The Digital Doctor: Hope, Hype, And Harm At The Dawn Of .

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The Digital Doctor:Hope, Hype, and Harm at the Dawn ofMedicine’s Computer AgeRobert Wachter, MDProfessor & Chair of the Department of Medicine, University of California, San FranciscoAuthor, “The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age”@Bob Wachter @UCSFMedicine

The Digital Doctor:Hope, Hype, and Harm at the Dawn ofMedicine’s Computer AgeRobert M. Wachter, MDProfessor and Chair, Department of MedicineUniversity of California, San Francisco@Bob Wachter

Why I Decided to Explore Health IT

“The Challenge That Will DominateYour Career ”

EHRs in US Hospitals, 2008-2015 75% Office of the NationalCoordinator for Health IT 30 billion in federal incentives under HITECH

The Big Picture:Two Transformational TrendsPressure todeliver high-valuecareThe Dominant IssueTodayThe digitization ofthe U.S.healthcare systemPrediction: The DominantIssue in 2025

Richard Baron on the Trauma ofComputerizing His Philadelphia OfficePractice“The staff came to workone day and nobody knewhow to do their job.”

The Demise of Radiology Rounds“The man who ruined radiology”– Paul Chang’s dad

Digital Radiology as Canary in Coal Mine The digitization of the thing creates the opportunityfor infinite distribution (at no cost) Social relationships and communication patterns thatpreviously depended on gathering around the thingwill wither Power relationships mediated by who controls thething will be renegotiated What happens when the thing isn’t the film, it’s themedical record

Residents’ Room Vs. The Ward

A 7-year-old Girl’s Depiction of her MD VisitToll E. The costof technology.JAMA 2012

MD Burnout in the EHR Era Physician burnout rates now over 50%– Higher than other professions– Up 9% in last three years Burnout associated with computerizedorder entry use and perceived “clericalburden”Shanafelt T, Mayo ClinProc, 2015 and 2016

2014 Advertisement For AZ ER JobArizona General Hospital will be coming to The Grand CanyonState later this year!! Located in Laveen, a Phoenix suburb, ArizonaGeneral is a 40,000 square-foot boutique general hospital.Services offered include: Emergency Room Radiology Suite inc. CT, X-Ray, and Fluoroscopy Two State-Of-The-Art Operating Rooms Outpatient Surgery 16 Inpatient Rooms NO ELECTRONIC MEDICAL RECORD

What Went Wrong? Adaptive vs.technical change Connecting the parts The digital squeezeon physicians The ProductivityParadox

Health IT: The Mother ofall Adaptive Problems“ problems that require people themselves to change.In adaptive problems, the people are the problem andthe people are the solution. And leadership is aboutmobilizing and engaging the people with the problemrather than trying to anesthetize them so that you canjust go off and solve it on your own.”– Ronald Heifetz, Kennedy School of Government

The Four Stages of Health IT1. Digitizing the medical record2. Connecting the partsa. Enterprise system to enterprise systemb. Third-party apps to enterprise systemsc. Patient-facing systems to enterprise systems, and toone another3. Gleaning meaningful insights from the data4. Converting these insights into action that improvesvalue

When Things Will Really Get InterestingTraditional EnterpriseEHRs (Epic, Cerner, etc.)Consumer-Facing IT(big data, apps, sensors )

The Digital Squeeze on PhysiciansEHR as unique and powerful enabler of g ofExpertise

How Will Practice Deviations be kindof athe CMOguidelinesfordeviation?moron?forapprovalsuggest

“You can see the computer age everywhereexcept in the productivity statistics.”-- Nobel Prize winning economist Robert Solow, 1986

The Two Keys for Unlocking theProductivity ParadoxImprovementsin thetechnologyReimaginingthe work itself

A Better Future (?) Productivity paradox usually takes 10 years to resolve – inhealthcare, it’ll take 15-20– Most productivity gains come from people “practicing at thetop of their license” Disruption: first in wellness, then chronic disease, and verylast, sick care system Don’t underestimate power of the guilds to block change– MDs are more powerful than cabbies In the end, highest value care will win– Will clearly be tech-enabled (and, in some cases, tech only)

What Do We Need to Do? Connect the digital pieces Focus on building decision support andmanaging alert/alarm fatigue Build skills and culture to reimagine the work– As much about teamwork, QI, systems as IT– Likely need new workflows, specialties Retain sense of optimism: it’ll get better

Choluteca Bridge, HondurasHurricane Mitch,1998

The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age Robert Wachter , MD Professor & Chair of the Department of Medicine, University of California, San Francisco

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