• Jochen Steil, Dominique Finas, Susanne Beck, Arne Manzeschke, and Reinhold Haux.
• Institute for Robotics and Process Control, TU Braunschweig, Braunschweig, Germany.
• Methods Inf Med. 2019 Jun 1; 58 (S 01): e14-e25.

BackgroundHealth information systems have developed rapidly and considerably during the last decades, taking advantage of many new technologies. Robots used in operating theaters represent an exceptional example of this trend. Yet, the more these systems are designed to act autonomously and intelligently, the more complex and ethical questions arise about serious implications of how future hybrid clinical team-machine interactions ought to be envisioned, in situations where actions and their decision-making are continuously shared between humans and machines.ObjectivesTo discuss the many different viewpoints-from surgery, robotics, medical informatics, law, and ethics-that the challenges of novel team-machine interactions raise, together with potential consequences for health information systems, in particular on how to adequately consider what hybrid actions can be specified, and in which sense these do imply a sharing of autonomous decisions between (teams of) humans and machines, with robotic systems in operating theaters as an example.ResultsTeam-machine interaction and hybrid action of humans and intelligent machines, as is now becoming feasible, will lead to fundamental changes in a wide range of applications, not only in the context of robotic systems in surgical operating theaters. Collaboration of surgical teams in operating theaters as well as the roles, competencies, and responsibilities of humans (health care professionals) and machines (robotic systems) need to be reconsidered. Hospital information systems will in future not only have humans as users, but also provide the ground for actions of intelligent machines.ConclusionsThe expected significant changes in the relationship of humans and machines can only be appropriately analyzed and considered by inter- and multidisciplinary collaboration. Fundamentally new approaches are needed to construct the reasonable concepts surrounding hybrid action that will take into account the ascription of responsibility to the radically different types of human versus nonhuman intelligent agents involved.Georg Thieme Verlag KG Stuttgart · New York.

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