When you walk into your physician’s office for treatment, what do you expect from your doctor? You assume she is current on the latest medical information and that your care will be the best available. Or you may hope this is the case but do not have an excellent way to know.
In reality, clinicians make medical decisions using implicit criteria—hidden internal knowledge from experience and intuition—rather than explicit criteria, external, up-to-date knowledge that can be checked, evaluated, and updated. Journal articles written by one researcher after another cite proof of glaring, unacceptable variations in how healthcare is provided and shed light on glaring regional disparities. Dr. John Wennberg, a professor at Dartmouth, devoted over four decades to the study of variation in care. He founded the Dartmouth Institute for Health Policy and Clinical Practice, the producer of the Dartmouth Atlas, a compendium of medical resources documenting care in the U.S.
Access 21st Century Information
Many providers are not taking advantage of twenty-first-century technologies to access twenty-first-century information, instead choosing to provide care the same way in which they were initially trained. Let me be clear: I am not calling out physicians, nurses, and other clinicians for not doing their best. They are, and I fully trust my caregivers. But we are not giving them the information technology tools they need to deliver the best care. It is impossible for any human being to keep up with the rapid change in medical knowledge. And it is time we stopped fooling ourselves that we can.
We must change from a paper-based system in which most clinical decisions are made primarily by gut-level or recalled judgments to a system driven by data- and evidence-based knowledge. I do not advocate replacing human knowledge and experience; rather, augmenting it with the many advanced technologies at our disposal. And undoubtedly, artificial intelligence embedded in a well-designed electronic health record that facilitates clinical workflow is an example.
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