Dr. Robert Wachter, a physician and author who spoke this week at the Health 2.0 conference in Santa Clara, California, told the story of an early adopting private practice that bought a state of the art ambulatory EHR system 10 years ago. The head of the practice told Wachter that on the day the system was deployed "the staff came to work and nobody knew how to do their jobs".
Wachter sees this anecdote as symptomatic of a fundamental shortcoming in the way that the healthcare industry has thus far engaged with digital technology.
"We think you digitize and you keep on doing the old stuff, just better or faster," he said. "But I think, as many of you know, that’s not the way life works. You digitize and you have transformed everything about the nature of the work and if you don’t think about it, you don’t get it right. In medicine, we didn’t get it right. We’ve come up with digital solutions without really thinking of the impact on the workforce, the workflow, how data are used, those sorts of things."
The most obvious example is the EHR which jumped from 10 percent adoption to 75 percent adoption in a short time thanks to government incentives, but which has had the unintended consequence of forcing doctors to spend up to 40 percent of their time doing data entry or hire a medical scribe to take over that task.
Another example Wachter used is alert fatigue: well-meaning hospital alert systems that in practice sometimes end up going off constantly so that the signal of real patient problems gets lost in the noise, and the patient may be, in effect, monitored less effectively than they were before.
In this case, Wachter said, there is another industry healthcare can look to that got it right: aerospace. As he researched his book "The Digital Doctor", Wachter interviewed Boeing scientists about the alarm system they used in their plane cockpit.
"They said 'We put in alarms, but then we spend thousands of hours watching the pilots in test flights and simulators, and when the alarms are going off falsely we pull them out,'" he said. "... It's not about being brilliant enough to develop the technology perfectly. It's about being brilliant enough to watch what happens when real people use your tools. I don’t think the technology designers in healthcare are doing that."
Finally, Wachter said, even when technology works well it can have unintended personal and social consequences. Digital radiology transformed radiology from a collaborative hub at the center of the hospital to a lonely, thankless job, he said.
"Every team came down every day to look at their x-rays. Your film would come up and we would have this very rich discussion about the patient and what’s going on. These discussions were incredibly rich, incredibly deep, and we both learned from one another," Wachter said. "Radiology went digital about 15 years ago. Nobody talked about this, nobody anticipated this, but about a day after that happened, those rounds ended. That’s not a good thing that they ended, but we didn’t give it a moment’s thought."