Science historian James Burke created and narrated a marvelous documentary television series, Connections, which first aired in the US in 1979 and whose popular success led to two sequels in the 1990's, a book, a regular column in Scientific American and even a video game. Much of the show's popularity derived from the strength of Burke's narration, his dry wit, and the historical reenactments often filmed on location.
Burke's central premise, and it was somewhat heretical at the time, was that history was neither linear nor goal-directed. In other words, those timelines that we all took such care to memorize in school tell us essentially nothing about how or why things came to be the way they are. Furthermore, that those timelines provide a narrow, and often highly biased, perspective - glibly expressed in the old adage that "history is written by the victors."
Instead, he argued, historical events occurred in a richly-interconnected, global context, where no one factor or event could be isolated as the sole cause of another. Demonstrating how seemingly unrelated events such as Napoleon's invasion of Egypt in 1798 and the invention of ENIAC in 1946, the world's first computer were actually tightly coupled - Napoleonic troops bring back Egyptian shawls to France, inspiring a fashion craze in Europe, to meet the demand shawls are manufactured on automated, perforated-paper control looms, American inventor Herman Hollerith is inspired by these looms to use punch cards to automate computation of the 1890 census, the company that he creates eventually becomes IBM, IBM provided the input/output equipment and interface circuits for ENIAC.
For those of you who are historians of science and technology, amateur or otherwise, this rambling, interconnected, zeitgeist-y view is very familiar as it has been the prevailing paradigm of the last two decades or so. For others it may be eye-opening, perhaps even a bit threatening as it seems to necessitate a certain randomness or unknowability in historical, current and future events.
Burke often liked to end his historical "mystery tours" with some thoughts about where we might be headed. In some of these, he was surprisingly prescient (predicting the existence and impacts of the internet, 20 years before they were fully felt). While I must concede that I don't have hard numbers in terms of how many predictions he made, how many were accurate and how his accuracy rate compares to the predictive accuracy of historians espousing the more traditional linear approach, I do believe that the weight of evidence supports the assertion that, on balance, the explanatory and predictive capability of a model based on a richly interconnected, systemic approach is both more accurate and more reliable (a subject for a future blog!).
My humble (or perhaps hubristic) goal is to bring a similar approach to healthcare IT, or at least my little slice of healthcare IT, and in the process to hopefully shed some new light on how we arrived where we are, where we might be headed and how we might change course towards more desired ends. I'll root myself very firmly in the now (I promise, no expositions on medieval scholasticism or the importance of Michel Foucault in postmodernism -- unless absolutely necessary) and I will seek to combine ideas and concepts from many different fields for a fresh perspective on the issue at hand.
I will neither guarantee that every post will achieve these grand aims, nor will I assert that every one of my conclusions will be novel and ineluctable, flowing from incontrovertible facts. I do hope, though, that I communicate stimulating ideas, ideas that generate discourse, ideas that add one or two more connections.
