Reflecting on Nortin Hadler's "Missing the Forest For the Granularity"

I read Nortin Hadler's Missing the Forest For the Granularity (July, 2014) on The Health Care Blog with great interest. The article draws attention yet again to the risks and preoccupation with processes and systems. This provides me with another opportunity to highlight the 4P's within Hodges' model: Process, Policy, Practice and Purpose and add some of the points that Dr Hadler addresses.

The 4Ps by themselves might have meaning but they can't do work. For that we need a context and several perspectives. As Dr Hadler points out big data intrudes on the clinical encounter determining not just what is collected, but how it is captured and structured.

There are frequently two datasets at the practitioner level: one is administrative and managerial in form and purpose; the other is clinical - patient, person centered. Effective communication already presents a challenge. On top of that then how relevant are the IT systems. The holy grail of IT systems still seems to be benefits for clinicians and patients - the public. Until then will the IT continue to push the patient-clinical relationship as if it is some wobbly toy? You bet it will!

Where exactly should the “Physician’s Dashboard” reside? Is it a case of "the ayes have it" but only on the right?

Nortin also refers to the United States postponing ICD-10. From Wigan Pier I clearly do not understand the issue, but this seems from here more like a very prolonged delay. A delay that perhaps says more; not just about the healthcare 'system(s)', but the many interfaces to be found there.

Many thanks to Dr - Prof. Hadler for his article:
https://thehealthcareblog.com/blog/2014/07/11/missing-the-forest-for-the-granularity/

individual
INTERPERSONAL : SCIENCES

humanistic ------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

group

“cognitive” specialists, the care of the patient revolves around the “granularity” of the narrative. PURPOSE individual attention and focus ability to share purposes  Using individual differences and idiosyncrasies	patients as widgets (here)? Can you see the dashboard here? PROCESS  data gathering big data, ICD-10 Electronic Medical Record -  templates and “smart sets”
PRACTICE Patient - BIG DATA - Doctor relationship  empathy 'NOISE' empathy life-course (“social”) epidemiology	POLICY Europe, health care systems, United States, health economists, hospital administrators, patients as “units of care”, physicians as “providers”, clinical demand = “throughput.” common denominators invoicing