Hot Best Seller

The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age

Availability: Ready to download

While modern medicine produces miracles, it also delivers care that is too often unsafe, unreliable, unsatisfying, and impossibly expensive. For the past few decades, technology has been touted as the cure for all of healthcare's ills. But medicine stubbornly resisted computerization - until now. Over the past five years, thanks largely to billions of dollars in While modern medicine produces miracles, it also delivers care that is too often unsafe, unreliable, unsatisfying, and impossibly expensive. For the past few decades, technology has been touted as the cure for all of healthcare's ills. But medicine stubbornly resisted computerization - until now. Over the past five years, thanks largely to billions of dollars in federal incentives, healthcare has finally gone digital. Yet once clinicians started using computers to actually deliver care, it dawned on them that something was deeply wrong. Why were doctors no longer making eye contact with their patients? How could one of America's leading hospitals give a teenager a 39-fold overdose of a common antibiotic, despite a state-of-the-art computerized prescribing system? How could a recruiting ad for physicians tout the absence of an electronic medical record as a major selling point? Logically enough, we've pinned the problems on clunky software, flawed implementations, absurd regulations, and bad karma. It was all of those things, but it was also something far more complicated. And far more interesting . . . Written with a rare combination of compelling stories and hard-hitting analysis by one of the nation's most thoughtful physicians, The Digital Doctor examines healthcare at the dawn of its computer age. It tackles the hard questions, from how technology is changing care at the bedside to whether government intervention has been useful or destructive. And it does so with clarity, insight, humor, and compassion. Ultimately, it is a hopeful story. "We need to recognize that computers in healthcare don't simply replace my doctor's scrawl with Helvetica 12," writes the author Dr. Robert Wachter. "Instead, they transform the work, the people who do it, and their relationships with each other and with patients. . . . Sure, we should have thought of this sooner. But it's not too late to get it right." This riveting book offers the prescription for getting it right, making it essential reading for everyone - patient and provider alike - who cares about our healthcare system.


Compare

While modern medicine produces miracles, it also delivers care that is too often unsafe, unreliable, unsatisfying, and impossibly expensive. For the past few decades, technology has been touted as the cure for all of healthcare's ills. But medicine stubbornly resisted computerization - until now. Over the past five years, thanks largely to billions of dollars in While modern medicine produces miracles, it also delivers care that is too often unsafe, unreliable, unsatisfying, and impossibly expensive. For the past few decades, technology has been touted as the cure for all of healthcare's ills. But medicine stubbornly resisted computerization - until now. Over the past five years, thanks largely to billions of dollars in federal incentives, healthcare has finally gone digital. Yet once clinicians started using computers to actually deliver care, it dawned on them that something was deeply wrong. Why were doctors no longer making eye contact with their patients? How could one of America's leading hospitals give a teenager a 39-fold overdose of a common antibiotic, despite a state-of-the-art computerized prescribing system? How could a recruiting ad for physicians tout the absence of an electronic medical record as a major selling point? Logically enough, we've pinned the problems on clunky software, flawed implementations, absurd regulations, and bad karma. It was all of those things, but it was also something far more complicated. And far more interesting . . . Written with a rare combination of compelling stories and hard-hitting analysis by one of the nation's most thoughtful physicians, The Digital Doctor examines healthcare at the dawn of its computer age. It tackles the hard questions, from how technology is changing care at the bedside to whether government intervention has been useful or destructive. And it does so with clarity, insight, humor, and compassion. Ultimately, it is a hopeful story. "We need to recognize that computers in healthcare don't simply replace my doctor's scrawl with Helvetica 12," writes the author Dr. Robert Wachter. "Instead, they transform the work, the people who do it, and their relationships with each other and with patients. . . . Sure, we should have thought of this sooner. But it's not too late to get it right." This riveting book offers the prescription for getting it right, making it essential reading for everyone - patient and provider alike - who cares about our healthcare system.

30 review for The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age

  1. 4 out of 5

    Austin

    This was an informative book, albeit one whose scope is much narrower than I originally thought. After all, 'digital' encompasses much more than just EHRs, which is the real focus of Digital Doctor. On the other hand, I didn't know just how large a role EHRs actually play: Turns out they are absolutely central to the functioning of modern medical facilities. Many of the issues and opportunities Wachter explores apply equally well to other aspects of the digitization of healthcare, including the This was an informative book, albeit one whose scope is much narrower than I originally thought. After all, 'digital' encompasses much more than just EHRs, which is the real focus of Digital Doctor. On the other hand, I didn't know just how large a role EHRs actually play: Turns out they are absolutely central to the functioning of modern medical facilities. Many of the issues and opportunities Wachter explores apply equally well to other aspects of the digitization of healthcare, including the apps and medical devices that are my research focus. For instance, doctors should be folded much more closely into product design and development processes. There are huge rewards for entrepreneurs who take the time to satisfy the needs of all stakeholders in healthcare though this is not an easy or quick task. My favorite quotes: --"The growing prevalence of EHRs offers grist for the AI and big-data mills . . . " --The Gartner Hype Cycle of technology: 1. Peak of inflated expectations, 2. trough of disillusionment, 3. slope of enlightenment, and 4. the plateau of productivity.

  2. 5 out of 5

    Robert

    Good mix of incidents and analyses of the impact of the increasing use of technology, especially of electronic health records, in medicine.

