles me why medicine hasn’t organized itself around these platform opportunities. [No - the successful practice of medicine is not a 'platform database' or any other reductionistic information retrieval problem - ed.]
I note that IT personnel like to refer to "
platforms", "solutions" - a rather presumptuous term, "paradigms", and other buzzwords to mask the fact that what they're referring to are more commonly known as "hardware" and "software" and arrangements thereof.
Does this "platform opportunity" view reflect naïveté about the complexities of medicine and medical decision making, or does it reflect something else? Could this "befuddlement" be construed as calling physicians obtuse? Is this yet another example of what I referred to in my post "
Healthcare IT Failure and The Arrogance of the IT Industry" and other writings as a
cross-occupational invasion of medicine by IT?
IT personnel seem to have a propensity to offer healthcare-related opinions far outside their own areas of expertise -- or if in healthcare organizations, edicts - based upon the narrow view of their own relatively linear and deterministic fields. The risk is, especially when coming from high perches, that such opinions and edicts can result in deleterious actions (e.g., government initiatives).
In an absurdist
reductio ad absurdum, deliberately made absurdist due to many years of exposure to equally absurd
(to those with actual domain experience) "who needs medical school/residency/patient care experience to profess on medical matters?" attitudes:
Why don't physicians offer the advice that Google could improve its search algorithms, or Intel and AMD their microprocessors, by utilizing intelligent psittacine platforms
as in this British Broadcasting Company (BBC) video narrated by a true technology expert, Captain James T. Kirk?
Kirk did have a (computerized) physician son: Nomad!
----------------
Quite seriously, physician reluctance to "embracing databases" and health IT in general is not about database platforms. I only
wish it were so simple.
The WSJ seems to understand this. In a Jan. 12, 2009 article by reporter Bret Stephens entitled "
Can Intelligence be Intelligent?", the observation is made that technology is a mere
facilitator, and intelligent, well trained, experienced, critical-thinking
people are the
enablers of any complex field that requires human judgment. They must be unfettered by machine and bureaucrat:
... Terrifying as the thought may be to many of its current practitioners, the true art of intelligence requires, well, intelligence. That is a function neither of technology nor of "systems" [a.k.a. "platforms" - ed.], which begin as efforts to supplement and enhance the work of intelligence and typically wind up as substitutes for it. It is, instead, a matter of experience, intellect, initiative and judgment, nurtured within institutions that welcome gadflies in their midst.
I've left the following comment at the WSJ health blog:
Mr Schmidt,
If you’d like to learn more about why many physicians are reluctant to embrace clinical IT, you might also do a Google search on “healthcare IT failure” and similar terms.
Need I say anything more about the irony of that advice?
I'd also noted a fixation on "
platforms" as solutions to biomedical problems (best when they come in shrinkwrapped, off the shelf, "on the IT roadmap" packages!) in my June 2008 post "
An Open Letter to Merck CEO Richard Clark on Merck's Mission to Rediscover the Wheel."
A nonmedical research IT leader Ingrid Akerblom, who'd found a move from basic research to clinical IT "quite an eye opening experience" (i.e., a domain in which she had little or no experience but was paradoxically appointed to lead) talked all about "platforms" in
Bio-IT World:
... We've invested a lot in some core platforms; we need to start translating that into results in the clinic at some point. And so having people who have an understanding of what does that really take to help inform the earlier research directions, the platform directions [i.e., research direction = platform direction - ed.], is a key theme...We already have siloed platforms to show that data, we need to integrate it more than it is... combining the results data from clinical samples with the associated patient data, what's that platform?
Platform, platform, platform. Who's got the platform?
My comments to that CEO in my Open Letter were that this was the wrong mindset and question, based upon an IT person's focus on
information technology. This is as opposed to a focus on
information science and on facilitating people in interacting with
data and information in order to gain actionable
knowledge, i.e., an information science and human-computer interaction-based approach that those in medical informatics thought about long ago.
In line with the conclusions of
Greenhalgh et al. [1] who called for "eschewing sanitized accounts of successful projects" and instead recommending studies of clinical IT in organizations that “tell it like it is” using the de-identified critical fiction technique, I'd written on how conflation of information technology and information science impaired R&D in pharma at my essay "
Sure path to R&D failure: Conflation of IT with information science in the pharmaceutical industry."
That piece and the aforementioned Open Letter were written before Merck sold itself to Schering-Plough in a "
reverse merger" due to the
unsustainability of doing business from an empty wagon of new products, a sign of just how well this IT-centric "
platformania" has been working out for R&D.
In the information science-centered view and approach, the "platform," a.k.a. computer technology, is merely a canvas and facilitator, the artist (clinician or scientist) and the brush wielded by them being the primary enabler of and contributor to the masterpiece.
Unfortunately, I don't think anyone is "home" in pharma or in the HIT sector anymore to parse these ideas; in fact I've only recently learned that the people I did work with who could parse these ideas into creative reality were laid off by the very IT people making such statements and asking such questions.
IT personnel perhaps need to move away from their reductionist
platformania. (Perhaps they are confusing "platforms" with "pixie dust.") Rather, they need to start thinking in terms of facilitating clinicians and scientists through domain specific and individualized-to-need information science and HCI innovation that arises of true cross-disciplinary expertise.
They need to leave creation of cybernetic miracles to people such as
Irwin Allen and
George Lucas. And platforms to carpenters.
-- SS
[1] Tensions and Paradoxes in Electronic Patient Record Research: A Systematic Literature Review Using the Meta-narrative Method. Greenhalgh, Potts, Wong, Bark, Swinglehurst, University College London. Milbank Quarterly, Dec. 2009. Available at:
http://eprints.ucl.ac.uk/18821/
I'd conducted a forensic exercise in that post using the publicly accessible Sitemeter access logs for this blog. The analysis pointed straight to that company.
Health IT Expert Socky the Sockpuppet!
That HIT company-based trolls would resort to psyops to support diffusion of tools that are eliciting widespread complaints from physicians — about the tool’s interferences with patient care, in fact — and ridicule those physicians is perverse, whether company-sanctioned or not.
It is not uncommon for company competitive intelligence and corporate communications personnel to monitor blogs. Aggregators actually sell information about what's being said in blogs and other new media back to the companies themselves, for enhancing market awareness among other purposes. It would not at all surprise me if companies were resorting to anonymous online harassment of those whose views they do not like.
In the case of HIT, however, everyone reading this could one day be a victim, or have loved ones who could be a victim, of defective health IT.
Imagine, say, Northwest Airlines conducting online psyops to discourage and discredit those fighting for better security screening of passengers.
Would that be perverse enough to attract attention?
By the way, it was rather unthoughtful for the perpetrator to have carried out these activities considering that I had conducted this research (PPT) a few years ago, a fact they might have been aware of if they had bothered to follow the HIT literature.
Anyone listening in the U.S. Senate or House of Representatives? (The visitation logs of this blog also show "hits" from those IP's.) Perhaps you should perform some health IT vendor forensics of your own.
-- SS1:00 PM Addendum:
Socky, ya still out there? We'd love to hear from you!
/sarc
-- SS