My experiences with digitalization have to do with nursing jobs I’ve held and with my personal evolution as a conscientious, selective user of digital services. I was born and raised in Germany, but got to move to America as a young adult and graduated with a Bachelors in nursing in 2010 in the United States. In various nursing jobs I used electronic health records and started liking it. During a brief stint as a public prison nurse I learned what it feels like to climb a step ladder and look for paper charts in the top shelf of some dusty file room. Or how hard it is to read handwritten progress notes that I was supposed to expand on in my shift note. No thank you, I thought. That was a clumsy system!
In nursing school we were already taught NOT to print out the medication orders, as they could be wrong and outdated the minute they left the printer, and we would not know and commit medication errors by following our sheet, instead of looking at real-time data. This left a deep impression on me. On one hand we students were looking for something tangible to rely on…but that did not exist, and part of our learning was the balancing act of keeping eyes, ears, and mind open and fluid as we go.
Some of the electronic charting was redundant, too. In the telemetry unit or the Intensive Care Unit (ICU), we were not supposed to copy and paste our own assessment from 4 hours ago, but everyone did it and then edited the parts that were different. One time I was cited into the manager’s office and had to explain an entry I had made that way, that was evidently incorrect, because the patient’s fall risk had increased between assessments, and then she actually fell, causing an investigation I became part of. It taught me what some of these entries even meant, and why we were asked to chart on these items. The wording was not always understandable to me, or my colleagues; we also did not have time to ask for clarification, just went through the motions to get the work done. This illustrates the reason why I wanted to get a masters in digital health: I want to be part of redesigning the charting systems and other areas of digitalized services, so that they become more meaningful and efficient. Badly designed interfaces or too many convoluted steps to get information or perform online services can give progress a bad name. Services become less human and remain mistake-ridden. Not a happy mix.
Currently, I work in the most digital nursing job I have ever had: as a telehealth advice nurse, since onset of the pandemic even from home and loving it! But so many patients call and need help with badly advertised, poorly designed, or malfunctioning services. Luckily, I am a member of the same healthcare company and know from personal use what they are talking about. I use our internal error reporting options often to try and alert our big machinery of its flaws. I am also part of two nursing committees that consult with management and IT every month to push for changes, but progress is sluggish, responses often indifferent, and nothing changes for what seems a small eternity – while it could be so fast and easy! Yes, I admit I am spoiled by my high-speed internet lifestyle!
My ideas for future improvements are often bubbling over. If so much is possible, why aren’t we already doing it? It takes more people with vision and an understanding of the problems and challenges that people on the whole spectrum of computer-literacy are experiencing. I expect there to be smart progress in the healthcare field. Smart, because a unique mix of strictest privacy laws, great need for huge capacity of data storage, and state-of-the-art technology will point the way for other innovations to become possible.
Some of the videos posted for this course were very inspiring, such as Andy Yen’s and James Lyne’s Ted Talks about online privacy (Lyne 2013; Yen 2014). Pranav Mistry’s 2009 (!) Ted Talk blew my mind with all the inventions he had created already, while the rest of the world was still writing with paper and pencil (Mistry 2009). However, as my friend Jon put it, his inventions are ‘mere child’s play’, and unless Pranav Mistry could figure out a way to eliminate large-scale moral injustices, such as economic exploitation of underdeveloped countries with abundant resources or perpetual wars bringing financial boons to large corporations, his inventions would not matter (Jhan 2022). I agree, Jon is right. But I am still inspired by the outlook of a new, lightweight future at our fingertips.
The risks of an open digital society are clearly not only loss of privacy. With machine learning and artificial intelligence, digital advances also affect our human agency: the freedom to make personal choices, emotional evaluations of situations, and allowing moral judgment to override logical reasoning (Cukier 2014). Beyond this, just imagine what would happen if all the data collected and the artificial intelligence using it fell into the hands of an evil entity. Already, cases exist where some autocratic governments turn off internet services in parts of their country to squelch political unrest and prevent citizens from fighting for democratic rights and freedom of speech. The Chinese government is using facial recognition software to distinguish and persecute Uyghur Muslims (Handley 2019). The opportunities for abuse of digital advances pose huge risks. And even small system errors can have escalating, devastating consequences, as machine learning can leave human thinking behind, unable to find where things went wrong.
The 2016 Data protection reform has probably caused me to be more protected from incessant data collection for commercial purposes. But it also has added cumulative hours of annoying popups before being able to access webpages. The reform is surely a step in the right direction, but has not had the impact I would wish for. Companies are still trying to trick web users into unwittingly permitting data harvesting. In my professional life, I have had to invent more complicated passwords to minimize the threat of looming cyber attacks. I am for tighter security measures, but saddened by the fact that there are so many vicious entities out there, trying their best to make the world a shady place.
I learned a lot by watching the videos for this course and by reading other students’ blogs. I feel like I wrote too much on this page. Maybe I should learn to be more concise. Please give me feedback, peers, I’d like to know. Thank you.
References
Cukier, Kenneth 2014. Big data is better data. TedSalon Berlin June 2014. https://www.ted.com/talks/kenneth_cukier_big_data_is_better_data. Accessed 10.2.2022.
Handley, Erin 2019. China’s mass surveillance of Uyghur Muslims in Xinjiang province revealed in data security flaw. ABC News 17.-18.2.2019. https://www.abc.net.au/news/2019-02-18/chinas-mass-surveillance-of-uyghur-muslims-revealed-in-data/10820634. Accessed 14.2.2022.
Jhan, Jon 2022. Friend. San Francisco, USA. Interview 11.2.2022.
Lyne, James 2013. Everyday cybercrime – and what you can do about it. Ted2013 February 2013. https://www.ted.com/talks/james_lyne_everyday_cybercrime_and_what_you_can_do_about_it#t-59111. Accessed 10.2.2022.
Mistry, Pranav 2009. The thrilling potential of SixthSense technology. TedIndia November 2009. https://www.ted.com/talks/pranav_mistry_the_thrilling_potential_of_sixthsense_technology#t-7146. Accessed 10.2.2022.
Yen, Andy 2014. Think your email’s private? Think again. TedGlobal October 2014. https://www.ted.com/talks/andy_yen_think_your_email_s_private_think_again?language=en. Accessed 10.2.2022.
Wow, as you said yourself that was a lot of text. But in a good way. Enjoyed every word of it and marveled your way with the words. I was also enjoying the videos and my family gathered around me to listen as well. The data protection reform has a lot to answer. I have about 50 different passwords at work to change at regular intervals but as you pointed out this is merely to protect us from the evil among us. As health care records are digital it still makes me wonder if paper was a better option. Why did I say that? Because I struggle everyday with slow data systems and disruption in the connections, In research data is still in paper form for a long time. At least for the next 25 years in the archives. Where are we with digital health then, are the ideas we heard in these videos part of our daily lives then?
Thank you Arja, I am so happy you and your family liked the page, despite its length, and the videos. They blew me away, too. Take care : ))