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What each chapter covers

• Introduction: Naming Healthcare's Disease. Why two decades of technology spending have not fixed American healthcare. The problem is a missing diagnosis and no accountable physician leader, not a shortage of technology.
• Chapter 1: The Chief Complaint, History, and Physical. How technology chosen by vendors, mandates and executive impulse degrades the visit between clinician and patient, and the cascade that follows: cognitive load, safety risk, quality drift and lost money.
• Chapter 2: Vital Signs of an Operating System. Reading hospital operating metrics such as boarding, length of stay and staff turnover the way a physician reads vital signs: as warnings to investigate, not numbers to chase with targets.
• Chapter 3: Laboratory Markers of Survival. The money. Where America's $5.3 trillion goes, why operating margin is a symptom rather than a diagnosis, and how documentation, quality payment and technology costs drive it.
• Chapter 4: The EHR: An Imaging Modality for Information. Why the electronic health record is a diagnostic instrument, not a cure, and why organizations that spent hundreds of millions on go-live never funded the people who make it pay back.
• Chapter 5: Hemolyzed Specimens: When the Data Are Corrupt. Data quality. How numbers pass through six to eight unowned transformations before an executive sees them, and what corrupt data cost in denials, rework, burnout and unreliable AI.
• Chapter 6: Iatrogenic Harm: When the Treatment Causes Harm. Patient harm caused by health IT itself: alert fatigue, wrong-patient orders, missed results and algorithm errors, and why no one in most hospitals owns technology safety.
• Chapter 7: The Multidisciplinary Care Conference: Team Medicine. Governance. Why parallel executive committees produce minutes instead of decisions, and how the tumor board model of one chair and one written plan applies to running a health system.
• Chapter 8: Investing in the Diagnostician: Name, Form, and Function. The economics of the CMIO role. Roughly 7 in 10 hospitals have the title, few give it the conditions to work, and the chapter prices a real informatics program against $867.5 billion a year in measured waste.
• Chapter 9: Clinical Technology Decisions: Who Should Make Them. Who should decide alert logic, order sets, documentation and AI deployment, and why clinical decisions made by analysts and vendors need the same scope-of-practice rules as medicine.
• Chapter 10: A Discipline in Disarray (The Profession of Clinical Informatics). The profession behind the title: board certification, the many routes to becoming a CMIO, and why so few of them produce the physician leader organizations need.
• Chapter 11: The Working Diagnosis (Making a Commitment). Committing to a diagnosis in writing. Why vendor choice explains little of EHR safety performance, why clinicians spend nearly 2 hours in the EHR for every hour with patients, and what fragmented governance costs.
• Chapter 12: Clinical Decision Support (The Impact of Crying Wolf). Alert fatigue. Override rates as high as 96%, alert libraries that grow without owners, and how to aim decision support at the orders most likely to cause harm.
• Chapter 13: Artificial Intelligence Is Here: Reading the Label. Clinical AI that reached patients without trials, with 96.5% of AI devices cleared through the FDA's 510(k) pathway, and how hospitals should validate, monitor, own and stop it.
• Chapter 14: Telehealth and Digital Health: The Route of Administration. Telehealth as a route of administration: who it reaches and who it misses, where remote teams improve outcomes, and the Medicare flexibilities set to expire at the end of 2027.
• Chapter 15: The Clinical Method Applied: Caring for a Patient. A full worked case: running a health system improvement the way a physician works up appendicitis, from history and examination to a written diagnosis, orders, follow-up and maintenance.
• Chapter 16: The Prognosis: Comorbidities Arriving on Schedule. Four pressures arriving on schedule: value-based payment, AI outpacing governance, a physician shortage of up to 86,000 by 2036, and the national interoperable record, and why each one depends on informatics.
• Chapter 17: Referral to a Higher Level of Care: The National Infrastructure for the EHR. The national problems no single hospital can fix: patient identity, a common clinical language and a record that follows the patient, and what the HITECH Act got wrong.
• Conclusion: The Discharge Plan. What recovery looks like a few years out: what to do now, what to do over time, and the warning signs that progress has stalled.
• Appendix A: The Six Conditions for the Diagnostician. A ten-minute screen that scores whether an organization has a working informatics function or only the title.
• Appendix B: The Comprehensive Informatics Assessment. The full examination: thirty-five items across seven informatics domains, an afternoon's work that produces a map of where the organization is sick.
• Appendix C: The Burden of Healthcare's Financial Disease Calculator. A worksheet that converts the national figures into what the absence of a working informatics function costs one organization each year.
• Appendix D: The AI Model Inventory. One form for every AI model in use: owner, local validation, monitoring and stopping rules. A form that cannot be completed is the finding.