The illusion of immediacy: on the need for human synchronization in data-intensive medicine

Abstract

Medical practice is increasingly shaped by big data sets and less by patient narratives. Data-intensive medicine promises to directly connect the patients with the clinic. Instead of medical examinations taking place at bedside and discrete moments, sensor-based technologies continuously monitor a certain body parameter and automatically transfer the data via a telemedical system. Based on a qualitative study of remote cardiac monitoring, I explore how the uncoupling of processes that used to happen in one place, changes the way diagnosis is made. Using ethnographic observations and semi-structured interviews with patients and tele-nurses of two university hospitals in Switzerland, I describe remote cardiac monitoring as a data network. The perception of being constantly connected to the hospital resulted in a reassuring effect among patients and healthcare professionals. Moreover, the notion of an automatically synchronized data network led patients to expect immediate feedback from the hospital as soon as an irregularity was detected. However, it obscured the fact that although the inserted sensor monitors the heart around the clock, the data is transmitted only once a day, and the tele-nurses only work during office hours, from Monday to Friday. I call this misperception “illusion of immediacy”. It takes time to accurately correlate and interpret a recorded episode with other types of data, such as the last hospital visit, comorbidities, and/or the actual situation in which the recording was made. Accordingly, tele-nurses and cardiologists play a central and privileged role in the data network. The findings highlight the importance of synchronizing the different temporalities that coexist in the patient remote monitoring data network in order to generate meaningful knowledge that ultimately leads to a diagnosis.