It should be of no surprise that Robert Wachter, M.D. wrote a book on technology in healthcare. The professor and associate chair of the Department of Medicine at the University of California at San Francisco (UCSF) is surrounded by technology.
He lives next to Silicon Valley. His wife writes about technology for The New York Times. UCSF, where he has been for years, is one of the preeminent healthcare organizations in America when it comes to implementing innovative technology.
Yet, it wasn't until technology failed that he came up with the idea to write a book on...yes, technology in healthcare. The computer error led to a significant, near deadly overdose administered to a young patient in UCSF's Children's Hospital. "I'm sitting there at the meeting explaining what happened and I'm thinking, 'Wow.' It's not so much the computer systems are clunky, they are, but we've turned our brains off. I came home and told my wife, 'I think I have to write this,'" says Dr. Wachter.
So he did, writing Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age. The book, which came out earlier this year after Wachter spent a year writing it, details the incident at-length. More than that though, it is a widespread, critical evaluation of how technology has been brought into the healthcare industry. It includes well thought-out analysis and interviews with a who's who of provider, government, vendor, and industry leaders.
Healthcare Informatics Senior Editor Gabriel Perna recently got a chance to speak with Wachter on the book, how it came together, some of its most important chapters, the future of healthcare technology, and the message he hopes people get out of it. Below are excerpts from part one in a two-part series.
Where did the idea for the book come from?
It was brewing over a few years. The genesis is my work for the last 20 years has been as someone who is an active clinician, an administer in healthcare, and I write and think about issues in healthcare that feel important to me. My issues tend to be the day-to-day work of doctors and patients. A lot of that in the last 10-15 years has been in patient safety. If you've been working in patient safety you've been waiting for computers to come and save us. I think the combination of my general interest in the way things work or don’t work in healthcare, my interest in patient safety, and layered on top, probably living in San Francisco and being surrounded by Silicon Valley, I was very hopeful they’d solve a huge number of our problems.
And then computers entered my world. There was no question they were solving problems. but it was clear they were creating their own sets of problems. It was clear some of the changes were interesting and quite subtle. I talked about it in the book about radiologists, where I saw that this wasn't just digitizing the work, it was changing the nature of relationships, the geography of the hospital, and the power structure. Most people would ask what computers have to do with that, well they have everything to do with it. I began pitching stories (about technology in healthcare) to my wife. I was living vicariously through her.
One day we committed that error that I go through in the book. I came home [after the meeting explaining the error] and told my wife, "I think I have to write this." Luckily for me she's a journalist, and she told me the only way to get this right is to approach it journalistically. You have to hear the stories. You have to educate yourself. Had she not told me that, I probably would have read a lot of stuff and tried to write a book and it would’ve stunk. The stories are what brought it to life. They allowed me to understand in a way that I never would have if I hadn’t gone in the field.
How did you get a chance to speak with so many people?
Everyone I asked said yes, some beyond what I would have expected. I happen to know Captain (Chelsey) Sullenberger who told me I should go spend a day at Boeing. So he wrote the head engineer at Boeing and told him I wanted to see how they think about cockpit automation. Next thing I know, I'm getting a day of VIP treatment at Boeing. Some of it was me, some of it was my contacts opening doors for me. I had amazing access.
I think people didn’t see me as a journalist;they saw me as an insider trying to learn this better. People were pretty unplugged in telling me unvarnished truths. They trusted that I’d be fair, open and honest about it. I tried to be. I learned that from my wife. You have to figure how to be really honest and fair, but remember that you’re writing this in service of the reader. If you’re too careful about not making anyone unhappy or you're tip toeing around, you don't get this right.
How long did it take you to write it?
It took exactly one year. For the first six or seven months, I was still doing my day job but I had just gotten so psyched about this. I was doing as many interviews as I could from the Bay Area, doing nights and weekends. I was 25 percent done with the research and writing by June. Then I went on sabbatical from June to December. From June until October, I was writing and researching and interviewing 12 hours every day. My wife was my editor. It was hard but it went better and faster than I thought.
Some writers know their story arc and have plotted every page.