Are computers evil?

One element of writing any long form is to transpose the reader “into the moment”. Therefore, the author explains the imagery, gives a brief background of the characters, and it often unfolds like a movie. The key element is the “human story”. Few authors have mastered it like Atul Gawande has done.

In a brilliant write up on electronic medical records, he’s mentioned about the travails of end users- how a giant corporation parachuted itself into the thick of federal payouts and how there is a general lack of interoperability. It is a fascinating read (and a template) for budding writers without getting swayed by the message. The important takeaway is the medium.

There is a general refrain that EMR’s is a time sink and reams have been written about how the patient-doctor relationship has been affected by the screen time. It also highlighted medical scribes. Last but not the least- open API’s and an emerging trend for “app stores”.

I am genuinely baffled with the timing of the story. I have been following his work, and he’s not singled out EMR’s at all. Does it have to do with his appointment in an Amazon owned subsidiary? Is there a conflict of interest?

Amazon’s healthcare ambitions are not hidden. They plan to upend the system of patient movement in the manner they deem fit and push towards home care model. The healthcare system in the US is complex with a thick fatty layer of bureaucracy that it would be impossible to “simplify” the discussion. However, I see a repetitive trend of bleating around “accessibility”/ diversity and fancy catchy marketing terms in the glitzy conferences.

EMR’s are inherently an excellent idea- provided they can harness the collective mindset of the organisation centred on patient care. However, as I have mentioned here, repeatedly if you take out the design component (UI/UX) it would suffer the fate like anything else. Again, a top-down approach wouldn’t work. It is critical (and essential) to get the stakeholders (and end users) to change the design process to achieve end goals efficiently.

Enterprise goals are difficult to achieve as there is no one size that fits all. Unless the EMR can undergo a “hack” from the end users, it would cannot meet the expectations. A centralised system with inevitably fails or be propped up to push through inefficiencies because it is too big to fail. We require a modular approach- silos that connects to the larger whole. Interestingly, it is doable with the right approach.

I know it won’t be done!