For the 2016 Nuffield Trust Health Policy Summit, the 'digital doctor' Robert Wachter presents lessons for embedding digital technologies into health care service delivery.

1. #ntsummit
Hope and hype in digitising health care (via Skype)
Dr Robert Wachter, Interim Chair of the Department of
Medicine, University of California, San Francisco
@Bob_Wachter

2. Robert M. Wachter, MD
Professor and Interim Chairman, Dept. of Medicine
Chief, Division of Hospital Medicine
University of California, San Francisco
Chair, Health IT Advisory Group for NHS England
@Bob_Wachter
Hope & Hype in Digitising
Healthcare

3. Why I Decided to Explore Health IT

4. “The Challenge That Will
Dominate Your Career…”

5. IT Adoption Skyrocketing:
Now >80% in MD Offices & Hospitals
EHR Adoption in US Hospitals. Ashish Jha 2015
~75%

6. When Things Will Really Get
Interesting
Traditional Enterprise
EHRs (Epic, Cerner, etc)
Consumer-facing IT (pt
portals, apps, sensors, etc)

7. Pressure to
deliver high-
value care
The digitization of
the U.S.
healthcare system
The Big Picture:
Two Transformational Trends
The Dominant Issue
Today
Prediction: The Dominant
Issue in 2025

8. Richard Baron on the Trauma of
Computerizing His Philadelphia
Office Practice
“The staff came to work
one day and nobody knew
how to do their job.”

9. The Demise of Radiology Rounds
“The man who ruined radiology”
– Paul Chang’s dad

10. Digital Radiology as the
Canary in the Coal Mine
The digitization of the thing creates the
opportunity for infinite distribution (at no cost)
Social relationships and communication
patterns that previously depended on gathering
around the thing will wither
Power relationships mediated by who controls
the thing will be renegotiated
What happens when the thing isn’t the film, it’s
the medical record…

11. Residents’ Room Vs. The Ward

12. A 7-year-old Girl’s Depiction of her MD Visit
Toll E. The cost of technology. JAMA 2012

13. 2014 Advertisement For AZ ER Job
Arizona General Hospital will be coming to The Grand
Canyon State later this year!! Located in Laveen, Arizona,
a suburb of Phoenix, Arizona General Hospital is a
40,000 square-foot boutique general hospital.
Services offered include:
• Emergency Room
• Radiology Suite inc. CT, X-Ray, and Fluoroscopy
• Two State-Of-The-Art Operating Rooms
• Outpatient Surgery
• 16 Inpatient Rooms
• NO Electronic Medical Record

14. What Have We Learned?

15. Health IT: The Mother of
all Adaptive Problems
“… problems that require people themselves to change.
In adaptive problems, the people are the problem and
the people are the solution. And leadership then is
about mobilizing and engaging the people with the
problem rather than trying to anesthetize them so that
you can just go off and solve it on your own.”
– Ronald Heifetz, Kennedy School of Government

16. “You can see the computer age everywhere
except in the productivity statistics.”
-- Nobel Prize winning economist Robert Solow, 1986

17. The Two Keys for Unlocking the
Productivity Paradox
Improvements
in the
technology
Reimagining
the work
itself

18. Ten Lessons from U.S. Experience
That May be Relevant to the UK
1. Gaining clinician buy-in is crucial (one of the fatal
flaws of NPfIT)
2. Home-grown systems can work in small GP practice;
far harder in 300-bed hospital
3. In U.S., a national programme that offered $s to
subsidize local purchases of IT systems meeting
national standards led to high level of implementation
4. That said, advantages of UK national system (Spine,
single ID) should be leveraged
5. Govt’s tendency to overregulate IT should be resisted

19. Ten Lessons from U.S. Experience
That May be Relevant to the UK
6. Interoperability is crucial for many reasons, so bake it
in early (hard to do later)
7. User-centered design must be a core value
8. Go-Live is just the start: systems need to
evolve/mature… need workforce (ie CCIOs) to do
that
9. The IT system is just the backbone–must have
culture, people, flexibility to innovate/reimagine
people/processes on that backbone
10. Learn the lessons of NPfIT, but don’t overlearn them
11. (Bonus Lesson): Be careful about overpromising:
remember the Productivity Paradox