Think more about how tech­nol­ogy af­fects qual­ity

Modern Healthcare - - Q & A -

“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.

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