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Figure 1

Figure 1. From: Four rules for the reinvention of health care.

The roles of existing healthcare professionals are also bound to change. Biomedical expertise, for example, will no longer be seen to reside in the heads of experts but will rather reside in the system. Knowing “about” is replaced by knowing “how to find out,” and clinicians and machines are always “connected” to each other via the information grid to share knowledge and decisions and to form “just in time” teams to deal with specific problems or patients. Since health is so complex and expensive, new roles are needed, including health service brokers who help consumers navigate the health system and identify where the best care can be found. Evidence interpreters will help consumers find the evidence they need to make informed choices and help them understand the meaning of that evidence.

Enrico Coiera. BMJ. 2004 May 15;328(7449):1197-1199.
Figure 2

Figure 2. From: Four rules for the reinvention of health care.

Consequently, this science of health service design must be a science of sociotechnical systems,3 and today that science is called informatics.4 This call to design sociotechnical systems is as much a challenge to health care as it is to informatics, which still has a bias to technology driven innovation. Although the sociotechnical viewpoint has been around for about 50 years, technology is still king. The sacred ground of health informatics remains anything to do with the computer, the web, information architectures, the electronic health record, and heroic challenges such as the creation of enormous terminology systems. The profane ground of health informatics, still mostly shunned, is the world of politics, culture and persuasion, complaints from users when systems disappoint them, the messy craft of system implementation, which requires different tactics from one site to the next, and our unacceptably high number of system failures.5

Enrico Coiera. BMJ. 2004 May 15;328(7449):1197-1199.

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