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In conversation with Bob Wachter – the digital doctor

The New York Times best selling author needs no introduction in the world of digital health, but for those of you who have been living in a cave, Dr Wachter is a Professor and Associate Chair of Medicine at the University of California, San Francisco and the author of The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Computer Age.

At a time of widespread frustration at the slow pace of adoption of technology in UK healthcare, The Digital Doctor takes you on a journey through the immense change of the US healthcare landscape over the last 5 years and tries to make sense of why it is such a difficult process.

At last night’s CHNi event the focus was on the NHS. Dr Wachter offered insights into what the hospitalist movement means for the NHS and where the future of IT in healthcare lies.

“Digitising healthcare is the master of all adaptive changes”. Yes, other industries have experienced similar problems in adopting technology, but the complexity of healthcare and the conservative nature of the medical profession have meant that new tech hasn’t exactly been embraced across the board. Dr Wachter puts this down to people finding it difficult to envision fundamental changes in the way they work and deliver care. People tend to see ‘digital’ as simply replacing pen and paper, instead of it overhauling their organisational and professional processes. But also, for many clinicians, digital simply isn’t delivering on its promise. Right now it’s mostly about input, not much output. This has led to frustration that doctors spend the majority of their time filling out online forms, instead of caring for patients.

Reviewing the experiences of clinicians and trust leaders, as well as the capacity and capability of trusts’ IT systems is a key part of Making IT work: harnessing the power of health IT to improve care in England, a review of the NHS ‘s computer systems led by Dr Wachter.

Asked why he accepted Jeremy Hunt’s invitation to lead the review, Dr Wachter answered “I wanted to have a national conversation….It was an opportunity to talk about digital in a mature way”. Citing the rise of digital as the most interesting change he has seen in his career, the opportunity to lead a national review was too exciting to pass up. It was also a chance to try things differently; to reflect on the issues navigated in the US, and to move away from the hype surrounding the potential of digital emanating from Silicon Valley.

The US has spent $30 billion since 2009 promoting the adoption and meaningful use of health IT. The funding incentivised hospitals to digitise their health records, and with partial success. EHRs account for 80 – 85% of health records now, compared to 10% five years ago. But issues remain, particularly around interoperability. The UK is in a much better position to manage these market failures. The report will be published at NHS Confed in June.

Asked specifically about the scale and speed of health tech in the NHS, Dr Wachter highlighted the need for buy in; not just as a ‘nice to have’, but an absolute necessity to make it work. “You need to frame it against patient safety and the quality and efficiency of care”. Indeed, digitisation for digitisation’s sake is something that has been criticised before.

Points to highlight include:

  1. Medical training has to change to accommodate the expectations from the system and patients for more efficient and personalised care. Clinicians have to see themselves as system leaders.

  2. We need to sell digitisation to patients. The reluctance of the population to embrace digital in their healthcare is in part due to poor communication of its benefits.

  3. Digital has to be central to overall organisational strategy and not simply an add-on. Echoing Dr Wachter, this is about doing it well, at the appropriate pace.

There is hope for the digitisation of the NHS. More and more people are embracing its potential and new resources help individuals navigate the system. What NHS organisations need is the space to implement IT projects without the fear of penalisation if things go wrong. They need to fail fast and embrace the idea that going digital is rational, not risky.


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