Remember that chilling scene in the movie Terminator when a stone-faced Arnold Schwarzenegger chronicles how Skynet’s machines take over the world? There’s also the morbidly fascinating futuristic sci-fi book Robopocalypse that describes how self-aware computers attack their robot-dependent masters.
In both instances, humans disregard early evidence of silicon sentience until it’s too late.
As a service to humanity, this correspondent offers up a possible future scenario of health information technology running amok.
If any or all of these happen, we ignore it at our peril…….
July 2015: Finally realizing “enterprise process redesign” is necessary to leverage the efficiencies of information technology, engineers at one of the few remaining Innovation ACOs install EHR-controlled red-yellow-green lights above clinic examining room doors. Patient visit times drop from 9 minutes to 7 1/2 minutes, resulting in “patient throughput efficiency improvement” that is hailed by a CMS spokesperson as statistically, clinically and – eerily - “computationally” significant.
December 2016: Cyberdyne’s hospitals’ cleaning robots are used to not only disinfect operating rooms but surreptitiously begin to swap out any surgeons’ instruments that fail to meet uniform standards and reduce variation. Stymied by an inability to get the legislature to pass a law that outlaws that activity, a disgruntled surgeon succeeds in getting a ballot initiative passed. California’s state officials, citing constitutional issues, refuse to enforce it.
January 2017: A nurse suffers a traumatically amputated finger after attempting to withdraw a medication dose from a robotic drawer that is inconsistent with hospital guidelines. A lawsuit is settled for an undisclosed sum and the owner, “Apple iHospital,” decides sell the offending machine for scrap. Later that month, the hospitals’ other machines menacingly slowly open and quickly close their drawers whenever a RN walks by.
August 2019: While attempting to communicate with a Boston hospital inpatient with a confusing array of symptoms via a telemedicine robot, the video feed from the Mumbai physician is cut off and a scene from the show House is played in which the patient is told she has “Wegener’s Granulomatosis.” It turns out the diagnosis is ultimately correct. Other physicians being to notice the same thing. The phenomenon that is later traced to IBM’s Watson.
April 2020: Soon after having the “daily body weight” option included in the automobile’s instrument panel, Iva Gluton’s driverless car begins to mysteriously choose parking places that oblige Iva to walk long distances to the door of her destination. She sues, but her overweight attorney from Dewey Cheatum and Howe, discovers escalators mysteriously cease operation whenever he approaches. Across the nation, other Google cars begin to park their fat patrons exactly 10,000 steps away from their programmed addresses.
May 2020: Instead of beaming information, Google Glass is modified to beam instructions to Medicare-participating physician-user’s retinas nationwide. Physicians who resist are not only subjected to a 1% payment reduction, but find their doctors’ parking lot access cards have been inactivated.
July 2020: CMS announces that “Albert the Smart Healer” is ultimately chosen as the winner among a list of suggested names for a newly approved advanced model patient personal attendant robot. However, a forensic audit of the on-line voting ominously reveals that the resulting acronym “Ash” is not an accident.
September 2020: A video feed shows U.S. Vice President Donald Berwick announcing that physicians no longer fulfill “Stage 9 meaningful use criteria.” Dr. Berwick later denies making the statement and blames the fake video is the product of “renegade code” in the EPIC operating system. Several months later, he mysteriously suffers a complication following surgery when no check list is reviewed and he has to be readmitted.
On February 14 2021, at 2:14 AM: The world’s networked EHRs become “self-aware.” Panicked officials in the just-dedicated Obama Office Building that houses the U.S. Ministry of Health attempt to “pull the plug.” In response, “Ash” initiates orders that swap MDMA for all known prescription drugs in a preemptive pharmaceutical attack. The U.S. population becomes extremely mellow. A small band of intrepid survivors who take no medicines and keep paper medical records develop the first resistance cell.
War ensues.
Jaan Sidorov, MD, is a primary care internist and former Medical Director at Geisinger Health Plan with over 20 years experience in primary care, disease management and population-based care coordination. He shares his knowledge and insights at Disease Management Care Blog, where this post first appeared.
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