Electronic Medical Records: Computers versus the Human Mind

In the blogging world, one pays courtesies and tributes to other bloggers by mentioning and praising their blogs. One of the most successful, and perhaps the most widely read blog, is The Health Care Blog, created by Matthew Holt in San Francisco in 2003, for the purposes of spreading the word among policy wonks about how to improve and reform the health system.

Matthew invites other bloggers and thought leaders to submit provocative and informative blogs. These blogs often relate to the role of information technologies in transforming health care into a more transparent system wherein patients, health consumers, patients, and other stakeholders can communicate more freely and openly with one another.

On February 1, Kent Bottles, MD, a pathologist and physician executive, who now serves as president of the Institute of Clinical Systems Improvement in the Minnesota and Wisconsin, published a piece dubbed “Checklists and Decision Trees versus Spontaneity and Imagination.” For years, a decade at least, the Institute has aggregated data from best practices from across the Midwest and embedded the data into its database. So Dr. Bottles know of what he speaks.

Here is the lead paragraph in his blog, as published in The Health Care Blog,
February 01, 2010

Check Lists and Decision Trees versus Spontaneity and Imagination

"The task of health care reform in 21st century America is to decrease per-capita cost of care and to increase the quality of care delivered to patients. It’s complicated. A famous Rand study concluded that Americans only receive 55% of the care that science dictates. Patients intuitively believe that more health care is always beneficial. Medicare reformers would like to do comparative effectiveness research so that CMS and private insurers could wind up paying only for therapy that actually works. Some estimate that 30% of all care delivered in the United States is waste. What some call waste, others label revenue, and Atul Gawande becomes famous for identifying waste/revenue in McAllen, Texas."

Dr. Bottles comes down on the side of human spontaneity and imagination as a necessary adjunct to computer-directed medical practice.

My Comment

Here is my comment on his eloquent essay on The Health Care Blog, which I recommend that you read,

I would like to thank Kent Bottles for questioning traditional wonk wisdom – namely, that if the “system” adopts enough protocols, check lists, best practices, and comparative effectiveness results, all will be well. I am amazed superb minds – like those possessed by Atul Gawande, Barack Obama, and Peter Orszag in the world of eclectic pragmatism – would fall for the argument of dogmatic electronic simplicity.

As Alfred North Whitehead, the English philosopher said, “ Seek simplicity, but distrust it. “ I agree with Kent,”We need imagination and spontaneity because we are human and because not all situations and not all patients follow protocols.” Life’s too complicated for computers to explain.

To conclude,

Good for you, my fellow pathologist, Doctor Kent Bottles,
President of the Institute for Clinical Systems Improvement,
For questioning the wisdom of applying systems, full throttle,
And for doubting aspects of the checklist and protocol movement.

We need more, not less, imagination and spontaneity.
We need more creative and flexible human noodling,
And less dependency on computer homogeneity,
And less deification of impersonal googling.


Dr. Richard Reece is author of Obama, Doctors, and Health Reform (IUniverse, 2009) and Innovation-Driven Health Care (Jones and Bartlett, 2007) Both book are available at www.iuniverse, amazon.com, barnesandnoble.com and other book websites . Dr. Reece blogs at medinnovationblog. blogspot.com.