Clinical Technology Decisions
Chapter 9 Bedside Questions · 9 questions · about 9 minutes
Clinical decisions (CDS logic, order set defaults, documentation architecture, AI deployment, alert burden) are made daily by analysts, IT, compliance and vendors without clinical informatics authority. The role is missing, rented, or demoted, or assigned to the wrong executive (CMO, CNIO, CIO) or an untrained physician, a specialty-matching failure.
The unlicensed prescriber and scope of practice: an administrator giving a pain medication produces a flinch at the bedside, but no one flinches when an analyst configures an order set. Medicine solved this with scope of practice; clinical technology has none.
Answer as your executive team would, with the evidence in hand. Each question has a factual answer in a system you already own.
For your top ten CDS rules, name the clinical leader (a person, not a committee) who approved the current configuration.
Add a note: where is the evidence, or who owns it?
Who chose the defaults in your three highest-volume order sets, and when were they last reviewed against evidence?
Add a note: where is the evidence, or who owns it?
Who has authority to switch off a deployed algorithm, and have they ever used it?
Add a note: where is the evidence, or who owns it?
Is anyone accountable for total interruptive burden per clinician per shift as a single measured quantity?
Add a note: where is the evidence, or who owns it?
Write one sentence each on which clinical technology decisions belong to the CIO and which to the clinical informatics leader. If the lists overlap or cannot be produced, there is no boundary.
Add a note: where is the evidence, or who owns it?
Walk one unit for an hour and count workarounds (taped barcode, shared login, parallel spreadsheet, sticky note).
Add a note: where is the evidence, or who owns it?
In the last year was the clinical informatics leader in the room when capital was allocated, not briefed afterward?
Add a note: where is the evidence, or who owns it?
Which posture describes you: not treating, treating at home, or treating as a minor complaint?
Add a note: where is the evidence, or who owns it?
What is the actual reason you have not built this function? If cost, recheck Chapter 8 and find the real answer.
Add a note: where is the evidence, or who owns it?
A reflection tool from the book, not a validated diagnostic test or benchmark. Your answers and notes stay in this browser unless you choose to send them. Please don't enter patient information.
We are arguing over a rounding error while the patient bleeds to death.
The Diagnostician, Chapter 9