… Medicine, our most intimately human profession, is being dehumanized by the entry of the computer into the exam room. While computers are preventing many medical errors, they are also causing new kinds of mistakes, some of them whoppers. Sensors and monitors are throwing off mountains of data, often leading to more cacophony than clarity. Patients are now in the loop – many get to see their laboratory and pathology results before their doctor does; some are even reading their doctor’s notes – yet are woefully unprepared to handle their hard-fought empowerment.

In short, while someday the computerization of medicine will undoubtedly be that long-awaited “disruptive innovation,” today it’s often just plain disruptive: of the doctor-patient relationship, clinicians’ professional interactions and workflow, and the way we measure and try to improve things. I’d never heard the term “unanticipated consequences” in my professional world until a few years ago, and now we use it all the time, since we – yes, even the insiders – are constantly astonished by the speed with which things are changing and the unpredictability of the results. …

The wiring of healthcare is proving to be The Mother of All Adaptive Problems. Yet we mistakenly treated it as a technical one: simply buy the computer system, went the conventional wisdom, take off the shrink-wrap, and flip the switch. We were so oblivious to the need for adaptive change that we usually misdiagnosed the problem after failed installations, mangled workflows, and computer-generated mistakes; sometimes we even blamed the victims, both clinicians and patients. Of course our prescription was wrong – that’s what always happens when you start with the wrong diagnosis.