Technology is nothing. What’s important is that you have a faith in people, that they’re basically good and smart, and if you give them tools, they’ll do wonderful things with them.
- Steve Jobs: Rolling Stone Magazine, 1994
In the nearly 20 years since I started medical school, I’ve seen the practice of medicine undergo a wholesale technological transformation. Take medical records as a simple example. I am 100 percent certain that today’s medical students are much slower walkers than me. Why? Because the days of sprinting on rounds to get ahead of the white coat phalanx, pull down a cabinet and open a three-ring binder chart to the next blank page before the intern reaches the door ended a decade ago.
Today’s medical students are instead both blessed and cursed with electronic medical records (EMRs) and patient care technologies that track and trend every aspect of the inpatient and outpatient course, demanding hours of tedious, field-driven data entry while yielding treasure troves of mineable new information.
Watch Dr. DeRienzo talk with HIMSSTV about how the industry is on the precipice of making fundamental improvement in population health with machine learning models.
With technology is now integrated into nearly every aspect of the patient-provider relationship, it’s crucial to note what patient care technology can’t do: it can’t replace our humanity.
No EMR can ease the despair of parents whose child you've just diagnosed with cancer, or with parents-to-be whose baby is being born weeks too early to survive. These conversations require human compassion, and sharing compassion is core to our humanity.
In centuries past, this human-to-human connection was all healthcare had to offer (beyond perhaps blood-letting). As a result, the human connection came to define the practice of medicine from Asclepius to Osler. Today’s technological transformation has opened panoplies of new treatment doors to walk through with our patients, yet too often detracts from instead of supports such a vital part of the practice of medicine as sharing our humanity.
This challenge begs a Jobsian question – can we, with great intentionality, use patient care technology (and specifically the benefits of artificial intelligence as a tool) to actually return some humanity to healthcare?
I truly believe we can in two fundamental ways. First, by serving up connections among data points either too numerous or too vast for people to have previously been able to access – allowing humans to do NEW things. Second, by freeing up people to spend more time connecting with and serving other people and less time on data entry, data discovery and simple sorting tasks – allowing people to do MORE of the RIGHT things.
One of the most valuable lessons I learned in medical school, residency and fellowship training was how to differentiate “sick” from “not sick” and “toxic” from “not toxic.” It's a skill that requires seeing thousands of patients one by one, each with a unique constellation of symptoms, all taking slightly different trajectories in the courses of their illness. Over time, as a doctor’s brain adds more and more examples of patients with a particular disease to her collective experience, clear patterns emerge. For me, each new patient added another set of observations to my mental library, clarifying the tiny variations in history, symptoms, physical exam and laboratory findings that could help predict which patients may take which course.
Once a doctor learns to differentiate “sick” from “not sick” and “toxic” from “not toxic,” it's like wearing glasses for the first time. While the corrective lenses are never perfect – any patient on any day can fool a doctor by looking and sounding fine while being on the verge of imminent disaster – the prescription gets just a little bit better with every patient. But even the best glasses won't bend the laws of physics to let a doctor see a hundred patients on a pediatric ward service or 50 critically ill babies in the neonatal intensive care unit all at once. This leaves even the best doctors always a step behind.
Thankfully it no longer has to be this way. We live in an era of augmented intelligence, where our smartphones use algorithms to guess where we want to go or what we want to say next. The key benefits of artificial intelligence are grounded in this ability to continuously comb the EMR, training on past patients’ trajectories in the same way clinicians are trained and hone the lenses of their own prescription glasses, patient by patient by the millions.
Used in real-time, artificial-intelligence-driven models can predict impending doom by aggregating every bit of information produced by network-connected vital signs monitors, notes, labs and anything else captured by an EMR and predict looming disaster before it happens. As systems like these become increasingly perfected, technologies grounded in artificial intelligence will enable us to extend the lenses of individual clinicians over thousands of patients at once. With the right design, development and deployment approach, the promise of artificial intelligence can offer doctors more opportunities to intervene upstream and prevent a patient’s descent from well to sick or from sick to toxic earlier than ever. Those opportunities to save other people from harm are both uniquely human and uniquely rewarding.
However, to fully realize the power and benefits of artificial intelligence in patient care technology we have to (as Simon Sinek would say) start with “why.” Our central purpose in designing, developing and deploying artificial-intelligence-based patient care technology solutions must be grounded in helping clinicians return to their patients’ bedsides (be they at home or in hospital), and serve them with more connected information, more upstream interventions and more time to spend with the patients who most need their human bond.
Once our purpose is clear, we must incorporate human factors from the outset of design, and continually ask and answer the question, throughout development, how will this tool help humans better serve other humans? Finally, when we deploy, we must avoid layering task upon task and we must measure as directly as possible the impact of our intervention on increasing human-human time and/or decreasing human-screen time. By refocusing our purpose and intentionally approaching the design, development and deployment of new technologies to once again augment the human element in healthcare, I am confident we can realize this shift, however tectonic it may seem.
Like the inimitable Steve Jobs, I have a fundamental faith in people. Once we fully commit to a goal and equip our teams with the right tools and the right approach to reach it, it’s truly amazing what wonderful things they can do.
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Updated April 17, 2019