  3. 5 out of 5

    Måns Magnusson

    Pinpoints a lot of the problems with EHR (Electronic Health Record) systems. In Europe, we have even more problems trying to introduce American systems that don't fit our health care system. Some highlights that I remember from the top of my head: - Alarm fatigue: The system gives you so many alarms that you don't see the important ones. If a system or device does not make an alarm when something goes bad, the manufacturer is responsible. But there is no responsibility of h Pinpoints a lot of the problems with EHR (Electronic Health Record) systems. In Europe, we have even more problems trying to introduce American systems that don't fit our health care system. Some highlights that I remember from the top of my head: - Alarm fatigue: The system gives you so many alarms that you don't see the important ones. If a system or device does not make an alarm when something goes bad, the manufacturer is responsible. But there is no responsibility of having alarms go off without there being any problem. There is a story about a boy getting a 38x overdose of antibiotics because of a unit transformation and an alarm for the 38x overdose looking the same as a 1.05x overdose. - User feedback is seen as harassment. Basically, there was no way for the technical support to modify and fix buggy user interfaces, etc. When someone repeatedly gave feedback about the system, he got a call from their boss telling him to stop the harassment. - NDA's that are extremely aggressive about not discussing the EHR system with others, and not showing the system to anyone. My reflection is that this is what keeps the reputation of EHR vendors like EPIC and Cerner. My reflections about EHR systems in Sweden right now: I think the solution to the problems introduced by systems like Epic and Cerner is to make sure the hospital owns the software of its EHR system and can modify it, with inhouse developers. The systems needs to be developed together with the users. Also, I think hospitals should aim for minimalistic EHR systems. Do one thing, and do it well. Forget the AI that tries to diagnose patients, etc, for now. It's not a very high priority. What we need are systems that are easy to use, and are not a hassle for the staff, which we know are best developed in an iterative process together with the end-users.

  4. 5 out of 5

    Darren

    Technology will transform the healthcare sector – this has been the promise for many years, yet in many cases it has been a costly, backward step. In the world where everyone can be a home doctor thanks to Google, it can be easy to forget just how dependent hospitals and the medical world are on information technology. Yet it has not been plain sailing for healthcare professionals, who have been often slaves to a very expensive, inflexible machine. This book looks at the gr Technology will transform the healthcare sector – this has been the promise for many years, yet in many cases it has been a costly, backward step. In the world where everyone can be a home doctor thanks to Google, it can be easy to forget just how dependent hospitals and the medical world are on information technology. Yet it has not been plain sailing for healthcare professionals, who have been often slaves to a very expensive, inflexible machine. This book looks at the great march of technology and how it has impacted on the healthcare sector. Written from a U.S.-perspective, this still provides a stunning, fascinating look at how technology is transforming (or hindering) one of the world’s most extensive, most advanced healthcare markets. Remember, technology and practices can be exported – so valuable lessons can be learned! This is a very thought-provoking, considerate look at a massive system that certainly benefits (and suffers) from technology. Is technology getting in the way of providing healthcare? Certainly in some situations yes is the clear answer. Many doctors are more focussed on their computer screens, entering vital and not-so-vital information to feed its thirst, forgetting sometimes the most basic elements of their profession - interacting with their patient. The technology can also mean that “simple human mistakes” can be overlooked and not questioned, such as a teenager being given a near 39-times overdose of a medicine due to a mix-up. Yet the computer said it was correct so…. Even if you do not have a specific interest in healthcare (other than being a patient) you can still get a lot out of this book as there is a great degree of commonality with project management, business development and information technology. The author is quite critical about the thoughtless rush towards technology implementation, noting: “Medicine, our most intimately human profession, is being dehumanized by the entry of the computer into the exam room. While computers are preventing many medical errors, they are also causing new kinds of mistakes, some of them whoppers. Sensors and monitors are throwing off mountains of data, often leading to more confusion than clarity. Patients are now in the loop—many of them get to see their laboratory and pathology results before their physician does; some are even reading their doctor's notes—yet they remain woefully unprepared to handle their hard-fought empowerment.” Some of the earlier moves to computerisation proved to be a hindrance rather than a help, so a nurse might need to consult 11 different information systems, featuring over 600 clicks and 200 screen transitions just to collate together necessary information. Many errors could occur in this wild interaction. A replacement system, noted the author, required just 25 clicks, it increased efficiency and accuracy and saved sometimes half-an-hour per patient record! Some of the problems or errors reported in this book may have you smiling, even though they are of course very serious in themselves, such as the patient being documented as having the same blood pressure, taken from his foot, every day for a month - the problem was that the foot had been amputated at the start of that month. One could talk about this book for a very long time. Even as someone who is not involved in the medical industry, this book presented an alarming and interesting look behind the scenes. One can only imagine how frustrating and annoying it might be if one was actually inside having to fight against the systems on a daily basis. The Digital Doctor, written by Robert Wachter and published by McGraw-Hill Professional. ISBN 9780071849463, 320 pages. YYYYY

