More thoughts on the "Fundamental Theorem of Medical Informatics"

Okay, I couldn’t help but think about this theorem a bit during the day. Here are some of my thoughts:

  • Corollary #1 identifies an intelligent user. I suppose there is an inherent idea that the user is a health care professional of some sort. Friedman provides a bit more detail and describes intelligent user as “what the person knows about the particular problem at hand”. It’s interesting that he also points out that the theorem does not hold “in the two extremes”. So, if you know nothing about the “problem at hand” (which could be a new patient), this theorem does not hold. Interesting. I think I might have to disagree.
  • Corollary #2 states that the technology must be able to “tell the user something he/she does not already know”. This statement is another one that intrigues me. One of the greatest advantages of technology isn’t so much that it can do things humans cannot do. Computer technology provides a means of easily performing manual and computational tasks. The result is that users now seemingly can do things we could not do in the past. Does this mean that the technology tells me something that I don’t know already? I would probably rephrase this to something like “technology must be a resource that allows a user to do things much more efficiently and effectively, and should provide access to information that was not previously readily accessible”. I highly doubt that a computer “knows” anything except that which is distilled by human experience and knowledge. And, the technology itself doesn’t tell us anything – it’s the content that users must interpet and apply.
  • Corollary #3. I’m not sure if I agree or disagree with this one. It’s the word “unpredictable”.

Given these issues, I think I would restate the corollaries a bit:

  • People define the problem, needs and context for the use of the technology.
  • Technology provides a more efficient means of accessing, identifying, and manipulating information than a human user could.
  • People using technology (i.e., people + technology) creates a socio-technical interaction that facilitates new (to the user) knowledge creation that was not practically achievable independently.
  • Result: people + technology > people alone

Again, I support the overall theorem, but wanted to tweak the corollaries a bit to be more general to encompass the facets of ehealth. I suppose at the end of the day, I conceptualize the technology as a tool to extend the capabilities of people. Is this an ehealth theorem? No clue.

Oh yeah, I have one more criticism of the original theorem. What if the information available to the user via the technology is flawed in some way? In this case, having this “flawed” information is worse than not having the information. That’s why in my revised corollaries, I wanted to describe the technology with no positive or negative attributes – it simply does what it does. Interpretation is left up to the user, be it patient or practitioner. Eysenbach has done some research examining if health information on the Internet causes harm. We need to be vigilant to test and question the information that we receive.