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This book describes an overlooked solution to a long-standing
problem in health care. The problem is an informational supply
chain that is unnecessarily dependent on the minds of doctors for
assembling patient data and medical knowledge in clinical decision
making. That supply chain function is more than the human mind can
deliver. Yet, dependence on the mind is built into the traditional
role of doctors, who are educated and licensed to rely heavily on
personal knowledge and judgment. The culture of medicine has long
been in denial of this problem, even now that health information
technology is increasingly used, and even as artificial
intelligence (AI) tools are emerging. AI will play an important
role, but it is not a solution. The solution instead begins with
traditional software techniques designed to integrate novel
functionality for clinical decision support and electronic health
record (EHR) tools. That functionality implements high standards of
care for managing health information. This book describes that
functionality in some detail. This description is intended in part
to be a starting point for developers in the open source software
community, who have an opportunity to begin developing an
integrated, cloud-based version of the tools described, working
with interested clinicians, patients, and others. The tools grew
out of work beginning more than six decades ago, when this book's
lead author (deceased) originated problem lists and structured
notes in medical records. The electronic tools he later developed
led him to reconceive education and licensure for doctors and other
health professionals, which are also part of the solution this book
describes.
Knowledge Coupling discusses the premises upon which the coupling
of knowledge to every action is based in the practice of medicine,
as well as why these premises must change. In concrete terms, the
volume explores the methods of structuring and using medical
knowledge and medical records that enables implementation of new
premises; it sets forth a specific approach to use of the computer.
The work examines the new roles and skills that will be demanded of
both patients and health care providers within the system based on
these new premises. The author takes into account the broad
implications of his philosophy for the social, economic,
educational, and political structuring of the health care system.
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