Instead of library updates imagine half the doctors and nurses don't speak English with a high degree of fluency and don't come from the native culture. That is so obviously a problem for communicating subtleties that it's infuriating that it has to be explicitly pointed out.

Speaking of reform. I think the only answer is closing the gap between action and success/failure i.e. a tighter feedback loop.

Some futuristic thinking is required.

For surgery I would propose a VR sim in which they performed the same surgery again and again, with the details/features changing all the time. Then at a high level of proficiency I would copy the real movements to a machine copying the surgeons actions on a real patient with the feedback visual presenting itself to the surgeon as part of the sim.

- This helps homogenize surgeons movements.

- Increases confidence of a successful operation.

- Allows for high level practiced skill rapidly.

- Removes them from the theater directly to prevent disease.

- Calms the nerves so the surgeon is able to work without fear.

- System gets better over time with more data.

For diagnostics I would record the patient's voice describing her symptoms with a visual of the person. I would then pattern match for related conditions in my database that appear to resemble the symptoms. The system has some degree of common sense as it is a traditional expert system. Audio/Video inputs would be used to make requests e.g. can I see your arm that is paining you for more detailed visual analysis using machine learning. Vocal analysis for other detectable disease. Finally a list of options would be offered up to the doctor as plausible possibilities. In the beginning these would be offered up after the doctor made an independent diagnosis and a second opinion would also be made. This is to give feedback accuracy to the diagnosis system. Later on the 'obvious cases' would be presented to a doctor in real time as the patient began describing his or her symptoms. This would be presented either as a list or perhaps more appropriately as a mind map.

- Acts as a medical record.

- Logic behind choices can be retroactively justified.

- General practitioners can see patients faster because they won't need as many notes.

- Patients will be more confident in their diagnosis with a digital second opinion.

- Prescriptions can be autofilled to prevent error.

- System gets better over time with more data.

Now it is important to note I have no idea what I'm talking about. This took literally 30 seconds to come up with. So why hasn't something radically better already been done? I say it is very simple. It is not allowed. It is defacto illegal to do any of the above. You can't even digitize medical records properly. That is frightening.

The only way this is going to work is if we

- Provide services where they are impossible e.g. third world.

- Only provide this technology to private healthcare. Possibly even on Seasteads to avoid anti-tech litigation.

- The government creates a SMZ (Special Medical Zone) outside of the medical establishment's reach.

In addition to this you'd have to make the general public aware of how bad their healthcare really is. That's the only way to get "Tech companies screw 3rd world with experimental medicine" stories from whoever will be the next Gawker off your backs because the established order is going to do everything it can to blacken your name.