  5. 5 out of 5

    Bobby Title

    I am not in the medical field, nor am I involved with IT in any way, other than an interest in them. I have loved all of Abraham Verghese's books and when I heard BookTV's presentation of Wachter's book and Berghese's moderating Wachter's presentation, I knew I would find this book to my liking. It certainly was as interesting as I expected it to be. But I was rather surprised with myself over my gut reactions: After I started reading the book on day one, I found myself lying in bed t I am not in the medical field, nor am I involved with IT in any way, other than an interest in them. I have loved all of Abraham Verghese's books and when I heard BookTV's presentation of Wachter's book and Berghese's moderating Wachter's presentation, I knew I would find this book to my liking. It certainly was as interesting as I expected it to be. But I was rather surprised with myself over my gut reactions: After I started reading the book on day one, I found myself lying in bed that night thinking what I'd read so far was the making of a wonderful Sci-Fi book. Images of lines of people waiting to be told they were worth saving were pointed to the left; those with more dire or dull problems were being pointed to the right. It hit me: Not Sci-Fi. Worse. After day two's reading, I thought I had figured out the bottom line: The bottom line. Vendors, Companies, Businesses, Conglomerates. Any place the bottom line is the issue; the bottom line is the determiner of how we will go. And that was a very discouraging thought. I finished the book this afternoon. I am still shaking my head. Don't the shakers and movers know there are millions of good but very dumb people in the world who faced with what the future as seen here will require of them, are lost? Dare I worry about hackers of the terrorist ilk who will be able to shut down a nationwide system in the future? And then I had to laugh to think that if I have another major attack of lichen sclerosis on my bottom side that to see a doctor I may have a choice of going to In-and-Out Burger as the site designated for people going to neighborhood "medical care sites" or producing a selfie of my bottom side and sending via Facebook to someone in China who just happens to be "on call" that day for medical problems that need to be seen to be appreciated? Do I jest? Oh, I forgot to say this important fact. I needn't worry about all the worriable thing I read about in this book. I just turned 80 and I don't think the finale of this scary scenario will be played in my lifetime. But that book sure did make me think a lot. I'm passing it on to my son in Sonoma; I'll probably hear his reaction down here in SoCal without even needing a i-phone, which incidentally I am one of the dumb people who don't have i-anythings. Aside from anything else, the book is a great piece of writing.

  6. 5 out of 5

    Vernon Smith

    An amazing book written by an amazing physician. I can easily see why he is currently referred to as the most influential doctor. Bob Wachter is a storyteller; able to weave an understandable tale around some very complex topics. He is self-depricating in his analysis of the current Health IT environment while clearly still possessing an immense depth in understanding of the topic. He concludes that while the current health IT offerings are poor, they are better than what we had before. He encou An amazing book written by an amazing physician. I can easily see why he is currently referred to as the most influential doctor. Bob Wachter is a storyteller; able to weave an understandable tale around some very complex topics. He is self-depricating in his analysis of the current Health IT environment while clearly still possessing an immense depth in understanding of the topic. He concludes that while the current health IT offerings are poor, they are better than what we had before. He encourages the current vendors to continue development while acknowledging that they hold a virtual monopoly on their markets. I feel he is appealing to their greater good, almost as if they were fellow practitioners instead of the huge corporations that they are focused on market share and revenue. I am not so naive as to believe that anything other than government regulation or a serious disruptive competitor is going to affect the needed change. Unlike banks, gas stations, or grocery stores, the work force is not freely mobile, the transactions are not simple, one-time affairs, and the cost of entry is devastatingly steep. We have certainly seen this situation before; the telephone and airline industry come to mind. And just like that situation, I believe it will take government action, or someone with a large amounts of disposable income, to traverse the obstacles. I, for one, am still waiting for the fantastic future as predicted by Arthur C. Clarke.

  7. 5 out of 5

    Jim Gleason

    book review by Steve Okonek: Have you ever left a medical appointment thinking your doctor interacted more with her computer screen than you? Health care’s long immunity to computers had been remarkable when compared to other industries, until we entered the 21st Century. Now it too has fallen under the spell that digital technology improves the performance of everything it touches. UCSF’s Chair of the Department of Medicine, Robert Wachter explores the good, bad and repugnant of we patient book review by Steve Okonek: Have you ever left a medical appointment thinking your doctor interacted more with her computer screen than you? Health care’s long immunity to computers had been remarkable when compared to other industries, until we entered the 21st Century. Now it too has fallen under the spell that digital technology improves the performance of everything it touches. UCSF’s Chair of the Department of Medicine, Robert Wachter explores the good, bad and repugnant of we patients becoming Patients in his delightfully entertaining and informative “The Digital Doctor.” It’s disconcerting reading about how medicine “en masse” teaches its doctors, nurses, and pharmacists to get in touch with their inner geek. Meanwhile, thousands of coders suddenly face that “Geez, wish I’d taken Anatomy” moment as they test software. The result “isn’t a technical project, but a social change project.” System designers face a particularly onerous challenge, as the term “big data” hardly does justice to the amount of records that must be sorted through. He suggests, “There are two big data problems. First, the literature of medicine currently contains about 24 million records, and expands at the rate of 2,100 articles per day.” Second, the data contained within a complicated patient’s own health record can easily contain thousands of pages, both structured (such as lab results), and unstructured (such as physician narratives).” Much of the hype stems from the promise that Electronic Health Records (EHR’s) would save lots of money. This belief was surprisingly bipartisan. In his 2004 State of the Union address, George W. Bush promised that every American would have a personal electronic health record by the end of the decade. His successor’s “Obama Care” effort utilizes digitization of health records massively for billing purposes. You’ll read how particular diagnostic codes can mean tremendous differences in Medicare payments, and how these peculiarities can be gamed. The author muses, “In most industries, they bring in computers and immediately start laying off people. Only in health care do we bring in computers and then hire extra people to use them.” A major gain of these EHR systems is the ability of the patient to see test results, (often before the physician), have encounter summaries, and of course, pay bills. But as yet unsolved dilemmas include interconnectivity between hospitals and complaints from privacy advocates. But should you fall sick and unconscious far away from home, an emergency room needs to know whom the heck you are. “Take Boston’s Longwood Medical Area, where several of the nation’s most prestigious teaching hospitals share a space of about ten city blocks. Exchange of information is critical, yet the joke goes around Longwood, ‘what’s the fastest way to get a patient record from Brigham to Beth Israel? Answer: A paper airplane.’ ” Wachter introduces us to Epic Systems of Verona, Wisconsin, the 800-pound gorilla of EHR’s. Never heard of it? Virtually every large medical provider in the Bay Area – Stanford, UCSF, Davis, Kaiser, PAMF, as well as most of the top ten “Best US Hospitals” - as determined by various surveys have it at the heart of their information technology (IT) systems. You’ll cringe while reading the drop-down menu details of how UCSF’s state-of-the-art computerized prescribing system ordered a 39- fold overdose of a common antibiotic (Septra) for a hospitalized teenager, nearly killing him. Even worse is how numerous hospital professionals didn’t catch this error. To add insult to injury, healthcare IT vendors enjoy a contractual and legal structure that renders them virtually liability free, even if their proprietary products may be implicated in adverse events involving patients. Wachter sees lots of potential in EHR’s, but believes there is a long way to go. Data entry is a source of heartburn for nearly all physicians, and he spends pages speculating whether diagnosis by computer can ever be as reliable as that of personal experience. “Medicine is late to this digital carnival, but there are barkers everywhere telling us that this app will change everything,” Wachter concludes. “Starting now and lasting until forever, your health and health care will be determined to a remarkable, and somewhat disquieting degree, by how well the technology works” see this and more than a hundred other organ donation/transplant related books - many with my personal reviews - at http://www.trioweb.org/resources/book...

