The past few years have been filled with technological innovation and development, and there’s been a lot of talk about the future impact of technology across various industries. In healthcare, discussion has focused on data and analytics, artificial intelligence, blockchain, machine learning, and the potential impact of technology on patient outcomes.
As a result of these recent discussions, the Dimensional Insight Book Club decided to kick off with The Digital Doctor by Robert Watcher. For the past six weeks, we have been enjoying this first read, whether on a plane travelling to HIMSS or over a cup of tea during one of the many Nor’easters we had in Boston in March. Our first book club panel consists of George Dealy, vice president of healthcare applications; Nora Lissy, director of healthcare information; Julie Lamoureux, senior healthcare consultant; Marissa Leone, healthcare consultant; and Kathy Sucich, senior content and communications manager. Here are their thoughts on this book.
Q: As someone who works in healthcare, did The Digital Doctor change your perspective about the industry?
Dr. Robert Wachter forces readers to reflect on the industry and the current challenges healthcare providers face.
Kathy: I’m not sure that it changed my perspective about the industry, but it certainly clarified many of the challenges that healthcare faces around technology. How can technology improve the lives of physicians and caregivers instead of causing new headaches? That’s a question that all of us who work in healthcare tech need to consider.
Julie: The book helped me realize how fast the implementation of mandatory and regulated EMR had been. The author keeps mentioning how “long” these regulations have been in place, but in the world of patient care, this is extremely destabilizing and rapid. Every change in healthcare has to be thought from 100 different perspectives because an unforeseen consequence of a change can negatively affect the lives of patients, even in IT. This helped me understand the huge failures that resulted from early implementation.
George: Yes, it did. Dr. Wachter provided a connection between the products we produce in healthcare IT (HIT) and the impact they have on patient care, both positive and negative. Despite the best efforts of companies like Epic, which have been very successful in gaining both commercial success and adoption among clinicians, there is still a long way to go. Dr. Wachter mentioned during his CHIME address that significant progress has been made since he wrote the book, both among HIT products and how they are implemented within healthcare systems.
Nora: It didn’t change my perspective, but it reaffirmed my thoughts on industry challenges. A lot of work needs to be done towards improving quality and workflow, even though the industry has made big strides in recent years, e.g. the mandatory implementation of EHRs under the Obama administration. I believe we will see a very different “electronic” healthcare system in about 10 years when the younger generation of caregivers who grew up with digital will make their mark and have improved the process and flow.
Marissa: The book didn’t change my perspective on the industry since the issues with EHRs have been present for some time. However, it did define the issue with EHRs and clarify how these issues can impact patients.
Q: How can EHR vendors work to improve their users’ experiences, based on Wachter’s interviews?
Dr. Wachter conducted various interviews with healthcare providers about the current EHR user experience, which shared some insights into potential areas of improvement.
Marissa: Vendors need to work on reducing the amount of time providers spend at the computer. If providers spend less time writing notes or reading off patient histories, it will increase their time spent talking to patients, maximizing their patient-provider relationship. Nowadays, it feels like doctors are treating their computers and hardly make eye contact with their patients.
George: Technology vendors need to learn from the trials and tribulations of customers’ experiences of integrating technology into the way their organizations function. Dr. Wachter made the point that installing an EHR is just an initial step. Using it to change the way an organization actually functions is work the organization itself needs to do; it’s not something that can be “outsourced.”
Kathy: EHR vendors need to work on reducing the number of clicks it takes to work through screens. The book contained a frightening story about a child who was given an extreme dosage of medicine, and this was partially due to the fact that EHRs give so many alerts (often false) that users click right through them. To improve the user experience, there needs to be a more streamlined way to integrate technology, and it’s imperative that vendors work on design and better understand their users’ workdays.
Nora: Just as in anything, they need to listen to their users. As Wachter noted early on in the book, the EHR was created in a “box” to meet requirements and regulations, and vendors didn’t seek input from their client users. As a result, the current EHR lacks the flow needed for the end user to use the tool properly. Therefore, practitioners and end users need to be involved in discussions about the next development phase of the EHR.
Q: Dr. Wachter’s mood about digitizing healthcare fluctuates throughout the book. After reading this book, what are your thoughts on the digital transformation of healthcare?
Dr. Wachter assesses digital transformation and healthcare’s adoption of digital technology. He also forces readers to think about a difficult question: is technology the solution for all our problems within the industry?
Nora: Because I “grew up” in healthcare around the same time as Dr. Wachter, I found myself shaking my head in agreement many times because I had/have many similar thoughts. Like Dr. Wachter, I’d like to believe that I am progressive and adaptive to change, but I also find myself being a little skeptical sometimes of the technology. I do believe in the long run that the technological transformation is here to stay, and it will be better and more useful in the years to come.
