Complexity and safety in medical computing: a clinician’s musings

Abstract

Some technologies, like scissors and chopsticks, appear inherently simple. Others, like nuclear reactors or life-support electronics, are inherently complex. By nature, the safety issues associated with complex systems are more involved than those associated with simple systems. There are always added cost requirements in complexity, such as special requirements for ensuring safe operation of the system. The very subsystems added to increase safety, however, necessarily add to complexity and, ironically, enrich the number of possible failure modes in the overall system. Thus there is a concern that the failure of any additional safety system may itself lead to new system failure modes that would not have otherwise occurred [1].These comments explain why simply adding complexity to a system may not always improve on the system’s performance. The following illustrates some of the concerns that I have developed about the potential misapplication of computers in medical technology. These concerns are based on my clinical experience over the last decade in dealing with high-tech aspects of medical care.