  8. 4 out of 5

    Jonna Higgins-Freese

    Interesting analysis of the role of ACA spending on IT (quoting former ONC Director Brailer saying that he would not have spent money on subsidies to digitize offices but on "standards, interoperability, a 'Geek Squad' to help with training and implementation, and creating a cloud-based 'medical Internet'" (18) In 2008 only 17% of med offices had basic EHR! (12) 1. Expenses would be borne by independent physician practices (provide 60% of US patient care), but benefits would accrue to Interesting analysis of the role of ACA spending on IT (quoting former ONC Director Brailer saying that he would not have spent money on subsidies to digitize offices but on "standards, interoperability, a 'Geek Squad' to help with training and implementation, and creating a cloud-based 'medical Internet'" (18) In 2008 only 17% of med offices had basic EHR! (12) 1. Expenses would be borne by independent physician practices (provide 60% of US patient care), but benefits would accrue to others, since the benefit of EHR is to make it easier for others to care for that patient. 2. Lack of interoperability standards (why Epic is so slow) cornerstone of ACA was to shift from fee-for-service to value: "a new reimbursement model under which providers would be paid a fixed sum to care for groups of patients and held accountable for their performance on measures of quality, safety, and patient satisfaction" (15). "Every system is perfectly designed to get the results it gets." Would need to change systems of recording patient info, ordering test sand meds, engaging patients in their own care, educating doctors and nurses, managing our tech within hospitals and clinics, designing and building computers for health care, paying for and regulating medical IT, instilling right amount of trust and skepticism re: technology. (19) Editor of NEJM, Relman, wrote NYReview of Books essay about fighting a losing battle with EHR for his physicians' attention. "Neither physician seemed to be actualy in charge of my care, or spent much time at my bedside . . . [both left copious notes in EHR] full of boilerplate language and lab data, but lacking in coherent descriptions of my medical progress, or my complaints and state of mind" (25). Abraham Verghese writes that "We're losing a ritual that I believe is transformative, transcendent, and at teh heart o fthe patient-physician relationship, the ritual of one individual coming to another and telling him things that she would not tell her preacher or rabbi; and tehn, incredibly, on top of that, disrobing and allowing touch. The ritual, he condluced, also signals to the patient that 'I will always be there; I will see you through this'" (27) (Culture Shock: Patient as Icon, Icon as Patient") Health IT more complicated than others. Large health care system processes about 10M computerized transactions/day, twice # on NASDAQ. So high volume plus complexity of patient's medical history, various places of treatment, and preferences. Also who needs access to what: insurance some info, providers other (43) SOAP note definition American using ops coordinator to handle 10-12 flights/time, Southwest using 1 who coordinated among all team members to do conflict resolution and sense-making (57) Christine Sinsky wrote about scribes, primary care physician in Dubuque who studies "joy in practice" among primary care physicians. http://www.nytimes.com/2014/01/14/hea... Importance of shoulder-tapping, constant communication, as factor in missed Ebola diagnosis, even though info was in medical record. "if you encounter a nonnormal situation, there is a preexisting relationship. You don't have to devote as many resources to getting the team members on the same page" (78) "The [EHR's] checkbox metnatity has even turned Larry WEed's beloeved Problem-Oriented Medical REcord -- in which the patients' issues are articulated, assessed, and addressed -- into a dessicated wasteland, devoid of thought or narrative arc. Part of the catch is that, while it is useful to enumerate problems one at a time, the real art of medical diagnosis comes in seeing the connections _between_ problems -- realizing that the patient's fever, heart murmur , and stroke, when woven together, add up to a diagnosis of bacterial endocarditis. Moreover, . . . we need to consider each case in its context: that the patient is scared, her mother died of cancer at an early age, she cant' afford her medications, and she has a teenager at home who's struggling with Asperger's." In 2012, author suggested a field for the uber-assessment: "In this field, please tell the many people who are coming to see your patient -- nurses, nutritionists, social workers, consultants, your attending -- what the hell is going on. What are the major issues you're trying to address and the questions you're struggling to answer? Describe the patient's trajectory -- is he or she getting better or worse? If worse (or not better), what are you doing to figure things out, and when might you rethink the diagnosis or your therapeutic approach and try something new? Please do not_ use this space to restate the narrow, one-problem-at-a-time-oriented approach you have so competently articulated in other parts of this record. We know that the patient has hypokalemia and that your plan is to replace the potassium. Use this section to be more synthetic, more novelistic, more imaginative, more expansive. Tell a story." (80) Argues that technology is difficult in medicine b/c it's processual -- at one moment it seems the diagnosis is one thing, but when it doesn't respond to antibiotics it's something else. But that's still a decision tree (101). Business case for diagnostic tools is hard to build b/c measuring whether diagnosis was correct is more problematic than measuring whether the correct medicine for asthma was given (107). Though we could change that through reimbursement policy. Use of big data: "what we once thought of as lung cancer is actually a series of different cancers, each with a particular genetic signature, which may prove to be the key predictors of outcomes and guide to treatment" (119). Watson using "patients like you" algorithm. "Much of the data in the EHRs continues to be collected for the purpose of creating a superior bill" (versus superior care) 121). Example of antibiotic overdose due to UI problem & alert fatigue, "Epic alert Lucca received is a model of bad design. There are no graphical cues, no skull and crossbones, no medical equivalent of a cockpit stick shaker -- nothing that would tell a busy physician that this particular alert, unlike the dozens of others that punctuate her days, truly demanded her attention" (149. Talks about how aviation UI folks are appalled by number of alerts in medicine. And problem of robot filling -- if a human had had to tear off 39 packs of abx, would have said something to pharmacist. Computers can now show how much faith we should put in a particular suggestion, appropriately calibrated trust. Open notes in fact decreased patient visits b/c they reviewed and suggested they not come in themselves. Zeiger and Frydman and SmartPatients and patient-centered communities.

