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“61% of physicians felt their EHR improved the quality of care they delivered to patients, but only 1 in 3 said it had improved their job satisfaction, and 1 in 5 said they would go back to paper if they could.

Tellingly, the more advanced the EHR; for example, systems that offered reminders, alerts, and messaging capability, the greater the unhappiness.”
― Robert Wachter, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age

“We have Dragon dictation software', one primary doctor said, 'which you have to be careful of, because, I just dictated: "patient's prostate is bothering him" and it turned out: "patient's prostitute is bothering him.”
― Robert Wachter, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age

“You can keep the Office of Personnel Management records, I don't need Electronic Health Records, give me the metadata, big data analytics and a custom tailored algorithm and a budget and during election time, I can cut to the psychological core of any population, period!”
― James Scott, Senior Fellow, Institute for Critical Infrastructure Technology

“Medical devices and EHR systems are notoriously vulnerable to remote compromise”
― James Scott, Senior Fellow, Institute for Critical Infrastructure Technology

“The program is grounded in 10 design principles, the aim of which is to create innovative solutions to intractable health problems....In other words, do not be content with the status quo. The remaining principles include several obvious but often overlooked themes in routine patient care: value each person, be human, be human-centered, codesign, facilitate connections, treat with dignity, and provide a stage from which the hardest, most important stories may be told.”
― Paul Cerrato, Realizing the Promise of Precision Medicine: The Role of Patient Data, Mobile Technology, and Consumer Engagement

“In nature, ecosystems consist of fauna and flora, climatic characteristics, soil conditions, geologic features, and a host of other interacting influences. Similarly, the precision medicine ecosystem is made of many interacting components, including patients, clinicians, researchers, laboratory services, CDS software, genomic databases, smartphones, servers, claims data, mobile apps, biobanks to store clinical specimens, and EHRs. EHRs need to serve as gateways to this ecosystem. And for the EHR to become an effective conduit, it needs a way to organize these diverse sources in a way that lets clinicians and patients make more effective diagnostic and treatment decisions.”
― Paul Cerrato, Realizing the Promise of Precision Medicine: The Role of Patient Data, Mobile Technology, and Consumer Engagement

“Using this technique, Baum et al constructed a forest that contained 1,000 decision trees and looked at 84 co-variates that may have been influencing patients' response or lack of response to the intensive lifestyle modifications program. These variables included a family history of diabetes, muscle cramps in legs and feet, a history of emphysema, kidney disease, amputation, dry skin, loud snoring, marital status, social functioning, hemoglobin A1c, self-reported health, and numerous other characteristics that researchers rarely if ever consider when doing a subgroup analysis. The random forest analysis also allowed the investigators to look at how numerous variables *interact* in multiple combinations to impact clinical outcomes. The Look AHEAD subgroup analyses looked at only 3 possible variables and only one at a time.

In the final analysis, Baum et al. discovered that intensive lifestyle modification averted cardiovascular events for two subgroups, patients with HbA1c 6.8% or higher (poorly managed diabetes) and patients with well-controlled diabetes (Hba1c < 6.8%) and good self-reported health. That finding applied to 85% of the entire patient population studied. On the other hand, the remaining 15% who had controlled diabetes but poor self-reported general health responded negatively to the lifestyle modification regimen. The negative and positive responders cancelled each other out in the initial statistical analysis, falsely concluding that lifestyle modification was useless. The Baum et al. re-analysis lends further support to the belief that a one-size-fits-all approach to medicine is inadequate to address all the individualistic responses that patients have to treatment. ”
― Paul Cerrato, Reinventing Clinical Decision Support: Data Analytics, Artificial Intelligence, and Diagnostic Reasoning

“Since the 19th century, medicine has focused on specific disease states by linking collections of signs and symptoms to single organs.... Systems biology and its offspring, sometimes called Network Medicine, takes a more wholistic approach, looking at all the diverse genetic, metabolic, and environmental factors that contribute to clinical disease. Equally important, it looks at the preclinical manifestations of pathology.

The current focus of medicine is much like the focus that an auto mechanic takes to repair a car. The diagnostic process isolates a broken part and repairs or replaces it.... Although this strategy has saved countless lives and reduced pain and suffering, it nevertheless treats the disease and not the patient, with all their unique habits, lifestyle mistakes, environmental exposures, psychosocial interactions, and genetic predispositions.”
― Paul Cerrato, Reinventing Clinical Decision Support: Data Analytics, Artificial Intelligence, and Diagnostic Reasoning