This is a brilliant article. There are some key points: realising “digital” isn’t about digitisation but deeply understanding our work and how we manage change, and manage our organisations.
He gives an example of a real-life/model mismatch, thinking a single problem list can be shared within an organisation of scale. The description of the clinician’s frustration is one reason I have designed multiple context-bound problem lists based on pathways and services.
When many of us say that “digital technology” is quite the best way of processing and making sense of large amounts of data, how can it be that, in 2018, we have a “massive monster of incomprehensibility”?
And @Atul_Gawande rightly points out the fundamental need of communication in healthcare but these aspects of collaboration appear to have been forgotten by some system designers.
The architectural approach must be different if we want complex information technology supporting our complex adaptive real-life systems. That means, modularisation and data standards. We need mixed economies with interoperability and a core focus on meaningful data.
The users of my own EPR wanted to be able to cc. their messages to a group but I challenged that. Send messages if you need action, not simply “to let you know”. Because with electronic records we have a different paradigm- the record will be there and accessible when I need it.
Sometimes it’s hard to forget our historic reliance on paper, and fall into the trap of building digital copies of paper based workflows. But there is a paradox in which we can also forget the inherent workflows paper brings when we design digital systems.
We need open standards, APIs and meaningful clinical data, with App Store models for user facing applications and even analytics or clinical decision support, but how fast we can deliver that (heterogeneous) interoperating vision?