  9. 5 out of 5

    Claudia Tessier

    As both a participant and observer in health informatics, I found this book to be a thoughtful overview of the evolution of the digital doctor: its initial vision, its beginnings, its difficulties, its false starts, its current reality, and its potential to make healthcare better for its practitioners as well as for those they serve, i.e., the patients. Wachter does all this by integrating his own experiences and knowledge with those of the myriad of experts he interviewed. It is well written an As both a participant and observer in health informatics, I found this book to be a thoughtful overview of the evolution of the digital doctor: its initial vision, its beginnings, its difficulties, its false starts, its current reality, and its potential to make healthcare better for its practitioners as well as for those they serve, i.e., the patients. Wachter does all this by integrating his own experiences and knowledge with those of the myriad of experts he interviewed. It is well written and captivating, and it reflects much of what I observed in the real world of healthcare documentation, healthcare informatics, and EHRs. He speaks knowingly of the the tremendous influence of vendors and government initiatives, particularly in regards to failed efforts at interoperability. And he recognizes that success and advancements will continue to be limited until the major parties (practitioners and patients) and their interests, needs, and preferences are recognized and attended to. As he notes, the problem is not that technology cannot do what we want it to do to advance healthcare, but rather that the limiting factors are social, cultural, financial, and self-interests. He acknowledges that we have a long way to go to achieve our full potential in the digital world of healthcare, but he is confident that we can do it. (Note: I'm the former CEO of the American Association for Medical Transcription and former Vice President of Medical Records Institute, where I led dozens of EHR workshops for physicians and their staff.)

  10. 4 out of 5

    Jonathan

    This review has been hidden because it contains spoilers. To view it, click here. The book is heavily focused on the rocky road america has taken in EHR (Electronic Health Record) implementation. The only surprising part of Watcher being an MD is the fact he is an excellent and poetic writer & journalist. Watcher takes you through an EHR implementation first hand at large health institutions & small clinics. He dives into health care policy driving EHR implementation & affecting it today. He takes a good look at HITECH, HIPAA, Meaningful use, and the ups&downs The book is heavily focused on the rocky road america has taken in EHR (Electronic Health Record) implementation. The only surprising part of Watcher being an MD is the fact he is an excellent and poetic writer & journalist. Watcher takes you through an EHR implementation first hand at large health institutions & small clinics. He dives into health care policy driving EHR implementation & affecting it today. He takes a good look at HITECH, HIPAA, Meaningful use, and the ups&downs of delivering value based health care to patients. He also dedicates a whole chapter to the private sector of EHR providers - specifically AthenaHealth & Epic. Most compelling is the personal and heart-wrenching stories he tells. Wachter also looks to other industries (auto manufacturing & commercial airlines) as basis for how to model the healthcare IT system of the future. I have read other reviews about the book which complain about the heavy emphasis on EHRs - but if you read between the lines what Watcher never says explicitly is an inter-operable EHR will be the first step to a functioning “doctor’s visit” of the future. One of the last chapters explains Watcher’s prediction of what the future of Healthcare in america may look like - it is so important to understand all the issues addresses with inter-operability, alert fatigue, population health management, and the loss of the “human” relationship in a doctor’s visit to get to how a true digital healthcare system may operate in the future Highly reccomend to anyone interested in healthcare IT, policy, value based outcomes - or just reading the chapters on “the patient” for a fantastic story that will have you on the edge of your seat wondering the outcome of Pablo’s 39X overdose

  11. 4 out of 5

    Pallav Sharda

    Most of the books that focus on innerworkings of American healthcare system hover around history, politics and whats-wrong-today perspectives. They are boring, esp. for outsiders. This book is entertaining. It reads more like a TV sitcom - describing characters, incidents. So it's different enough in that perspective alone to warrant a read. The history and issues are explained (as usual) - so that may be repetitive for some. Interesting add-on flavor is the frequent dives Most of the books that focus on innerworkings of American healthcare system hover around history, politics and whats-wrong-today perspectives. They are boring, esp. for outsiders. This book is entertaining. It reads more like a TV sitcom - describing characters, incidents. So it's different enough in that perspective alone to warrant a read. The history and issues are explained (as usual) - so that may be repetitive for some. Interesting add-on flavor is the frequent dives into the culture in medicine. Bob has a flair to do it in an engaging way, since he has a certain command over language and expressions. If you are looking for health IT product features and capability insights, or get an overview of the vendor space, market trends in health IT, this is not the book for you. PS: The narrator is not very effective. Does an average job. Sounds robotic throughout. Not a big drawback though.

