American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

From the Directors Desk

Machines and Medicine: Friend or Foe

Heidi Nelson, MD, FACSHeidi Nelson, MD, FACS
Medical Director, ACS Cancer Programs

While we all can appreciate the upsides of having new cancer diagnostics, therapeutics, better screening tools, and less invasive surgical procedures, we probably overlook the downsides of having so much new information to manage. The price we pay for the wealth of new knowledge from the translation of biologic and genetic sciences is information overload, an overload that exceeds our cognitive capacity. While this is a great problem to have, developing new forms of knowledge management has brought yet more burden and is often not well received, as in the case of the electronic medical record (EMR). The prior system of books, libraries, and journals was familiar and comfortable, like an old shoe. Providers read books and journals to build and expand their knowledge base, and this, in turn, was used to deliver on the diagnostic and therapeutic needs of patients.

We are now approaching an inflection point where the extent of new knowledge exceeds our capacity to keep up; perhaps this is why so many of us are pinning our hopes on computers. We expect machines will help us turn narrative clinical text into data that can be stored, retrieved, and then turned into new knowledge, hence the excitement around artificial intelligence and natural language processing (NLP). Unfortunately, there is little to no evidence that NLP can make data out of narrative clinical text. Instead, it seems increasingly apparent that if we want to take advantage of computers for knowledge management, providers will have to contribute clinical information in some kind of standardized format that computers can manage as data. Just as our predecessors had to agree on the grammatical rules and definitions for communicating with each other using the written word, we will now have to agree on how best to communicate and interact with computers. While programming can take place behind the scenes, clinicians will still have to agree on, and accept, some standardized approaches for communicating medical care.

The EMR has been an important first step in the direction of organizing medical information, but so far it has felt like a foe. The next step is to layer “just in time” information on top of the EMR in ways that provide readily accessible and meaningful up-to-date cancer knowledge, while at the same time facilitating the capture of vital cancer information in a standardized format. It is our aspiration that this tradeoff of just-in-time information and standardized formatting will be the user-friendly approach that brings us closer to a computer-assisted information management system for staging and cancer surgery standards.

There is much to say on this critical, complex topic, so stay tuned for more on the subject in future issues of Cancer Programs News.