Plenary: Keep No Secrets and Tell No Lies: Computer Interfaces in Clinical Care

Michael G. Kahn, MD, Ph.D.
Rodeer Systems, Inc.

The art and science of clinical care is based on a special relationship of openness and trust which exists between clinicians and their patients. Clinicians require that their patients keep no secrets or else any hope of reaching the right diagnosis or selecting the right therapy will be lost. Patients require physicians to be non-judgmental to establish this trusting relationship. Yet at the same time, clinicians are taught to question everything they hear from patients and colleagues and to base no clinical decision on information obtained by others. How many times have you been asked the same question by many different people? Now you know why.

Clinicians will gratefully accept access to patient information which previously was not available; yet at the same time demand that that data be perfect. As the clinician's "mirror" into the system, the interface and its designers are held "responsible" to account for, or at least to make visible, the compromising sins of prior data collection, storage and computation processes that precede the user interface. "Keep No Secrets" refers to the desire to make available all information that is known about a patient; "Tell No Lies" refers to the desire to ensure that all such information accurately reflects what has actually occurred. New methods of analysis must be utilized to ensure that we can develop systems which show information which is needed and no more, and can highlight where data integrity compromises have been made-where there are secrets and maybe even lies.

Dr. Kahn received his MD from the University of California, San Diego, did his Internal Medicine internship and residency at St. Marys, a UCLA affiliate program, and his Ph.D. from the University of California, San Francisco. Dr. Kahn was responsible for the development of a 15-hospital clinical data repository and Web-based physician interface. Dr. Kahn is a member of the Board of Directors for the American Medical Informatics Association, the Board of Scientific Counselors at the National Library of Medicine, the editorial board for the Journal of the American Medical Informatics Association and the International Journal of Medical Informatics.