  12. 4 out of 5

    D.C. Lozar

    As a Family Practice Physician deeply concerned about the interposition of technology between my profession and the patients I care for, I found Robert Wachter's, "The Digital Doctor," highly informative and thought-provoking. We stand on the cusp of a new age in medicine, one that is both exciting and dangerous. Mr. Wachter did a fantastic job of showing both sides of this growing debate in a way that allowed the reader to develop their own bias and provided supporting evidence for each argumen As a Family Practice Physician deeply concerned about the interposition of technology between my profession and the patients I care for, I found Robert Wachter's, "The Digital Doctor," highly informative and thought-provoking. We stand on the cusp of a new age in medicine, one that is both exciting and dangerous. Mr. Wachter did a fantastic job of showing both sides of this growing debate in a way that allowed the reader to develop their own bias and provided supporting evidence for each argument he discussed. This book is superbly written, engaging, and, if you buy the audio version, narrated. If you've noticed that your doctor spends more time data entry than they do listening to you, the book begins to explain why. As a fellow author, D.C. Lozar, I know how hard it is to keep an audience informed, engaged, and actively thinking and would happily recommend this book to anyone willing to learn something new while being entertained. Well done.

  13. 5 out of 5

    Erlend Skaga

    Unfortunately I was disappointed by the book. It takes 100 pages to go through the invention of patient records and how previous radiology rounds functioned etc. until todays systems, which seems far more exhaustive than necessary in a book trying to address the new computational technology in medicine. It further elaborates extensively in one major mistake in which a patient was harmed due to human and technological errors, before it discusses some upsides and downsides of technology and AI in Unfortunately I was disappointed by the book. It takes 100 pages to go through the invention of patient records and how previous radiology rounds functioned etc. until todays systems, which seems far more exhaustive than necessary in a book trying to address the new computational technology in medicine. It further elaborates extensively in one major mistake in which a patient was harmed due to human and technological errors, before it discusses some upsides and downsides of technology and AI in medicine and a political discussion about the American health care. Working in a modern Scandinavian health care system where the digitalization of medicine seems to be years ahead what is presented in the book, it gives very limited new insight.

  14. 4 out of 5

    Satrughan Kumar Singh

    TL;DR Summary : "When it comes to healthcare, writing code is the easiest piece of the puzzle" Lengthier Version: As a software engineer reading it, in an age where anyone who can write afew decent lines of code is considered a rockstar, this book humbled me. It showed me enough to get me to understand that the most challenging problems of our time wont be solved just by dumping technologies at it, but by supporting it with proper policies and processes. It showed me that a TL;DR Summary : "When it comes to healthcare, writing code is the easiest piece of the puzzle" Lengthier Version: As a software engineer reading it, in an age where anyone who can write afew decent lines of code is considered a rockstar, this book humbled me. It showed me enough to get me to understand that the most challenging problems of our time wont be solved just by dumping technologies at it, but by supporting it with proper policies and processes. It showed me that although the ability to write code is fantastic, it is pointless in the hands of an engineer who is not in touch with people he builds for.

  15. 5 out of 5

    Rachel

    Excellent presentation of the benefits and the dangers of modern Health IT. I appreciated the numerous examples given throughout the book to support thoughts or opinions. The plethora of interviews and differing opinions gave the book an overall unbiased look at current Health IT as well as the future of it. I appreciated the author's attempt at instilling the idea of medicine as being human. Although robots and digitization may help with safety and quality, medicine still requires a large part Excellent presentation of the benefits and the dangers of modern Health IT. I appreciated the numerous examples given throughout the book to support thoughts or opinions. The plethora of interviews and differing opinions gave the book an overall unbiased look at current Health IT as well as the future of it. I appreciated the author's attempt at instilling the idea of medicine as being human. Although robots and digitization may help with safety and quality, medicine still requires a large part of the human element; something I wholly agree with.

  16. 4 out of 5

    Josh

    Everyone should read A fantastic book on the evolution of IT in healthcare. Should be interesting to everyone, even if you're not in IT or Healthcare. Wachter addresses some of the key challenges and promises of tech in healthcare with a lot of interesting stories, and he does it all with style and wit.

  17. 5 out of 5

    Christopher Benassi

    The 1st half of the book is a definite "5 stars"...very well researched and provides the reader with a great foundation in EMRs and the legislation/regulation The second half of the book is maybe "3 stars" - it is much more qualitative and feels redundant to many of the points made earlier in the book. Overall, the first half alone makes it a great read and I would highly recommend

  18. 4 out of 5

    Jason Hamm

    Wachter gave a great synopsis of the state of technology in the medical field. Great examples and anecdotal stories to go along with his opinion. He also gives his version of what the future in health care is going to look like. This was an interesting book, but wasn't a page turner for me.

  19. 5 out of 5

    Aaron

    Entertaining expose of modern healthcare IT, but it reads as a dated academic physician in a modern system reminiscing of times past. Probably most interesting for recent internal medicine resident graduates who lived through the anecdotes first hand.

  20. 5 out of 5

    Saket Saurabh

    Pick your copy today if you are a believer in tech driven healthcare, if a cynic then it makes even more sense. Very detailed account but is not overdone. The author did have access to people who matter.

