The Digital Doctor
An Interview with Robert Wachter, MD

Health Tech | Shiv Gaglani

Arguably one of the influential academic physicians, Robert Wachter, MD, currently serves as a professor of medicine at the University of California, San Francisco. He is regarded as the academic leader of the hospitalist movement and has served on the advisory boards of organizations as distinct as Google and the American Board of Internal Medicine. Earlier this year he published the book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age. We had the opportunity to ask him a few questions about the book and his views on the rapidly changing medical technology landscape.

One common talking point is that clinicians are averse to new technology. You appear to have embraced it; can you describe how you’ve become so involved with new technologies for health care?
I always chuckle when I hear people say that clinicians are Luddites. Walk around a modern hospital, and you’ll quickly see that we love technology. It’s just that we love it when it can sit in a corner of the building, and we can bill for it. What is new for us is a ubiquitous technology, like electronic health records, that changes everyone’s work (and that we cannot bill for). What I’ve also discovered is that physicians, just like people everywhere, love technology that is easy to use and well-designed. Unfortunately, most of the information technology tools that clinicians are using today is poorly designed, with nothing like the user interface that we have become used to in our consumer world.

As for me, I have always been a fan of technology, and was an early adopter of the Macintosh (in the mid-1980s, when most people thought Apple wouldn’t make it), as well as social media like blogging and tweeting. And, because much of my research has been in patient safety, I’ve been anticipating the entry of technology into my world, because I thought it would solve many of the problems I was seeing with medical errors. When we finally did go digital, however, I was surprised by the challenges I was seeing, including new problems with patient safety. This is what led me to decide to write a book about it. I wanted to try to understand why things were not living up to my expectations, and to see if I could chart a path forward.

Amara’s Law states, “We tend to overestimate the effect of technology in the short run and underestimate the effect in the long run.” What is an example of a medical technology that we’re currently underestimating, but won’t be in a few years? 
There are so many technologies that illustrate this Law today—we are massively over-hyping things like big data and patient sensors. I suspect, though, over the long run that both of these will turn out to be quite useful. The challenge has less to do with improvements in technology, and far more to do with reimagining the nature of the work. You simply can’t put sensors on people and collect boatloads of new data and expect that things will automatically improve. You need to figure out who is going to receive the data, how to present it in a way that is useful and actionable, how to handle issues around payment, malpractice, and more. We haven’t really thought through these complex issues of adaptive change, and until we do, we won’t get it right.

How has your new book, The Digital Doctor, been received by the medical community? 
Extraordinarily well. The reviews have been gratifying, and many people in the community have told me that it validated their feelings—they were reading and hearing the hype but that wasn’t their experience at all. Many of them thought, “Well, there must be something wrong with me.” The book made clear that it is not just them, but it also helped explain why things weren’t working out as well as they hoped, and how we might actually reach that state we all hope for—where the technology makes the lives of patients, and clinicians, better.

Given that our audience is primarily comprised of cardiologists, do you have any specific words of wisdom to share with them? 
Cardiologists work in a high-tech environment, and so are generally comfortable with new electronic tools. Also, cardiology has been a leader in outcomes research, and in understanding the importance of process and system change to improving care. Take for example our modern management of MI–not only did cardiologists do the research to demonstrate the importance of rapidly administering certain meds and quickly performing a needed intervention, but the field also took the lead in figuring out how to reimagine the work. What needed to happen when a patient with chest pain arrived in the emergency department? Who needed to do what? What kind of equipment was needed? This is the kind of thinking that we need in health IT. The tools are fabulous, but we need to think about them in the context of the people, processes, and policies if we’re going to take full advantage of them. Cardiologists are well positioned to lead this work.

Shiv Gaglani is an MD/MBA candidate at the Johns Hopkins School of Medicine and Harvard Business School. He writes about trends in medicine and technology and has had his work published in Medgadget, The Atlantic, and Emergency Physicians Monthly.

Keywords: CardioSource WorldNews, Delivery of Health Care, Electronic Health Records, Health Information Systems

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