Wachter does an about face on the evils of health IT
No one has ever accused Robert Wachter, MD, chair of the Department of Medicine at the University of California, San Francisco, of seeing health IT through rose-colored lenses. However, the outspoken critic of HIT seems to be changing his view on the inherent evils of the technology.
Wachter is the author of the New York Times bestselling book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age, which describes the unanticipated consequences of the widespread adoption of electronic health records—including medical errors.
However, speaking in a keynote address on Monday at the CHIME CIO Forum at HIMSS18 in Las Vegas, Wachter declared that he is in a “much more optimistic place” than when he wrote his 2015 book.
“If you had heard this talk two or three years ago, it would have been pretty grumpy,” Wachter told the audience. “I think things are getting a lot better.”
In the case of his own hospital, he believes the healthcare facility is “safer, better than it was before we digitized.”
Wachter gave an example of how clinicians at UCSF successfully used EHR data to identify the source of hospital infections by tracking the movements of more than 85,000 patients admitted to one of its medical centers through time and location stamps entered into the Epic system.
Using spatial and temporal mapping, they were able to leverage the data to reconstruct where all patients with C. diff infections had travelled in the medical center. What they found was that that one location in the hospital—a CT scanner in the emergency department—was a significant source of exposure-related infections.
After more than $30 billion in EHR incentives paid to providers by the federal government to adopt EHRs, healthcare has finally found its digital backbone, according to Wachter, who praised the public sector for effectively digitizing a $3.5 trillion industry.
“In a very short period of time, we’ve gone from a paper industry to a digital industry,” he noted. “Ten years ago, fewer than one in 10 American hospitals had electronic health records. Today, fewer than one in 10 does not. So, it is not hyperbolic to say that in the last decade we’ve gone from the most information-intensive industry known to man— whose information backbone was the piece of paper and the Post-It note and the fax machine—to one whose information backbone is the electronic health record and all the digital tools that surround it. That is an enormous change.”
While healthcare has digitized medical records over the past decade, Wachter argued that the industry still faces the challenges of interoperability, analytics to glean meaningful insights from the data, and converting those insights into actions that improve value.
“We are very, very early in our progression here, but to me this is a logical progression—we’ll get (interoperability) done in the next three to five years,” he concluded, adding that when it comes to analytics and turning data insights into valuable actions “you’re seeing examples at this conference of early victories in this and I think we’ll see much more—and, that’s partly why I’m optimistic.”
Another reason Wachter said he is optimistic is that he believes healthcare can overcome a so-called “productivity paradox” of IT—a phenomenon in which increased investment in technology actually results in decreased productivity. “Over the last three or four years, I have begun to see examples of both technology getting better and the reimagining of the work” of medicine for the digital age, he added.