Robert M. Wachter

Why doctors dislike high-tech healthcare

A doctor listening to a patient inside a medical centre of the Greek delegation of the Doctors of the World in Perama, near Athens, on March 5, 2015. -- PHOTO: RETUERS 
A doctor listening to a patient inside a medical centre of the Greek delegation of the Doctors of the World in Perama, near Athens, on March 5, 2015. -- PHOTO: RETUERS 

Last year, I saw an ad recruiting physicians to a Phoenix-area hospital. It promoted state-of- the-art operating rooms, dazzling radiology equipment and a lovely suburban location. But only one line was printed in bold: "No EMR." In today's digital era, a modern hospital deemed the absence of an electronic medical record system to be a premier selling point.

That hospital is not alone. A 2013 Rand survey of physicians in the United States found mixed reactions to electronic health record systems, including widespread dissatisfaction. Many respondents cited poor usability, time-consuming data entry, needless alerts and poor work flows.

If the only negative effect of healthcare computerisation were grumpy doctors, we could muddle through. But there's more.

A friend of mine, a physician in his late 60s, recently described a visit to his primary care doctor. "I had seen him a few years ago and I liked him," he told me. "But this time was different." A computer had entered the exam room.

"He asks me a question, and as soon as I begin to answer, his head is down in his laptop. Tap-tap-tap-tap-tap. He looks up at me to ask another question. As soon as I speak, again it's tap-tap-tap-tap."

"What did you do?" I asked.

"I found another doctor."

Even in preventing medical mistakes - a central rationale for computerisation - technology has let us down. A recent study of more than one million medication errors reported to a national database from 2003 to 2010 found that 6 per cent were related to the computerised prescribing system.

The unanticipated consequences of health information technology are of particular interest today. In the past five years, about US$30 billion (S$41.4 billion) of federal incentive payments have succeeded in rapidly raising the adoption rate of electronic health records. But whopping errors and maddening changes in work flow have even led some physicians to argue that we should exhume our three-ring binders and return to a world of pen and paper.

This argument is utterly unpersuasive. Healthcare, our most information-intensive industry, is plagued by demonstrably spotty quality, millions of errors and back-breaking costs. We will never make fundamental improvements in our system without the thoughtful use of technology. Even today, despite the problems, the evidence shows that care is better and safer with computers than without them.

Moreover, the digitisation of healthcare promises to be transformative. Patients who today sit in hospital beds will one day receive telemedicine-enabled care in their homes and workplaces. Big-data techniques will guide the treatment of individual patients, as well as the best ways to organise our systems of care. New apps will make it easier for patients to choose the best hospitals and doctors for specific problems.

Some improvements will come with refinement of the software. Today's healthcare technology has that Version 1.0 feel, and it is sure to get better.

But it's more than the code that needs to improve. In the 1990s, Dr Erik Brynjolfsson, a management professor at MIT, described "the productivity paradox" of information technology - the lag between the adoption of technology and the realisation of productivity gains.

Unleashing the power of computerisation depends on two keys, like a safe-deposit box: The technology itself, but also changes in the workforce and culture.

We also need far better collaboration between academic researchers and software developers to weed out bugs and reimagine how our work can be accomplished in a digital environment.

Our iPhones and their digital brethren have made computerisation look easy, which makes our experience with healthcare technology doubly disappointing. An important step is admitting that there is a problem, toning down the hype and welcoming thoughtful criticism, rather than branding critics as Luddites.

In my research, I found humility in a surprising place: The headquarters of IBM's Watson team, the people who built the computer that trounced the Jeopardy! champions. I asked the lead engineer of Watson's health team, Dr Eric Brown, what the equivalent of the Jeopardy! victory would be in medicine. His answer reflected his deep respect for the unique challenges of healthcare. "It'll be when we have a technology that physicians suddenly can't live without," he said.

And that was it. Just an essential tool. Nothing more, and nothing less.

The writer is a professor 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.