The Digital Doctor by Robert Wachter

The Digital Doctor -Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age

In The Digital Doctor Robert Wachter reviews the successes and disappointments of recent investments in information technology in healthcare in the US.  More recently this  included a €30bn incentive program between 2010 and 2014.  His focus is very much on IT in hospitals and the implementation of Electronic Health Records (‘EHR’).  He compares what people are trying to achieve and what they are actually achieving.

The book provides  excellent background reading

for any clinician or administrator currently involved in planning for an EHR implementation or in building a clinical/ business case for the same.  From the start Wachter distinguishes between the technical and the adaptive challenges,  He argues convincingly that the adaptive changes offer by far the greater challenges and the greater rewards.

Pro Technology Investment

The Digital Doctor should not in anyway be seen as being anti investment in technology in healthcare.  In fact Wachter is clear on the requirements for the investments in EHR and the tangible benefits.  However he shares with the reader some of the mistakes or misapprehensions of previous EHR implementation sponsors.  He would prefer that previous errors are not repeated.  And in the later part of the book the author draws a clear picture of hospitals operating in a highly technology dependent environment.  In this hee also makes the point that all of the constituent elements are already available.

Practical examples and commentary

The book is full of practical and relevant commentary and analysis.  He references patients concerns at doctors focusing on computers rather than patients.  He has a number of suggestions on this.  He references rapid advances in IT in Radiology – but the growing isolation of Radiology from other parts of the hospital.  Again he has a number of suggestions.  On the EHR itself part of the issue relates to trying to serve too many masters. The EHR is important to the clinicians, the insurers, the patients and, sometimes, the lawyers.  As a result having struggled to consolidate/ aggregate the data it may be ‘watered down’.  Lots of discussion also included on ePrescribing and alerts.  His comparison of management of alerts in aircrafts and hospitals provides food for thought.

Relevant to all involved in EHR

We know that to get EHR right we need clinical leadership and sponsorship.  As a CIO and CFO I found the clinical perspective in the book thoughtful and informative.  Would recommend to clinicians, IT and admin/ finance personnel involved in upcoming EHR projects.