Self-Driving Cars are Like Most EMRs


Drivers are distracted klutzes and computers could obviously do better. Self driving cars will make all of us safer on he road.

Doctors have spotty knowledge and keep illegible records. EMRs with decision support will improve the quality of healthcare.

The parallels are obvious. And so far the outcomes are disappointing on both fronts of our new war against human error.

I remember vividly flunking my first driving test in Sweden. It was early fall in 1972. I was in a baby blue Volvo with a long, wiggly stick shift on the floor. My examiner had a set of pedals on the passenger side of the car. At first I did well, starting the car on a hill and easing up the clutch with my left foot while depressing and then slowly releasing the brake pedal with my right forefoot and at the same time giving the car gas with my right heel.

I stopped appropriately for some pedestrians at a crosswalk and kept a safe distance from the other cars on the road.

A few minutes later, the instructor said “turn left here”. I did. That was the end of the test. He used his pedals. It was a one way street.

Three times this spring, driving in the dark between my two clinics, I have successfully swerved, at 75 miles (121 km) per hour, to avoid hitting a moose standing in the middle of the highway. Would a self driving car have done as well or better? Maybe, maybe not.

Every day I get red pop up warnings that the diabetic medication I am about to prescribe can cause low blood sugars. I would hope it might.

Almost daily I read 7 page emergency room reports that fail to mention the diagnosis or the treatment. Or maybe it’s there and I just don’t have enough time in my 15 minute visit to find it.

For a couple of years one of my clinics kept failing some basic quality measures because our hasty orientation to our EMR (there was a deadline for the incentive monies to purchase EMRs) resulted in us putting critical information in the wrong “results” box. When our scores improved, it had nothing to do with doing better for our patients, only clicking the right box to get credit for what we had been doing for decades before.

Our country has a naive and childish fascination with novelties. We worship disrupting technologies and undervalue continuous quality improvement, which was the mantra of the industrial era. It seems so old fashioned today, when everything seems to evolve at warp speed.

But the disasters of these new technologies should make us slow down and examine our motives. Change for the sake of change is not a virtue.

I know from my everyday painful experiences that EMRs often lack the most basic functionalities doctors want and need. Seeing a lab result without also seeing if the patient is scheduled to come back soon, or their phone number in case they need a call about their results, is plainly speaking a stupid interface design.

I know most EMRs weren’t created by doctors working in 15 minute appointments. I wonder who designed the software for self driving cars…

Hans Duvefelt is a family doctor in Maine. This piece was first published at his blog A Country Doctor Writes

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2 replies »

  1. I Read your Article which is packed with facts and data. Each point is very well explained.
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  2. My Dad (a WWII surgeon who served a Pre-MASH tent hospital in the Philippine Islands) always ended a discussion about a new car very succinctly, “How reliable does it run from point A to point B?” Color, model, and gadgets were irrelevant when it came to its cost. Similarly, “AI” for an automobile is much different than for healthcare.

    Attending the Scientific Meeting of Academic Health this week, one of the seminar-like presentations was about maternal C-Section rates for nulliparous women. One of the presentations was an evaluation to assess the alignment at several hospitals between the hospital’s administration, medical staff and the birthing unit staff regarding the health care GOALs of the birthing center. The CSX rate at the hospitals with the best alignment was 25% less than for the nulliparous women delivering at the hospitals with the lowest level of alignment with no difference in contributing adversities.

    So, can we really anticipate that “AI” can define and execute the interactional processes during a woman’s labor and delivery to achieve a lower CSX incidence? As a frame of reference, I define a Caring Relationship as follows.

    “A CARING RELATIONSHIP may be defined as a social interaction between two persons, occurring with an evolving purpose, synergy and permanence, that both persons understand as representing a Beneficent intent to enhance each other’s Autonomy by communicating in harmony with Warmth, Non-critical acceptance, Honesty and Empathy.”

    Obviously, there is no “AI” mediated application amenable for enabling a woman’s successful labor and delivery…easily the most complicated human event that occurs within all of human experience (think – a naturally occurring termination of immune tolerance ). Isn’t it really a message that true healthcare reform for its cost and quality must occur with an investment of Social Capital, community by community, to enhance its level of Trust – Cooperation – and – Reciprocity. In addition, Mass shootings, suicide/homicide, obesity, maternal mortality, substance abuse, depression, and social mobility issues will not be solvable without it.

    .Eleanor Roosevelt