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’.”
8 March 2018 @ 20:33
So Person, process and communication (or information system/technology)?
Let one dominate or get ignored, you have a broken system.
8 March 2018 @ 21:14
People, Process and Product (in IT + technology) I agree. People make processes and Processes employ technology where appropriate. I’v seen key processes where a school exercise book is adequate.
8 March 2018 @ 13:26
There is a factor that techno-geeks overlook regularly in ‘digitisation’ and that is a PROCESS. Everyone must understand that technology is a tool and unless you have something to use it for, you need a design or a process. Bolting technology, however clever, onto a broken process will not work; just get to a screw-up faster. The UK NHS is a good example of a broken process, i.e. communications. When I say this, people leap to say ‘but they/we are putting in iPhone, iPads and iEverything but they will not mend a broken process.
‘Facts do not cease to exist because they are ignored.’ – Aldous Huxley
8 March 2018 @ 15:37
Sorry, no suggestion that Dr Wachter is a techno-geek but techno-geek mentality drives these initiatives, usaully from the IT-unwashed, such as Senators and MPs.
9 March 2018 @ 10:55
The trouble with this is that it is correct but it is not that easy to resolve those processes.
Here are some examples, I could come up with lots of others.
– There are lots of different processes. I looked at EPRs in the US and the complaints are the same as in the UK, “they aren’t designed for me.” A check suggests that a system that is good in one hospital is not transferable because each unit is different. Often users see a clinical risk in changing processes or the process is partly driven by, for example, how close pathology is to the ward and how samples travel between the ward and pathology.
– Validating who a patient is for digital services is surprisingly difficult. Building a system that works for the digitally disenfranchised (who seem to make up a disproportionate segment of regular healthcare users) and the digitally savvy is difficult. I did a cashpoint transaction during UML training, writing UML for all the routes possible for a patient accessing healthcare for the first time in 10 years is a bit more complex,
– We still haven’t got the security model and communication right. This includes the difference between who or why people see records. “I only want my doctor to be able to see my record.” How do we build in – “The radiographer needs to understand this bit of your record to take the correct views.”, “Is it OK for an administrator (Medical Secretary) to see you record while typing minutes of the MDT?” “Is it even OK for your case to be discussed in the MDT?” without adding admin and delay in to the system.
9 March 2018 @ 11:11
I like the way changing processes was covered in ‘The Patient Will See You Now by Topol’. Many of our processes are designed around organisations, he suggests this is changed to people (i.e. the Patient).
As an example, we make a mess of trying to sort security. Instead of using technology to get the consent from Patient (people) like we are used to on the internet (when we allow apps to access our data such as ‘logging in via facebook or google’), we instead use technology to retain existing processes.