Wachter: Digital health is now the norm, but it needs work

In closing the annual American Medical Informatics Association conference in San Francisco Wednesday, Dr. Robert Wachter, chief hospitalist and chief of the medical service at nearby UCSF Medical Center, told the audience that he is “kind of an interloper in this field,” though far from a Luddite.

“Up until a couple of years ago, I couldn’t tell you the difference between an API and an APB,” Wachter quipped. But something changed.

“It is not an exaggeration to say that in the last five years, we have gone from a primarily analog business to a primarily digital business. That is a huge deal,” Wachter said. Digital health has arrived.

Much of that had to do with Meaningful Use, the federal health IT incentive program that has paid out some $30 billion to date to convince doctors and hospitals to switch to electronic health records. That has changing the industry, but there is so much more work to be done.

“The $30 billion woke up Silicon Valley,” said Wachter, who is credited with starting the field of hospital medicine in the 1990s. Now the healthcare industry has become digital enough for outside tech companies to jump in.

Sure, Silicon Valley has tried before because healthcare it is, after all, a $3 trillion industry in the U.S., so there is plenty of money to be made. “Google left with its tail between its legs,” noted Wachter, who was on the advisory board of the ill-fated Google Health experiment.

Wachter said that there are two “transformational” trends underway now: pressure to deliver high-value care and the digitization of the U.S. healthcare system. “Value pressure” is the dominant issue in 2015, according to Wachter, but he expects digitization to be the dominant trend by 2025, with the potential to “completely disrupt” organizational charts in healthcare.

And he has no specific idea what the future might hold; people often don’t understand what the world will be like with new technology until they are in that world. Wachter then quoted Henry Ford: “If I asked people what they wanted, they would have said, ‘Faster horses.'”

What Wachter is sure about is that current technology is inadequate. He said he would not go into a hospital as a patient now if the facility did not have EHRs, computerized physician order entry and clinical decision support. But he knows healthcare can do better in terms of IT. “Most of it is good, but we have to face up to the part that is not so good,” he said.

Wachter showed a slide of a 2014 advertisement for a new branch of Dignity Health’s Arizona General Hospital, a free-standing emergency department.

Yes, a modern, “boutique” hospital that opened early this year has no EMR, and that’s apparently a selling point to emergency physicians. (That facility currently gets just two stars from Yelp reviewers.)

EHRs and EMRs — two names for essentially the same thing — aren’t good enough, as illustrated by this drawing Wachter showed from a 7-year-old, with the physician sitting in front of a computer, far from the child and her family:

“I think it’s an incredibly accurate picture except for one thing: the smile on the doctor’s face,” Wachter said.

Information is hard to find. “We have to figure out interoperability,” Wachter said. Electronic progress notes are bloated. CPOE systems fire off too many alerts.

Wachter’s research on patient safety has taken him to a Boeing aircraft factory. He said Boeing planes have three levels of alerts in the cockpit, and they don’t all look the same. The most urgent is red — for an imminent risk of fatal error — and not only does a message pop up on a screen, the flight control lever shakes violently. In healthcare, alerts look pretty much the same, so it’s easy for clinicians to tune out warnings of potentially harmful situations.

“If anyone can figure out the fix to alert fatigue, you should win the Nobel Prize,” Wachter said.