  21. 5 out of 5

    Erin

    I think the author wrote this book as a "letter" of sorts to his fellow healthcare providers. . . Like a "Dear Future Doctor or Nurse" time capsule letter. Very informative. Very interesting. Very thought provoking.

  22. 5 out of 5

    Elizabeth

    Wonderful overview of digital’s impact on medicine, the patient experience, and the clinician’s efficacy. Learned about the impact of HITECH, the ONC, and the contributions of David Blumenthal. Great perspective on the future of medicine in the digital age.

  23. 5 out of 5

    Sharath Reddy

    Great survey of digitization in medicine

  24. 5 out of 5

    Emes

    Intelligent and eloquent written.

  25. 5 out of 5

    Vijay Gaikwad

    Great overview of the landscape of healthcare IT This book is great for any tech entrepreneur to understand the impact of technology on different industries and not only healthcare

  26. 4 out of 5

    Matt Lavin

    He spent more time talking about how things can be bad rather than how things could be good. It was nice to see how some people in the medical profession view technology changes.

  27. 5 out of 5

    Max Nova

    An interesting take on the history of Electronic Health Records and how they're changing medicine for better and for worse in America. I'm not particularly interested in this specific topic, but the book is valuable as a case study of the challenges of integrating technology into existing complex, highly regulated, high stakes industries that are filled with specially trained professionals. Several of my favorite quotes below ####################### Harvard psych An interesting take on the history of Electronic Health Records and how they're changing medicine for better and for worse in America. I'm not particularly interested in this specific topic, but the book is valuable as a case study of the challenges of integrating technology into existing complex, highly regulated, high stakes industries that are filled with specially trained professionals. Several of my favorite quotes below ####################### Harvard psychiatrist and leadership guru Ronald Heifetz has described two types of problems: technical and adaptive. Technical problems can be solved with new tools, new practices, and conventional leadership... Heifetz contrasts technical problems with adaptive ones: problems that require people themselves to change. In adaptive problems, he explains, the people are both the problem and the solution. During Burton's years working at Otis, he had learned an important lesson: although his work was ostensibly about computers, cables, and controls, solving the technical puzzles wasn't nearly as hard, or as important, as fixing the underlying business, cultural, and political problems. That's what really determined how well the system worked. In a 2013 study, researchers at Johns Hopkins found that medical interns spent just 12 percent of their time talking to their patients, versus more than 40 percent of their time on the computers. To Reiser, the discovery of the stethoscope had even broader implications. The rise of the stethoscope, and the triumph of auscultation that resulted, also marked the beginning of what the historian called "modern therapeutic distancing," as the doctors' attention shifted from the words spoken by patients to the sounds produced by their organs. And thus began the transformation of the doctor-patient relationship. Medical historian Stanley Reiser captured the impossibility of all of this when he called the medical record a "contradictory hybrid: a confidential and public document." One of the most fascinating solutions to the physician-as-data-entry-clerk problem has been the emergence of scribes, often premedical students or paramedics who are hired by physicians to perform documentation in real time... In the 23 physician practices that Sinksy observed, she found that the scribes were one of a small number of innovations that reliably led to happier doctors and a better-functioning clinic... "In every other industry, they bring in computers and start laying people off... Only in healthcare do we bring in computers, and then hire extra people to use them." The issue of distractions is, of course, well appreciated in aviation. In fact, one of the sacred rules of the field is known as the "Sterile Cockpit," which prohibits distractions, including conversations about matters other than flight safety, when the plane is flying at an altitude below 10,000 feet - generally during takeoff and landing. As the economist Paul Krugman has observed, while productivity isn't everything, it is almost everything, because it is what ultimately determines the financial vitality of a business and the living standards of a country. I heard many references to this notion of honoring the pilots' experience and traditions in my discussions with various folks at Boeing and with pilots themselves. It is clearly part of the DNA of commercial aviation. I never heard anything like it from a health IT vendor, many of who see clinicians as expensive cogs to be replaced or technophobic obstacles to be overcome. "The more questioningly we ponder the essence of technology, the more mysterious the essence of art becomes" - Martin Heidegger, The Question Concerning Technology, 1977

