Saturday, January 23, 2016

Techno-Optimists’ Health Care Dream
Health care techno-Optimists share  a dream  - that computers and megadata  will  result in a low cost, quality, universal,  rationale  health care system  – free from emotional content, free from ethical content, and free from political content.
I have always thought this dream was half-baked.    In my mind,  it has ignored the humanistic,  individualistic, political  sides of humankind  and of the infinitely varied aspects of the patient-physician relationship.  There’s more to life and health than data.
But now, after reading John von Neumann: the Scientific Genius Who Pioneered the Modern Computer, Game Theory, Nuclear Deterence, and Much More, by Norman Macrae (Pantheon Books, 1992), I am not so sure.  “Much more” included von Neumann’s roles in developing the atomic bomb ,  in founding computer science, and predictions that computers could control the weather,  prevent global warming,  and rationalize economic growth.
John von Neumann (1903-1957) was a Hungarian immigrant, a PhD mathematician,  and one of a group  of  Jewish European  physicists  and mathematicians selected for the Institute of Advanced Study at Princeton  in its 1930 founding.
Above all,  “Johnny,” as he preferred to be called,  was “fast.”  He was always four steps ahead of everybody else.  He could multiple two 8 figure numbers in his head and instantly come up with the correct answer.    He could reel off  off-color jokes in 5 languages.  He had a photographic memory,  and at the drop of a hat, could recite chapter and verse everything he had ever read.
 He could quickly “mathematize”almost anything – the movement of molecules and atoms,  the implosive device for the atomic bomb,  and  the behavior of humans in  economics, world events,  and games like poker and chess, and in an instant , write equations to verify his solutions.  He believed  mathematical rigor one was key  to economic, philosophical, and social science solutions.    He was an American  patriot and a staunch believer in  United States democracy, and its capacity to do good and to fend off and defeat its enemies.
Were he alive today,  I believe he would be a consultant to the U.S. government and to private health care firms on how to improve health care via mathematics and computer theory   In his 1944 book, Theory of Games and Economic Theory,  he and his co-author, Oscar Morganstern,  discussed  conflict and cooperation between intelligent rational decision-makers in economics, political science, and psychology, as well as logic, computer science, biology and poker. Originally,  the book  addressed zero-sum games, in which one person's gains result in losses for the other participants. Today, game theory applies to a wide range of behavioral relations, and is now an umbrella term for the science of logical decision making in humans, animals, and computers.
Today  von Neuman would sit on the board or be a consultant for the Fast Health  Interoperability Resources (FIHR) project.   Its aim is to implement health care megadata through simple easy to understand human computer  interfaces.    The idea is to render health care more rational and less costly and more effective.    FIHR has the backing of such giant health care vendors as Athenahealth ,  Cerner, and Epic and a host of interested  major health care organizations, involved in a related Argonaut project, including,

·         Athenahealth

·         Cerner

·         Epic

·         Intermountain Healthcare

·         Mayo Clinic

·         MEDITECH

·         McKesson

·         Partners HealthCare System

·         The Advisory Board Company

The major  obstacles to FIHR implementation  are cultural  and political  not technical.    Two major  players in the health system  - hospitals and physicians   have not yet  bought into the FIHR concept,  perhaps because they think FIHR would be too disruptive for their interests.   And CMS has abandoned its efforts to implement  Meaningful Use, stage 3, of EHRs because of physician resistance and refusal to adopt MU3.   
In a recent The Health Care blog,  “FIHR: The Last, Best Chance to Achieve Interoperability,”  David Shaywitz,  MD (Harvard) and PhD (MIT), asks   “Can an  impassioned band of savvy, battle-tested save our health system from its worst instincts?   Shaywitz hopes so.  So, I believe,  would von Neumann.   Hope sometimes ends in depair, but sometimes it is the light before the dawn.




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