Marissa: I’m ultimately positive about the direction healthcare is going in. The first decade (2000s) was about getting patient records into a digital format, and now the industry is starting to realize the importance of the user experience. Although there will be hiccups along the way, I believe that the digital transformation of healthcare will positively influence healthcare.
Kathy: In my role here at Dimensional Insight, I talk to many of our customers about the successes they’ve seen through using Diver. From these conversations, I know that technology can make a huge difference for hospitals and their patients – in terms of revenue saved and care delivered to patients. So digitizing healthcare is important, and it can be life-saving. To optimize this technology, we need to figure out how the current technology can “talk” to other systems easier.
Julie: My mood about digitizing healthcare fluctuated throughout the book! And it still does. On the positive side, I can think off the top of my head, the elimination of unreadable notes from providers, the ease of sharing test results and encounter information, the possibility to store and analyze data rapidly to get insight into populations and the decrease of some errors. On the negative side, I can think of the steep learning curve for the providers, the decrease time to have personal interaction with the patient (the provider having his/her nose on the computer screen), and the monetary investment that doesn’t show a return at this point. However, for right now, it is the right thing to do for the advancement of science and for the bettering of patient care.
George: I felt that Dr. Wachter provided a very realistic view of the state of technology in healthcare, from stories and interviews that show many points of view. My primary takeaway was that there is tremendous potential for technology to transform the healthcare industry. Dr. Wachter doesn’t take issue with that. This will happen, and technology itself will promote the disruption that is likely to accelerate change. Progress is inevitable.
Q: How can healthcare providers work to better integrate digital technology without losing sight of patient care?
For those in healthcare, it’s important to evaluate how new technologies will drive patient outcomes and improve patient care. With that, can healthcare providers work to better integrate digital technology without neglecting patient care?
George: This is a tricky balance for sure: providing the best possible care for patients (including their ability to care for themselves) while minimizing the risk of error and harm. Progress will likely come from a combination of incremental change, refining processes with experience, and disruption, where new technologies allow for a completely different approach. Maintaining this balance is challenging, despite the best of intentions. Dr. Wachter and many others suggest that the best industrial model for healthcare to take lessons from is aviation. Like healthcare, there is minimal room for error, and the integration of technology comes with both tremendous opportunity and risk around how it is incorporated into the “overall system.” Aviation’s respect for the pilot experience is likely a good model for healthcare to follow.
Julie: Providers have to have an active role in this integration, and it can’t be as effective when the subject matter experts are not involved. The integration of technology in healthcare has to be interoperable, improve workflow and quality, and grant providers access to real-time data so they can gain insights into their practice and patient population.
Nora: First, healthcare providers need to see technology as a partner in their decision-making, not an impediment. They need to realize that they can use the data they “collect” at every visit to paint a picture of how to provide care in an individualized way but also create a story from a “population” point of view. The technology is here to stay, and providers need guidance around creating solutions to make it better. One interesting point that Dr. Wachter brought us regarding artificial intelligence (AI), for example, was that medicine is both an ART and a SCIENCE. AI might be able to cover the science part quicker through algorithms and patterns but it will never replace the face-to-face ART of the process. Therefore, technology can enhance medicine, not replace it.
Marissa: Providers need to be given the proper tools by their administrations to balance digital technology with patient care. If a system is too cumbersome and detailed, the physicians spend less time with their patients because they invest in trying to understand the complexity of the tool. At the same time, physicians need to be willing to work with administrations and IT departments to help create systems that work best for their user experiences and their daily workflow.
Kathy: I think a lot of responsibility falls on the technology vendors to make sure they are designing tools that complements patient workflow, instead of complicating it. At the same time, providers themselves have a role too. Training needs to be ongoing, and providers need to rethink processes so the technology is seamlessly integrated and minimally invasive. For example, instead of having my nurse review my medication list with me during every single appointment (to review information that is unchanged), couldn’t I do that ahead of time while I’m in the waiting room?
Thank you to our book club panelists! Did you read The Digital Doctor along with us? What are your thoughts on the book? Feel free to add your comments below.
Next Book Club pick – Proof: The Science of Booze
Interested in our book club? For our next selection, we pivot from healthcare to alcohol. Stay tuned for our upcoming post on Proof: The Science of Booze. In this book, Adam Rogers dives into the physics, biology, chemistry, and psychology behind the production of alcohol, our society’s appreciation for it, and the effects that alcohol has on our bodies post-consumption. If you want to read along with us, you have until May 22. Also, let us know if you’d like to be on our book panel or have any suggestions for future selections!