THE DIAGNOSTICIAN

Healthcare has become the most complex high-stakes industry in the world, and its operative system - the electronic health record, its clinical decision support, the analytic layer above it, and now the generative-AI tools layered on top - has become the most consequential clinical instrument in medicine. It is also the least examined. When that system fails, the failure is rarely recognized as iatrogenic. It is recorded as a documentation error, a denied claim, a missed alert, or a clinician who quietly resigned.

The Diagnostician applies the structured discipline of clinical reasoning - history, physical, differential, diagnosis, treatment - to the modern American health system as if it were a single patient presenting with a constellation of symptoms.

Written by a physician, longterm CMIO, executive advisor, industry consultant, speaker, informatics educator, and workforce developer, the book moves through seven informatics domains where the diagnostic findings are most often missed: executive governance, clinical-informatics capacity, clinical decision support, artificial-intelligence oversight, data quality and master data, iatrogenic technology disease, and the documentation-workflow-burnout axis.

The book closes with two practitioner tools that operationalize the framework: a seven-domain organizational informatics self-assessment scorecard, and a burden-of-disease calculator that quantifies the annual cost of clinical-informatics deficiency for a given health system - typically $15 M to $50 M, against a $3 M to $7 M cost of a properly funded informatics program.

For chief medical informatics officers, chief medical officers, chief information officers, chief executives of hospitals and health systems, board members, healthcare consultants, enthusiasts of structured critique, and the world clinical informaticists who suspect that what their organization treats as administrative noise is in fact a clinical syndrome with a name.