Think more about how technology affects quality
“We see doctors and patients no longer looking each other in the eyes, and the fastest-growing profession in medicine is pre-med students hired as scribes.”
Dr. Bob Wachter is a professor and chief of the division of hospital medicine at UCSF Medical Center in San Francisco.
A nationally recognized expert in patient safety, he has a widely read blog on the subject called Wachter’s World. He’s a past president of the Society of Hospital Medicine and coined the term hospitalist. Modern Healthcare editorial programs manager Maureen McKinney recently spoke with Wachter about the good and the bad of healthcare going digital, the challenge of reducing diagnostic error rates, and the relationship between meaningful-use standards and clinical quality. This is an edited transcript.
Modern Healthcare: Please recap the themes from your recent keynote talk on healthcare in the digital age.
Dr. Bob Wachter: We’re in a remarkable period in healthcare because we have gone in the last few years from being an analog industry to a digital industry. What we’re seeing is not all positive. We see doctors and patients no longer looking each other in the eyes, and the fastest-growing profession in medicine is pre-med students hired as scribes. In every other industry when they bring in technology, they lay off half the people. Only in healthcare do we bring in technology and we’ve got to hire people to feed the computers.
One of the things technology does is change the geography. It used to be that I’d have to go to radiology to look at my film and talk to the radiologist. I don’t have to do that anymore.
It used to be I’d have to go to the floor to do my charting. I don’t have to do that anymore. It changes everything in ways we haven’t really thought through carefully.
At my own institution recently, we gave a kid a 40-fold overdose of a commonly used antibiotic. Why? Because someone put in the wrong order in milligrams rather than milligrams per kilogram. In the old days, a pharmacist would have gotten an order and would have said, “What’s going on here?” Now, we have a $3 million robot that does it.
So we just have to take a step back and think about how it’s changing the way we communicate, the workflow and the way we think, because to some extent, we’re beginning to turn our brains off.
MH: There was research recently showing a lack of correlation between the federal meaningful-use requirements and actual clinical quality. Are we taking enough time to evaluate if the path we’re taking is the right one?
Wachter: There’s a tendency to say, “We’re going too fast.” The meaningful-use standards are a little bit overly bureaucratic. But I think we had to go through this stage. I have no sympathy for the argument that we should have just waited until it was perfect, because we would never have gotten there. The only way we’d get there is we push pretty hard, figure out what’s not working and then make it better. And I think we’ll get there.
MH: Thoughts on the ICD-10 delay?
Wachter: I have tremendous sympathy for the individuals and organizations that geared up and were ready to go on Day One and now have to twiddle their thumbs for another year. On the other hand, it gave some people a chance to catch their breath and be a little bit more thoughtful about the implementation. It’s a mixed bag.
MH: Are quality improvement programs starting to focus more on diagnostic errors?
Wachter: They’re beginning to, but the problem is we have no idea how to measure diagnostic accuracy. You can look like the safest hospital in the world by doing the right things for patients with heart failure or MIs or pneumonia and get every diagnosis wrong. People are thinking and talking about it more than they used to. But until we figure out how to measure diagnostic errors so it appears side by side with things we can easily measure, such as central line-associated infections, or bed sores, or falls, organizations and training programs will focus on other parts of safety and quality and leave diagnostic errors behind.