Healthcare leaders need to prepare for a new world of continuous change and unexpected consequences to intended actions, one in which information technology will be transformative both in anticipated and unanticipated ways: that was the message that Robert Wachter, M.D. delivered on Nov. 3 at the Sofitel Hotel Los Angeles at Beverly Hills, during the Health IT Summit in Beverly Hills, sponsored by the Institute for Health Technology Transformation (iHT2, a sister organization to Healthcare Informatics under the Vendome Group, LLC corporate umbrella).
In an afternoon keynote address whose title matched that of his book The Digital Doctor: Hope, Hype and Harm at the Dawn of the Computer Age, Dr. Wachter, a professor and interim chair of the Department of Medicine at the University of California, San Francisco (UCSF), told the assembled audience that “I have been waiting for technology to come into healthcare for more than 15 years, partly because of my involvement in patient safety. That was part of the reason I was interested in technology,” Wachter said. “The other was my iPhone. I think we had this sense that healthcare IT would be similarly easy and straightforward; and perhaps if Apple had done it, it might have been, but they didn’t, and it wasn’t. This has turned out to be extraordinarily complex, far more complicated than anybody had believed.”
Robert Wachter, M.D.
Wachter told his audience Tuesday afternoon that “I was thinking about those things until about 10 years ago at UCSF, when we gave a kid 39 antibiotic pills when the correct dose was one. And we were sitting in a meeting about this, and I little light bulb went off, and I said, I need to find out about this. So I went up to the head of risk management and I said, we have to do something about this. And she said, great, let’s have meetings about this. And I said, no, I need to write about it. And her hair went on fire, and I took a fire extinguisher and put it out. And then we had some meetings, and I approached the CEO, and he gave me permission to write about it publicly. And that was extraordinarily courageous of him and our institution.”
The first part of Wachter’s speech reflected some of the same background information he had shared with HCI’s Gabriel Perna in interviews published on May 8 and May 15. Of course, Wachter noted in his iHT2 keynote address and in his HCI interviews, he had been a practicing physician and a medical administrator for many years, but never a journalist. So it was fascinating for him to speak with healthcare leaders, and leaders from other industries like aerospace, and get a truly big-picture view of the changes rocking U.S. healthcare. Wachter said he was very gratified that the book made it onto the New York Times bestseller list, but he admitted that, like any author, he carefully watched how well the book was doing on Amazon’s ranking of book sales.
Meanwhile, Wachter told his iHT2 audience, “I’m going to take a wide-angle lens and make sure we’re all thinking about where this is all going,” as he showed a slide of a photo of a group of UCSF medical students. “They’re wonderful, smart, and haven’t been jaded yet,” he said of the med students, adding that, “I was trying to shake them up, so about a year ago, I said to them, ‘You folks are entering a profession totally different from the one I entered 35 years ago, because you are under unrelenting pressure to figure out how to deliver the highest-quality care at the highest level of satisfaction and at the lowest cost.’ And one student raised his hand and said, ‘What was it you were told you were supposed to do?’ And what’s odd is not that we’re under this pressure, but that it’s new. It’s odd that we were under no pressure to deliver the highest-quality care and the lowest cost, as in other industries. That’s new. And that’s called value.”
In fact, Wachter said, there are two major pressures facing clinicians and administrators in the U.S. healthcare system right now, and purchaser- and payer-driven efforts to compel a fundamental shift towards value-based care delivery and payment systems are one; the other is the pace of clinical practice and operational change being created by the digitization of healthcare in the U.S. “Healthcare has gone from an analog to a digital industry in just the past few years,” he said. “People say to me all the time, were you Luddites? We loved technology when you could stick it in a corner and bill for it”—meaning medical technology that is not information technology. “But in terms of information technology, our fundamental technology was pencil and paper.”