QZ&A

Software has changed the world, but here’s why it hasn’t improved healthcare

The computer age promised great transformations but so far it’s done little to transform healthcare.

You still need to visit your doctor for most ailments. If you’re to be hospitalized, the care isn’t great despite extremely high costs. The use of technology was supposed to help increase face time with a doctor, but the exact opposite has happened. And all the data gathering hasn’t really brought radical new treatments.

Bob Wachter, a physician and professor of medicine at the University of California, San Francisco, has championed the use of technology in hospital care. And, yet, he has seen time and again that the problem lies mainly in the implementation of technology.

The case of a patient, who received a 39-fold overdose of an antibiotic despite his hospital’s state-of-the-art healthcare software, spurred Wachter to look more critically at why technology continues to fail patients. Wachter’s book, The Digital Doctor: Hope, Hype, and the Dawn of Medicine’s Computer Age, portrays a picture where everything gets worse before it gets better.

Quartz caught up with Wachter recently to discuss why doctors seem technophobic, how UK’s £20-billion digitization program failed, and what the health industry can learn from Apple and Boeing. The conversation has been edited and condensed for clarity.


QZ: Why are doctors so resistant to employing technology in their daily practice?

Bob Wachter: There is reasonable evidence that, when we get to that future state, it will make care safer, cheaper, and better. But that is not the predicament in which doctors finds themselves on a daily basis. She doesn’t care that much about what life looks like five years from now. She has a sick patient in front of her, and she has to make decisions about it right now.

Then you come in and say, “I have this new tool that will change your life in five or ten years for the better, but until then it will make your life worse. And in that period, you will have to change how you work: allocate time differently, alter workflow, add more layers to the decision-making process, etc.” Doctors are not going to willingly accept ways in which bureaucracy can more easily become intrusive.

It’s unlike how things work when you download a new app. The difference is that getting used to an app will only take a week and life will be better after. For doctors, that waiting period right now is five years, and in that period they are worried that using these tools they might actually end up hurting people.

Why can’t we disrupt the hospital business to function more like startups?

I’m afraid the barriers are too high in the hospital business, both in the capital costs and regulatory hurdles. But we are seeing examples in clinical care, such as One Medical in San Francisco, where physicians think like startups. They want to rethink the system from the ground-up with technology at the core. Such experiments show how technology completely changes physician-patient relationship, in a way that makes a patient’s role much more active. “Doctors are not going to willingly accept ways in which bureaucracy can more easily become intrusive.” 

The hope is that, as these experiments succeed, they will one day find it a sensible investment to build a hospital from ground-up. But that cannot be the first step yet.

The US has leap-frogged the world in digitization of healthcare. But it all started in the UK, didn’t it? Why did it fail?

Because the UK’s National Health Service is government-run, the pre-conditions for digitization were better in the UK than in the US. Theoretically, all the hospitals want to be on the same platform, want to be able to talk each other, and have a powerful incentive to keep care as inexpensive as possible.

In the short-term, that’s hard. Even in the US, we are seeing that the productivity advantages don’t come immediately. So you need to get over this short-term hump. And that involves a period where you will have doctors doing this complicated, important, and potentially deadly work.

Robert Wachter, MD
Bob with his students at UCSF Medical Center. (Susan Merrell/UCSF)

The state of digitization in the UK is still rudimentary, despite having spent billions on it before the US got into the game. This is ironic because George Bush setup the programs that he did because he was jealous of Tony Blair’s attempt in the UK.

When you ask people in the know in the UK about why Connecting for Health [the UK program for digitization] failed, they say it was because of a fundamental misunderstanding of the complexity. The person in charge of the program was a master of logistics and procurement, and he believed that this whole thing could be run centrally. It was like procuring arms and ammunitions for the military—he didn’t want each base to worry about their own supply and wanted to buy at scale. There might have been the need for some boots on the ground, but most of the implementation was to be done centrally.

That is why a hospital like ours has a massive IT staff. You’d say that you bought a software application, and you should be able to use it out of the box. But that’s not how it works. You need all that staff to localize it for the needs of our hospital. They also need to setup policies and even sell it to the technophobes.

An iPhone is made for a mass-market, where anybody can pick it up and learn quickly how to use it. Why does healthcare software not use principles of consumer design?

Think about the engineers at Apple or Boeing. They believe they have the solution for what customers want, so they go ahead and build something. But then they spend thousands of hours watching how potential consumers interact with their products. Then they tweak it to make it better. There is a remarkable amount of humility in that process. “You bought a software application, and you should be able to use it out of the box. But that’s not how it works.” 

That has been lacking among those who design healthcare software. When doctors use the software, they realize that the engineers who have designed the software really do not know what doctors do.

To be fair, what Apple needs to do to test their phones is not that hard. Those designing healthcare software, however, need to do a lot of additional work to really understand the problems before coming up with a solution.

What can the aviation industry teach the health industry?

The aviation industry today is remarkably safe, and it wasn’t always the case. So it seemed logical for the healthcare industry to look to aviation industry for lessons. A lot of things they’ve done, such as the standardization of the cockpit, the use of simulation to train pilots, and the enforcement of safety standards, are great examples.

But whenever you speak to a physician about this example, I can tell you that it annoys them. And that’s because what aviation has to do is easier than what doctors need to do. For instance, in computerizing the cockpit, Boeing or Airbus can focus on creating something that two highly trained individuals can operate with the singular aim of flying the plane safely. In case of computerization of healthcare, the software is built not just for keeping patients safe but also to ensure many other things. Healthcare software is be used by doctors, nurses, pharmacists, accountants and managers, and deals with everything from a routine prescription to intensive patient care.

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