Interview by Art Kleiner: “In 2015, Robert Wachter published The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, a skeptical account of digitization in hospitals. Despite the promise offered by the digital transformation of healthcare, electronic health records had not delivered better care and greater efficiency. The cumbersome design, legacy procedures, and resistance from staff were frustrating everyone — administrators, nurses, consultants, and patients. Costs continued to rise, and preventable medical mistakes were not spotted. One patient at Wachter’s own hospital, one of the nation’s finest, was given 39 times the correct dose of antibiotics by an automated system that nobody questioned. The teenager survived, but it was clear that there needed to be a new approach to the management and use of data.
Wachter has for decades considered the delivery of healthcare through a lens focused on patient safety and quality. In 1996, he coauthored a paper in the New England Journal of Medicine that coined the term hospitalist in describing and promoting a new way of managing patients in hospitals: having one doctor — the hospitalist — “own” the patient journey from admission to discharge. The primary goal was to improve outcomes and save lives. Wachter argued it would also reduce costs and increase efficiency, making the business case for better healthcare. And he was right. Today there are more than 50,000 hospitalists, and it took just two years from the article’s publication to have the first data proving his point. In 2016, Wachter was named chair of the Department of Medicine at the University of California, San Francisco (UCSF), where he has worked since 1990.
Today, Wachter is, to paraphrase the title of a recent talk, less grumpy than he used to be about health tech. The hope part of his book’s title has materialized in some areas faster than he predicted. AI’s advances in imaging are already helping the detection of cancers become more accurate. As data collection has become better systematized, big technology firms such as Google, Amazon, and Apple are entering (in Google’s case, reentering) the field and having more success focusing their problem-solving skills on healthcare issues. In his San Francisco office, Wachter sat down with strategy+businessto discuss why the healthcare system may finally be about to change….
Systems for Fresh Thinking
S+B: The changes you appreciate seem to have less to do with technological design and more to do with people getting used to the new systems, building their own variations, and making them work.
WACHTER: The original electronic health record was just a platform play to get the data in digital form. It didn’t do anything particularly helpful in terms of helping the physicians make better decisions or helping to connect one kind of doctor with another kind of doctor. But it was a start.
I remember that when we were starting to develop our electronic health record at UCSF, 12 or 13 years ago, I hired a physician who is now in charge of our health computer system. I said to him, “We don’t have our electronic health record in yet, but I’m pretty sure we will in seven or eight years. What will your job be when that’s done?” I actually thought once the system was fully implemented, we’d be done with the need to innovate and evolve in health IT. That, of course, was asinine.
S+B: That’s like saying to an auto mechanic, “What will your job be when we have automatic transmissions?”
WACHTER: Right, but even more so, because many of us saw electronic health records as the be-all and end-all of digitally facilitated medicine. But putting in the electronic health record is just step one of 10. Then you need to start connecting all the pieces, and then you add analytics that make sense of the data and make predictions. Then you build tools and apps to fit into the workflow and change the way you work.
One of my biggest epiphanies was this: When you digitize, in any industry, nobody is clever enough to actually change anything. All they know how to do is digitize the old practice. You only start seeing real progress when smart people come in, begin using the new system, and say, “Why the hell do we do it that way?” And then you start thinking freshly about the work. That’s when you have a chance to reimagine the work in a digital environment…(More)”.