LOADING… PLEASE WAIT…. LOADING…. PLEASE WAIT….LOADING…PLEASE WAIT
Yesterday morning, our hospital’s EPIC system went down. It was a partial outage which only impacted those of us outside the hospital. Most of our town’s specialists and local docs are now hospital employees. That means they only work in EPIC and only communicate to the rest of the non-hospital owned patient doctors through EPIC.
So, those of us outside of the hospital can’t see our patients’ hospitalizations unless we access EPIC through something called EPIC Carelink. But we can’t get those records because EPIC is giving us a big circling “wait” sign. Was there a lung nodule needing follow-up? Were there other issues that need addressing? We have no idea. It’s locked in the system.
Was EPIC hacked? Did the database get hit with Ransomware? The more vague these companies are, the more suspicious I get!
After about 24 hours, the system was back up and running. That may sound relatively fast, but not when you realize how many patient decisions you’ve made without adequate data.
Medicine is a business run by businessbots with large salaries and a value/compensation ratio of zilch. Doctors are lesser bots in white coats who are rewarded for serving the Business System by acting as intermediaries whose true tasks and rewards are directed and calibrated toward maximizing the flow of money from the otherwise redundant and worthless Insurance Enterprise to the Healthcare Enterprise. Etc. Yes, I am retired …
There are too many things to point out about algorithmic medicine and the doom of the profession of physician, to even touch on them here. Were I running a medical school, I’d make it a mandatory course to understand the SECI model of knowledge dimensions. (see Nonaka-Takeuchi modelThe comprehension of the principle of tacit knowledge as a working set of resources in the professional’s experience is ignored by algorithmic medicine.
Computers cannot comprehend any information which cannot be reduced to numerical representation. This is called explicit knowledge. But this is only one of a set of ways to approach the knowing of practical things, and it takes tacit knowledge to know which approach is appropriate in any case of patient illness.
The push to computerize things involves the embedding of many wrong assumptions into the production of numerical representation of findings. One example is the push of all numbers into the assumption that they obey ratio statistics, when actually statisticians classify statistical objects into types: nominal, ordinal, interval, and ratio scales. (see types of data here.) Things such as the BNP are very useful measures of heart function, if they are considered in terms of their appropriate statistical type. I have seen management of heart failure using the BNP as futile attempts to quantify improvement in patient care.
These bad assumptions are baked solid into the superstition of medical statistics and knowledge. Until someone can contemplate the nakedness of the emperor, it will just get worse. There are so many examples of this! But until there is genuine contemplation that the computerized medical record has not yet shown its fundamental utility to the art of medicine, we will play along, and continue the process of degradation through improvement. “I did everything right, but the patient died.” is a buzz-phrase of the times.