Health care tech – The Health Care Blog

Implementation May Be a Science, But, Alas, Medicine Remains an Art

Apr 11, 2023

By KIM BELLARD

I’ve been working in healthcare for over forty (!) years now, in one form or another, but it wasn’t until this past week that I heard of implementation science. Which, in a way, is sort of the problem healthcare has.

Granted, I’m not a doctor or other clinician, but everyone working in healthcare should be aware of, and thinking a lot about, “the scientific study of methods to promote the systematic uptake of research findings and other EBPs into routine practice, and, hence, to improve the quality and effectiveness of health services” (Bauer, et. al).

It took a JAMA article, by Rita Rubin, to alert me to this intriguing science: It Takes an Average of 17 Years for Evidence to Change Practice—the Burgeoning Field of Implementation Science Seeks to Speed Things Up.

It turns out that implementation science is nothing new. There has been a journal devoted to it (cleverly named Implementation Science) since 2006, along with the relatively newer Implementation Science Communications. Both focus on articles that illustrate “methods to promote the uptake of research findings into routine healthcare in clinical, organizational, or policy contexts.”

Brian Mittman, Ph.D., has stated that the aims of implementation science are:

“To generate reliable strategies for improving health-related processes and outcomes and to facilitate the widespread adoption of these strategies.
To produce insights and generalizable knowledge regarding implementation processes, barriers, facilitators, and strategies.
To develop, test, and refine implementation theories and hypotheses, methods, and measures.”

Dr. Mittman distinguished it from quality improvement largely because QI focuses primarily on local problems, whereas “the goal of implementation science is to develop generalizable knowledge.”

Ms. Rubin’s headline highlights the problem healthcare has: it can take an alarmingly long time for empirical research findings to be incorporated into standard medical practice. There is some dispute about whether 17 years is actually true or not, but it is widely accepted that, whatever the actual number is, it is much too long. Even then, Ms. Rubin reminds us, it is further estimated that only 1 in 5 interventions make it to routine clinical care.

AI: Not Ready, Not Set – Go!

Mar 27, 2023

By KIM BELLARD

I feel like I’ve written about AI a lot lately, but there’s so much happening in the field. I can’t keep up with the various leading entrants or their impressive successes, but three essays on the implications of what we’re seeing struck me: Bill Gates’ The Age of AI Has Begun, Thomas Friedman’s Our New Promethean Moment, and You Can Have the Blue Pill or the Red Pill, and We’re Out of Blue Pills by Yuval Harari, Tristan Harris, and Aza Raskin. All three essays speculate that we’re at one of the big technological turning points in human history.

We’re not ready.

The subtitle of Mr. Gates’ piece states: “Artificial intelligence is as revolutionary as mobile phones and the Internet.” Similarly, Mr. Friedman recounts what former Microsoft executive Craig Mundie recently told him: “You need to understand, this is going to change everything about how we do everything. I think that it represents mankind’s greatest invention to date. It is qualitatively different — and it will be transformational.”

Mr. Gates elaborates:

The development of AI is as fundamental as the creation of the microprocessor, the personal computer, the Internet, and the mobile phone. It will change the way people work, learn, travel, get health care, and communicate with each other. Entire industries will reorient around it. Businesses will distinguish themselves by how well they use it.

Mr. Friedman is similarly awed:

This is a Promethean moment we’ve entered — one of those moments in history when certain new tools, ways of thinking or energy sources are introduced that are such a departure and advance on what existed before that you can’t just change one thing, you have to change everything. That is, how you create, how you compete, how you collaborate, how you work, how you learn, how you govern and, yes, how you cheat, commit crimes and fight wars.

Professor Harari and colleagues are more worried than awed, warning: “A.I. could rapidly eat the whole of human culture — everything we have produced over thousands of years — digest it and begin to gush out a flood of new cultural artifacts.” Transformational isn’t always beneficial.