Study Set Content:
is also important to recognize that humans are still () to electronic systems in understanding patients and their problems, in efficient collection of pertinent data across the spectrum of clinical practice, in the interpretation and representation of data, and in clinical synthesis.
superior
human cognitive processes, being more suited to the complex task of diagnosis than machine intelligence, should not be overridden or trumped by computers
Miller, 1990
states that when adequate decision-support tools are developed, they should be viewed and used as supplementary and subservient to human clinical judgment.
standard view
clinician caring for the patient knows and understands the patient’s situation and can make compassionate judgments better than
computer programs
Corollaries of the standard view are that:
1. practitioners have an obligation to use any computer-based tool responsibly, through adequate user training and by developing an understanding of the system’s abilities and limitations; and
2. practitioners must not abrogate their clinical judgment reflexively when using computer-based decision aids
the standard view may be seen as a tool for both
error avoidance and ethically optimized action
➢ Ethical software use should be
evaluated
potential users of such systems include physicians, nurses, physicians’ assistants, paramedical personnel, students of the health sciences, patients, and insurance and government evaluators
Miller et al. (1985)
is a process rather than an event,
Diagnosis
Diagnosis is a process rather than an event, so even well-validated diagnostic systems must be used appropriately in the overall context of patient care
Miller (1990):
To use a diagnostic decision-support system, the clinician must be able to recognize when the computer program has (), and, when it is (), what the output means and how it should be ()
erred, accurate, interpreted
…the clinician must communicate the diagnosis, prognosis, and implications to a patient and must do so in ways both appropriate to the patient’s () and conducive to future ()
educational background, treatment goals
The care provider must also offer context when, () when needed, and () as appropriate.
available, comfort, hope
A computer program should be used in clinical practice only after appropriate evaluation of its efficacy and the documentation that it performs its intended task at an acceptable cost in
time and money
Users of most clinical systems should be health professionals who are qualified to address the question at hand on the basis of their licensure, clinical training, and experience. Software systems should be used to (), rather than to replace or supplant, such individuals’ decision making.
augment or supplement
All uses of informatics tools, especially in patient care, should be preceded by adequate () and instruction, which should include review of all available forms of previous product evaluations.
training
Users of clinical programs must rely on the work of other people who are often far removed from the context of use. Users depend on the () of a system and must trust evaluators who have validated a system for clinical use.
developers and maintainers
➢ Although this complexity imposes certain obligations on end users, it also commits a system’s developers, designers, and maintainers to adhere to reasonable standards and, indeed, to acknowledge their () for doing so
moral responsibility
embodies a number of complex assumptions linking ethics, evidence, outcomes, and professional training
STANDARD OF CARE
To determine the effectiveness of a procedure, we gather
evidence and proof