  28. 4 out of 5

    Perry Dinardo

    Few would doubt that the incorporation of modern technology into medical care has been “strewn with land mines, large and small.” In The Digital Doctor, Robert Wachter shows us the ways in which our modern healthcare system has changed with the addition of new technology and offers insight into the future of healthcare. Written in a thoughtful, yet entertaining and almost conversational, style, The Digital Doctor is a worthwhile and important read for new and experienced healthcare pr Few would doubt that the incorporation of modern technology into medical care has been “strewn with land mines, large and small.” In The Digital Doctor, Robert Wachter shows us the ways in which our modern healthcare system has changed with the addition of new technology and offers insight into the future of healthcare. Written in a thoughtful, yet entertaining and almost conversational, style, The Digital Doctor is a worthwhile and important read for new and experienced healthcare professionals, as well as for anyone who views the future of medical care with concern, excitement, or a mixture of both. The problem, Wachter writes, is that, “Medicine is at once an enormous business and an exquisitely human endeavor…it is about science, but also about art; it is eminently quantifiable and yet stubbornly not.” He effectively balances the hope, hype and harm associated with his topic by interviewing experts from all perspectives– including doctors such as Abraham Verghese, important players in Silicon Valley such as technology optimist Vinod Khosla, and patients– all who interact with medical technology in an entirely different way. The book opens with an exhaustively comprehensive background of the politics behind recent legislature that has affected the ways hospitals use technology, as well as a historical section which serves to remind us that today’s concerns about technology in medicine are nothing new. Although this political discussion is certainly important for placing the current state of healthcare into context, the politics section is a whirlwind and may be confusing for anyone without a background in this area, due to the sheer volume of names and decisions described. Wachter draws comparisons to other fields outside of medicine, particularly aviation. Aviation experts have managed to effectively deal with many issues that still present a thorny issue for doctors. For example, commercial pilots now have a clear and well-organized alert system in place to eliminate inefficient alerts and avoid “alarm fatigue,” while doctors are faced with a cacophony of alarms every day. Many of the alarms doctors hear on a daily basis are insignificant or accidentally triggered when no emergency is present, but ignoring the wrong alarm could result in the death of a patient. The harm associated with medical technology is perhaps easier to pinpoint than the hope. Negative effects of computerization are immediate and dangerous. Central to the book is the story of 16-year-old boy who was prescribed a common antibiotic, but mistakenly given a 39-fold overdose that nearly killed him. To explain how such an incredible error could have occurred, Wachter takes us through the interface between human and technology at each step: from the doctor who prescribed and confirmed the medication (with a tiny error in the unit), to the robot in the pharmacy that filled the order, to the nurse who administered the overdose. Without placing blame on any of the parties involved, Wachter describes the “Swiss cheese model of error”: in a system where each step is designed to be a check on the last, all of the “holes” aligned in exactly such a way that nobody caught the error. “While someday the computerization of medicine will surely be that long-awaited ‘disruptive innovation,’ today it’s often just plain disruptive.” But Wachter believes we are headed in the right direction. Though careful to balance the hope and the harm, Wachter ends the book with a hopeful depiction of the ideal picture of integrated technology in the hospital of the future. Posted on the Arnold P. Gold Foundation Blog at: www.humanism-in-medicine.org

  29. 4 out of 5

    Malin Friess

    EMR...Electronic Medical Records has been postured as the technology that can make medicine safer, less expensive, and faster. Government health care subsidies have thrown billions of dollars towards hospitals and practices that will comply and initiate EMR. Yet once Doctors and Dentists started using EMR they noticed that something was wrong.. -a hospital still gives a 39 fold overdose of antibiotics to a child -Doctors are no longer making eye contact with patients but typing on an i EMR...Electronic Medical Records has been postured as the technology that can make medicine safer, less expensive, and faster. Government health care subsidies have thrown billions of dollars towards hospitals and practices that will comply and initiate EMR. Yet once Doctors and Dentists started using EMR they noticed that something was wrong.. -a hospital still gives a 39 fold overdose of antibiotics to a child -Doctors are no longer making eye contact with patients but typing on an ipad or computer -A 5 minute patient visit...can easily turn into a 20 minute computer visit (toggeling through 8 computer screens and clicking on no less than 35 boxes to fill our all the required templates) - A recruiting ad for physicians boasts the absence of EMR -Now that the doctor is no longer tethered to the patient chart..hospitals have changed. Residents are not in the wards (there in a conference room all staring at computers), doctors don't visit or talk with radiologists, doctors spend 1/3 of their time at a computer. - Chart entries (with cut and paste) are so bloated they become almost nonsensical How is technology transforming medicine (it should do more than just exchange bad manuscript for 12 size font) for the better and the worse? Wachter acknowledges that medical doctors are not luddites..they actually want to see EMR work. Medicine could learn a lot from aviation..checklists, alerts that matter (and could actually stop an overdose of antibiotics), simulations. 85% of doctors (since EMR) are spending more time on documentation and see fewer patients. EMR has created problems it didn't expect by rearranging social relationships. Doctors don't talk to nurses who see's a patient who traveled to Liberia recently with a fever, actuaries and accountants are now privy to the data mine of EMR..which use to rest safely behind the nursing station in paper charts. Wachter is a big proponent of open notes (Patient can see online all doctors entries and labs)..even though it scares physicians. And engaged patient can catch mistakes. Wachter is still optimistic about EMR and presents a scenario in the future where the doctor patient conversation is seamlessly integrated into the appropriate chart and visualized on a screen real time. He see's primary care doctors becoming case managers and more reliance on apps..less in person visits. 5 stars. Every physician, nurse, dentist, and patient ought to read this book.

  30. 4 out of 5

    Connie Anderson

    When my healthcare system (one of the first in the country) first went digital, receptionists (the first phase) were overwhelmed until they learned the system. Then there were computers in the exam rooms. When I read the description of Dr. Robert Wachter's new book, I had to read it. He explained why doctors like mine stopped making eye contact with their patients. That was the reason I most wanted to read it. Plus his hope that once all the bugs are worked out, medicine is going to change expon When my healthcare system (one of the first in the country) first went digital, receptionists (the first phase) were overwhelmed until they learned the system. Then there were computers in the exam rooms. When I read the description of Dr. Robert Wachter's new book, I had to read it. He explained why doctors like mine stopped making eye contact with their patients. That was the reason I most wanted to read it. Plus his hope that once all the bugs are worked out, medicine is going to change exponentially for the better, especially for patients. This book needs to be read by everyone: hospital staff, clinicians, and patients alike. Dr. Wachter is also the leader in patient safety. He set out to find out why the medical field could not implement new computerized electronic health records. While the government's EHR program was a failure, according to Dr. Wachter, it advanced medical information technology. He tells how medicine is going to change for the better, with the focus on the patient. The hope for the future is like seeing the sunshine after a storm. Dr. Wachter informs that the storm is almost over and that we all must participate in our healthcare. I was given a free copy to read and give my honrst review.

Add a review

Your email address will not be published. Required fields are marked *

Loading...
We use cookies to give you the best online experience. By using our website you agree to our use of cookies in accordance with our cookie policy.