Tuesday, October 14, 2008

electronic medical records, Reece personal musings - A Voice in the Wirelessness

Beware of Geeks Bearing Formulas.

Warren Buffet

In previous blogs, I’ve suggested clinical algorithms, computer-driven best protocols, diagnostic support systems, and electronic medical records aren’t necessarily what they’re cracked up to be, nor do they automatically improve care.

I’ve been a Voice in the Wilderness, or perhaps I should say a voice in the Wirelessness.

In this blog, I pose these simple questions:

• Is it possible that the 85% to 90% of American physicians who failed to install complete EMR systems or to use computer algorithms for diagnostic support know or smell something that geeks have missed.

• Is it possible that computer compulsivity interferes with compassionate care?

• Is it possible you can’t accurately judge or guide quality of care by when or how often a physician uses computers?

Lately I’ve been wondering if parallels exist between the current financial crisis and the clinical crisis, and whether reliance on algorithms contribute to those crises.

In an October 11 New York Times piece, “The Rise of Machines,” Richard Dooling an expert on artificial intelligence vis a via human intelligence, observes:

The Wall Street geeks, the quantitative analysts (“quants”) and masters of “algo trading” probably felt the same irresistible lure of “illimitable power” when they discovered “evolutionary algorithms” that allowed them to create vast empires of wealth by deriving the dependence structures of portfolio credit derivatives.
Is it possible clinical geeks are suffering from this same lure of “illimitable power,” i.e., that you can better cure disease and create health from derivative algorithms rather than on-the-spot conversations and direct observations?
As the current financial crisis spreads (like a computer virus) on the earth’s nervous system (the Internet), it’s worth asking if we have somehow managed to colossally outsmart ourselves using computers. After all, the Wall Street titans loved swaps and derivatives because they were totally unregulated by humans. That left nobody but the machines in charge.

Is it possible that we have outsmarted ourselves by believing artificial intelligence from cyberspace is superior to human intelligence on the ground and that we can regulate care through algorithms?

“The unlimited replication of information is generally a public good…The problem starts, as the current crisis demonstrates, when unregulated replication is applied to money itself. Highly complex computer-generated financial instruments (known as derivatives) are being produced, not from natural factors of production or other goods, but purely from other financial instruments.”

Is it possible that unregulated and unlimited replication of information is not a good thing?

We are still fearful, superstitious and all-too-human creatures. At times, we forget the magnitude of the havoc we can wreak by off-loading our minds onto super-intelligent machines, that is, until they run away from us, like mad sorcerers’ apprentices, and drag us up to the precipice for a look down into the abyss.

Is it possible that those who program, i.e. technocrats and bureaucrats and specialistcrats, these super-intelligent machines have lost sight of the human consequences of their work?

Here’s a frightening party trick that I learned from the futurist Ray Kurzweil. Read this excerpt and then I’ll tell you who wrote it:
But we are suggesting neither that the human race would voluntarily turn power over to the machines nor that the machines would willfully seize power. What we do suggest is that the human race might easily permit itself to drift into a position of such dependence on the machines that it would have no practical choice but to accept all of the machines’ decisions. ... Eventually a stage may be reached at which the decisions necessary to keep the system running will be so complex that human beings will be incapable of making them intelligently. At that stage the machines will be in effective control. People won’t be able to just turn the machines off, because they will be so dependent on them that turning them off would amount to suicide.

Brace yourself. It comes from the Unabomber’s manifesto.

I’m not suggesting clinical algorithms will bring about the doom of clinical medicine, or that there is anything intrinsically evil about them. I’m merely saying that we not get ourselves in the position where we think A.I (Artificial Intelligence) is superior to emotional intelligence and the subtleties of human interaction.

It is possible we can place too much faith in machines and too little in clinical judgment.

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