One of the unintended consequences of digital health is that we became extraordinarily good at collecting information without spending nearly enough time teaching clinicians how to use it together.
For years, health care informatics focused largely on documentation itself. We trained clinicians to click, complete, reconcile, acknowledge, and navigate increasingly complex systems. Conversations emerged around reducing clicks, decreasing documentation burden, and improving workflow efficiency. Those things matter.
But somewhere along the way, we quietly accepted a much smaller vision for digital health than what was originally promised. Because the true promise of digital transformation was never simply digitizing paper. It was helping clinicians, across every specialty, discipline, and shift, retrieve shared meaning from information in ways that improve human care. That is a very different skill, and we have not taught it nearly well enough.
Digital health evolved largely around transactional needs: billing accuracy, regulatory compliance, risk reduction, order management, and information availability. Those were necessary advances. But systems designed primarily to capture, store, and transport information do not automatically create shared understanding. Interoperability is not the same as coherence. Coherence is not merely information availability. It is the ability to integrate fragmented clinical facts into a continuously understood human story.
Two years ago, I became the patient myself. I spent twenty-one days hospitalized and critically ill at one of the most recognized health systems in the country, a fully digital institution, a place that by every conventional measure represented the best of what modern medicine has built.
And yet.
What I experienced from the other side of the bedrail was not the seamless integration that digital transformation promised. It was fragmentation, quiet, persistent, and exhausting. Specialist teams rotated in and out. Each was competent. Each had access to the same electronic medical record. And yet the information they carried into my room was often incomplete, sometimes inaccurate, occasionally contradictory. My wife, who did not leave my bedside for the duration of my hospitalization, and I, weak, febrile, frightened, became the primary communication bridge between teams.
We corrected medication histories. We repeated context. We tracked what one team had decided and relayed it to the next. We asked questions that should have already been answered by the record. We educated ourselves in real time because no one was synthesizing the whole picture for us. We followed up on things that should never have required a patient’s follow-up. We were, in every meaningful sense, functioning as our own care coordinators, inside the hospital, inside a system with every technological advantage available to modern medicine.
I do not say this to assign blame. The clinicians caring for me were skilled and genuinely committed. But they were operating inside a system that had optimized for documentation without adequately solving for coherence. The information existed. What was missing was someone, or something, whose explicit responsibility was to hold the whole human being in view simultaneously.
And then the harder question arrived, the one I could not stop thinking about from my bed. What happens to the patient who is alone?
We speak often about patient advocacy as though it is a personal responsibility, something individuals owe themselves. But advocacy requires capacity. It requires consciousness, literacy, energy, language proficiency, family support, and the kind of institutional confidence that comes from knowing how to navigate systems that were not designed with you in mind. I had all of those things, more than most, and it was still nearly more than I could manage.
So who advocates for the patient who has none of them? The elderly woman with no family admitted through the emergency department at two in the morning? The man whose first language is not English and who nods when he does not understand? The person whose illness has consumed the very cognitive resources required to participate in their own care? The answer, too often, is no one.
This is the gap that digital health has not closed, and in some ways has obscured. Because when information is technically accessible, it becomes easy to assume it is being meaningfully used. When the record is complete, it becomes easy to assume the patient is known. But a complete record and a truly known patient are not the same thing, and the distance between them is where people are harmed.
Today, artificial intelligence is generating enormous excitement because it can rapidly analyze vast amounts of data, identify patterns, summarize information, and surface insights faster than any human being could process independently. In many ways, this is exactly what health care has been building toward. But medicine has always been more than pattern recognition.
The patient with pneumonia in bed space A is not the same as the patient with pneumonia in bed space B, even when the diagnosis, laboratory values, and orders appear identical on the screen. One may live alone. One may be unable to afford medications. One may be quietly confused but too frightened to say so. One may have no transportation, no support system, no trust in the institution caring for them. The data may look similar. The human beings rarely are.
The most transformative use of AI in health care may not be generating documentation faster. It may be reconstructing continuity where modern medicine has fragmented it. If AI can surface not just clinical patterns but gaps in coordination, the specialist who does not know what the other specialist decided, the patient whose story has been told five times and integrated zero, then it will have earned its place in the care environment. But tools do not create cultures. And the culture health care requires is one that treats coherence as a clinical responsibility, not a patient burden.
We speak often about the “human in the loop” in artificial intelligence, the idea that a person remains present to review, correct, or authorize what the system produces. It is a reasonable safeguard. But it is a passive architecture. The human in the loop stands at the edge of the process, watching for failure. What health care requires is something more demanding: the human in the middle. Not positioned at the periphery of a system to catch its errors, but standing inside the interpretation of it, responsible not just for their own piece of the patient’s story, but for understanding how it connects to every other piece. Not a reviewer. A holder.
The difference is not semantic. Someone signed off. Someone reviewed. And still, no one held the whole.
Because in the end, patients are not datasets moving between departments. They are people, often frightened, often alone, often unable to do for themselves what we have quietly asked them to do. The measure of digital health’s success will not be how much information we can collect. It will be whether the people we care for ever have to wonder if anyone is holding the whole of them in mind.
Robert Nieves is a registered nurse, health informatics executive, and vice president of health informatics at Elsevier Clinical Solutions. With more than 35 years of experience spanning clinical practice, leadership, and digital health, he has worked with health care organizations across North America, Latin America, Europe, the Middle East, and Africa to advance evidence-based practice and improve patient care.
A published health care thought leader, Robert writes about the intersection of health care, technology, leadership, personal growth, and the human experiences that shape our lives. His articles have appeared in The Journal of mHealth, Nursing Review, and Hospital + Healthcare, and he contributed Case Study 12.1, “Clinical Practice Model Framework Approach to Achieve Clinical Practice Interoperability and Big Data Comparative Analysis,” to the Springer Health Informatics Series textbook Big Data-Enabled Nursing.
Through his Human in the Middle series, Robert explores what happens when innovation, purpose, and humanity meet in an increasingly complex world. He shares updates on LinkedIn.
