Dr. Robert Wachter believes that while the industry is still in the very early stages of digitizing healthcare, it’s also on the cusp of meaningful transformation.
Delivering the opening keynote Sunday at the American Telemedicine Association’s annual conference in Chicago, Wachter, chair for the department of medicine at the University of California, San Francisco School of Medicine, said that there are four stages of health IT: digitizing the record; connecting the parts, such as hospitals to hospitals or third-part applications to enterprise systems; gleaning meaningful insights from the data; and converting those insights into action that improves value.
To date, he said, the industry has been stuck in a productivity paradox, not seeing the anticipated benefits from technology use increased in large part, by the federal government’s electronic health record incentive programs, established in 2011. Many tools have been created and deployed with a focus on continuing to deliver care in the same manner, said Wachter, author of 2015’s The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age.
.@Bob_Wachter at #ATA18: Digital healthcare is all going to be pretty magical when we're done, but we're not done yet. We're still at the beginning. @AmericanTelemed @CDW_Healthcare pic.twitter.com/vjAaegrjnS
— Dan Bowman (@Dan_Bowman) April 29, 2018
But it appears that the industry is slowly starting to reimagine its processes rather than simply deploying new technology to old problems, he said.
“There are massive needs of workflow, workforce and culture, because reimagining work is not trivial,” Wachter said. “It means you take a step back and really ask fundamental questions” about hows and whys of process and deployment.
Not Just a Replacement for a Doctor’s Office Visit
For telemedicine to reach its full potential, Wachter said, it can’t simply serve as a replacement to visiting the doctor’s office. Rather, the technology must be connected to other parts of the health system. “It’s got to be tightly interwoven into the electronic health record and other parts of the health system,” he said.
Additionally, figuring out the use cases, the impact on people and organizations, the business and political opportunities, and obstacles will be far more important than improving the technology, Wachter said.
“Many uses won’t become clear until it’s actually in widespread use,” he said. “You can try to be smart and creative and clever … but it’s really hard to do until you’re actually using it and seeing the opportunities that flow from those uses. … Henry Ford was reputed to have said, ‘If I had asked people what they wanted, they would have said faster horses.’ They had no ability to see what the car could do until there were cars.”
Moving forward, Wachter said the No. 1 question for telemedicine will be, can the technology lead people to reimagine the work? If it merely leads to untethering patients from clinicians and sites of care, it will not have reached its potential, he said.
“We have to figure out ways of delivering care that’s safer, more accessible, more satisfying and — very, very importantly — less expensive,” Wachter said. “To me, there’s no question that the bridge is going to be made largely of digital, and we won’t get the digital right until we reimagine the work.”
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