2084

Americans have a lively faith in the perfectibility of man, they judge the diffusion of knowledge must necessarily be advantageous, and the consequences of ignorance fatal; they all consider society as a body in a state of improvement.

Alexis de Tocqueville (1805-1859), Democracy in America

Centerware

It’s 2084.   Everything has its place, and there’s a place for everything.   Everything is digitized. Everything is rational. Everything is transparent.  Everything is comprehensive. 

Everyware information technology reigns.  Hardware and software  are everyware.  Everyware judges quality, efficacy, efficiency, optimumability , acceptability, equity, and costs.  As far as the eye can see and the mind can grasp, there are devices, apps, algorithms, protocols, and guidelines.    

Everything is systematized.   Everywhere every aspect of health care is  precisely predictable, ideally  structured,  with rigid processes in place,  with machine predetermined  outcomes .   

Everything can be made  virtual.  All knowledge is accessible. If  you can’t get it yourself, drones will bring it to you.  Every patient is empowered  with universal digital knowledge.   Everyone can monitor themselves, or be monitored by others  from afar.  

Everything is integrated. Everybody is interconnected to the nth degree. All electronic health records are interoperable.  Interdigitation  rules the land.

Physicians are cogs in machine,  responsive and responsible only to the data systems they must feed and  that guides them.

Data is language.  Collectivism is individualism.  Artificial intelligence is king.

And Big Brother,  Big Sister,  Little Brother, and Little Sister are watching you, guiding you, and directing you to a more perfect world.

To err is human,  to forego data malign.

Edgeware

If you are designing a machine, you had better think of everything because a machine does not think of everything.

B.Zimmerman, C. Lindberg, P.Pisek, Edgeware: Insights from Complexity Science for Health Care Leaders, 1998

Edgeware followers  beg to differ from Centercare  cognoscenti.    The Edgeware crowd maintains health care  realities  and human relationships are  so complex that there is  not a place for everything,  and not everything has a place.  

Data cannot predict everything,  and humans must  always have freedom of choice outside the sphere of data  at the end of the data rainbow. 

Humans are not perfect.   Nor are their  machines.   Humans have souls.   They live at the edge of humanity, where human disagreements, gossip, and desire for change  exist at every level of human activity.  

Humans are  imperfect.  That’s what makes them unpredictable and  changeable - and human.  

Edgewarians do not have perfect vision, but  it’s good enough for human consumption,  and they do not need to know every detail in advance  or from the past.    They are tuned to the edges of reality.  They  can build a good-enough vision and follow minimal standards rather than trying to work out every detail.  

They like to go for  multiple actions and to test every human  action  at the fringes, letting the right direction emerge  rather than believing they  must be sure before proceeding with anything. 

They like to “chunk,”  trying small things out of simple actions that work well independently rather than listening to the machine.   

Doctors like to  listen to  patients, and patients to their doctors, with both acting in  collaboration and cooperation with each other rather than blindly listening to some higher authority or digitally-driven machine.

To err is human, to go offline is benign.