The vast US healthcare industry is slowly seeing the benefits of a decade of investment in IT systems, but much remains to be done before it achieves the full productivity benefits of digitisation.
This was the key message from Dr Robert Wachter, author of ‘The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Computer Age’, in his keynote address at the CHIME CIO Summit in Las Vegas on Monday.
After $30 billion of investment, through the HITECH Act, the $3.5 trillion US healthcare industry has reached encouraging levels of digitisation, but remains on a 10-15 year journey to realise the productivity benefits other industries have seen through computerisation.
“If you had heard this talk two or three years ago it would have been pretty grumpy,” he told his audience.
“But I find that things are getting a lot better.”
In ten years, the number of Americans with an electronic health record has gone from just one in ten, to a position where only one in ten now don’t have one.
Its been a pretty bumpy journey, but one absolutely necessary to take.
“I’m no luddite, but we could do so much better,” said Dr Wachter.
“Every doctor I know is very unhappy with state of affairs.
“Nobody went into medicine to become bad data entry clerks.”
“The delight people tend to get out of new IT tools don’t seem to get out of electronic medical records.”
But he stressed he was not for turning back the clock, but instead completing the digital revolution.
“Things are better, no question about it,” Dr Wachter said.
“Those people that say we should go back to 3 ring-binder are crazy.”
Dr Wachter described digitising the medical record as the first part of a four-stage journey the US healthcare system had to follow. The second “connect all the parts of the system, is interoperability.”
“This remains very much a work in progress,” said Dr Wachter.
The third step is: to “gain meaningful insights from data” and the fourth to “convert these insights into actions”. And on these last two steps, Dr Wachter said, the potential has been recognised but very little yet done.
He pointed this was why health had yet to achieve the productivity benefits that other sectors had achieved through computerisation. The lesson, though, from other sectors was that the productivity benefits always arrived eventually.
“The happy ending is that it always goes away, it takes about a decade. In healthcare it takes longer,” said Dr Wachter. “I think our productivity paradox is about 15 years and we are now five years in.”
To date, the digitisation of US healthcare has largely replicated paper processes. What has only just begun to change was re-imagining the work, he said.
“The technology will continue to get better. But that turns out not to be the key thing.
“The key thing is re-imagining the work, workflow and processes and training and asking questions of why we do it this way. And the answer is almost always ‘that that’s the way we used to do on paper’.”