Summary. The chart is a clinical artifact and a commercial product simultaneously. Both things are true. The clinical obligation is to act as if only the first one is real when I am in the room with the patient, and to take the second one seriously when I am deciding what tools I am willing to let into the workflow.
This is a holding page for a longer essay on the political economy of clinical data. Open questions:
- How should I think about consent for downstream uses of the chart that the patient cannot reasonably anticipate?
- Where does the line sit between research data flows that genuinely serve future patients and data flows that simply enrich a vendor?
- What is the practical version of “data sovereignty” inside a large hospital system, and what does the individual clinician owe to it?
- How do I describe these dynamics to a patient who is asking a sincere question about why I just had to sign three different consent screens?
A more developed treatment is in progress.
— Jeremy Tabernero, MD · More case studies · Get in touch