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One student on a recent Systems Thinking course said they found GST difficult because “anything could be seen as a system depending on the boundaries you set”. The student was in one sense correct, but in GST we also expect systems to have emergent structures and simplicity. We recognize that both a wave and a hospital are actually very complex but are happy to accept they exist as systems that we can observe and reason about. Choosing boundaries wisely is important. The challenges facing health informatics professionals are getting harder not simpler. Many healthcare organizations have successfully implemented health information systems and are now asking how they can use their computer systems to improve their internal structures, processes and deliver better care. We would recommend GST and a systems approach to help make a hard job somewhat easier and more rewarding. Teaching questions for reflection 1. Reflect on a health informatics system that you are familiar with; write a definition of the system following the definition of GST in Section 1.2. Describe the system in terms of its most significant components and their relationships. Reflecting on the healthcare environment where this informatics system is used, identify a system of healthcare provision and write a similar definition and description. How should the health informatics system contribute to the “survival” (continued viability and effective working) of the healthcare system it is part of? 2. Discuss your understanding of General Systems Theory with people from a range of disciplines (clinical, informatics, management etc.). Looking through the italicized terms in this chapter ask your colleagues whether they recognize these terms and whether they have the same meaning regardless of discipline. 3. From the perspective of GST, our complex healthcare systems can be seen to be in a state of continuing flux and the data in our health informatics systems reflects this. Can Artificial Intelligence (AI) that has been trained on such highly variable data ever be considered safe for clinical use in these constantly changing environments? 4. Reflect on a care pathway that you are familiar with; how could you help implement a learning health system that used health informatics to capture data that would help health care professionals continually learn about and improve the pathway? References [1] P. Checkland, Systems Thinking, Systems Practice, Wiley, NY, 1981. [2] K.L. von Bertalanffy. An outline of general system theory. British Journal for the Philosophy of Science, 1, 1950. 134-165. [3] E. Coiera, Guide to Health Informatics, CRC press, NY, 2015. [4] K.E. Boulding, General systems theory—the skeleton of science, Management Science,1956 Apr;2(3):197-208. [5] K. L. von Bertalanffy, General System Theory: Foundations, Development, Applications, NY, 1968. [6] T.M. Mandel, Yes, there is a general system principle, No it is not a theory. In Proceedings of the 56th Annual Meeting of the International Society for the Systems Sciences (ISSS) 2012, San Jose, CA, USA 2013 Mar 8. [7] P. Senge, The fifth discipline, the art and practice of the learning organization, Wiley, NY, 1991. O.Johnson /GeneralSystemTheoryand theUseofProcessMining to ImproveCarePathways 21