Bridging the Inferential Gaps in Healthcare

Abstract

Inferential gaps are the combined effect of reading-to-cognition gaps as well as the knowledge-to-action gaps. Misdiagnoses, medical errors, prescription errors, surgical errors, under-treatments, over-treatments, unnecessary lab tests, etc. – are all caused by inferential gaps. Late diagnosis of cancer is also due to the inferential gaps at the primary care. Even the medical climate crisis caused by misuse, underuse, or overuse of antibiotics are the result of serious inferential gaps. Electronic health records (EHR) had some success in mitigating the wrong site, wrong side, wrong procedure, wrong person (WSWP) errors, and the general medical errors; however, these errors continue to be quite significant. In the last few decades the disease demography has changed from quick onset infectious diseases to slow onset non-communicable diseases (NCD). This changed the healthcare sector in terms of both training and practice. In 2020 the COVID-19 pandemic disrupted the entire healthcare system further with change in focus from NCD back to quick onset infectious disease. During COVID-19 pandemic misinformation in social media increased. In addition, COVID-19 made virtual healthcare a preferred mode of patient-physician encounter. Virtual healthcare requires higher level of audit, accuracy, and technology reliance. All these events in medical practice widened the inferential gaps further. In this position paper, we propose an architecture of digital health combined with artificial intelligence that can mitigate these challenges and increase patient safety in the post-COVID healthcare delivery. We propose this architecture in conjunction with diseasomics, patholomics, resistomics, oncolomics, allergomics, and drugomics machine interpretable knowledge graphs that will minimize the inferential gaps. Unless we pay our attention to this critical issue immediately, medical ecosystem crisis that includes medical errors, caregiver shortage, misinformation, and the inferential gaps will become the second, if not the first leading cause of death by 2050.