Understanding what technology does for/to us

by Paul Maharg on 06/01/2010

Over at Slashdot, the story that hospital computerization didn't save money nor did it improve administrative efficiency.  The study, published in The American Journal of Medicine, was carried out by Harvard Medical School on a dataset consisting of around 4000 hospitals over the period 2003-07, with admin cost data from Medicare Cost Reports and other data from the 2008 Dartmouth Health Atlas.  They concluded: 'As currently implemented, hospital computing might modestly improve process measures of quality but does not reduce administrative or overall costs.'

There are a number of interesting features to this study, but perhaps the most telling point was made by Dr David Himmelstein, the study's lead author, in an interview with Computerworld: 'computer systems are built for the accountants and managers and not built to help doctors, nurses and patients'.  

The findings bear out similar studies, as Himmelstein shows in the course of his article.  It's a conclusion that others have come to in different disciplines.  As Jos Boys pointed out a while back with regard to MLEs, technology is used to mimic traditional forms of university administration, teaching, learning and assessment, and a key opportunity for change, organisational and technical, is lost.  Indeed, Boys argues that 'the portal approach is taking hold precisely because it enables institutions to avoid difficult questions about how they organise themselves' (Boys' website here — report, called 'Managed Learning Environments, Joined Up Systems and the Problems of Organisational Change' seems to be is unavailable from JISC site or archive)

This failure is nothing new in transitional periods.  In chapter five of Transforming Legal Education I discuss the shift that thirteenth century scholars made to avoid such failure, particularly in law and theology, where they dealt with hugely difficult questions of information organisation presented by the avalanche of data they encountered in Justinianic & canon law.  We can see the failure happening in fifteenth century incunables (printed books designed to look like manuscripts — Margaret Smith is good on the complexities of this, eg here), and in the early bankruptcies of print firms (eg in Venice — see Lisa Jardine) who hadn't quite figured out the organisation of the product or the market.  We can see the failure in military history and the encounter with new technologies there — the suicidal frontal attacks by the British in WW1, eg at the Somme, completely misunderstanding the significances of the technologies of trenches, machine weaponry, massive bombardment and aerial reconnaissance until much later in the war (by contrast German tactics of defence in depth were much more effective throughout).  According to Ferguson, summarising research on the issue, at least part of the British failure in this regard was due to the failure of the military hierarchy to learn from frontline experience — German hierarchical organisation was by contrast much more receptive to ideas from lower ranks, to changing tactics around weapons technologies and their effects.  

Re-reading this I realise what a dismal post it is for a new year and a new decade. Happy New Year to all three of my readers!   I'll try to be a wee bit more upbeat. 

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