We hear a lot of talk about how technology has “disrupted” healthcare. But as I noted in my presentation at this year’s VUE19 conference, we haven’t seen anything yet. Yes, IT has significantly altered how hospitals and physicians practice medicine. But based on historical precedent, we’re still 5 to 10 years away from our “Netflix moment.”
It’s hard to imagine this now, but only 15 years ago Netflix was running on fumes and in danger of going out of business. Desperate for cash, the CEO went to Blockbuster and offered to sell the company for $50 million. The Blockbuster CEO just laughed. A few years later, Blockbuster was out of business; today, Netflix has a market value of $150 billion.
That’s what truly disruptive digital transformation looks like. It’s turned industries upside down not only in entertainment media but in retail (Amazon), telecom and photography (Apple), journalism (Axios, Politico) and transportation and travel services (Uber, Airbnb). And it’s coming to a hospital near you.
The good news is that, while our digital journey so far has been a slow and bumpy ride, we finally have reasons to be optimistic. Consider this: A decade ago, fewer than 1 in 10 hospitals used EHRs. By 2017, nearly 90% of hospitals had them, with most now able to electronically send patient summaries of care records and e-prescriptions.
Evolution of Health IT
We also can be encouraged by the fact that it’s been 10 years since we began our digital transformation, which is how long it’s typically taken other industries to reap the benefits of new information technology. This long incubation period has been called the “productivity paradox of IT”: the observation, first made by MIT professor Erik Brynjolfsson, that big investments in IT don’t deliver any meaningful productivity benefits for the first few years. After 10 years, however, companies figure out how to leverage the technology to achieve these productivity gains.
This evolution will take longer in healthcare, perhaps another 5 to 10 years, for many reasons, including:
- The size and complexity of providing highly distributed healthcare services
- Regulatory requirements and rules around data sharing
- Powerful forces such as hospitals and physicians capable of resisting changes
- The Silicon Valley mantra, “fail fast,” doesn’t work in healthcare when a failure may equate to a dead patient
In fact, health IT is still barely in the second stage of digital transformation, which includes these relatively discrete steps:
- Digitize records (EHRs)
- Connect the parts (PCPs to hospitals; hospitals to hospitals; third-party apps and patient-facing systems to the enterprise system)
- Glean meaningful insights from the data
- Convert insights into actions that improve value
This last step is the hardest, because it requires hospitals to constantly ask themselves: What do we do now to make care better, safer, more accessible, more equitable, more satisfying and less expensive? Is the answer a new app, or new people, or new workflows, or new predictions or a new culture? Only when hospitals can leverage their health IT capabilities to improve value can they accomplish something of real importance.
Reimagining Work: The Key to Unleashing Technology’s Power
In any industry, the two keys to moving beyond the productivity paradox are 1) technology improvements, and 2) reimagining the work itself. I am enthusiastic that healthcare technology is entering a new phase. Though far from perfect, we now have more interoperability to connect a growing number of digital tools. Our data is increasingly stored in the cloud, not on servers in a closet. Perhaps most important, digital healthcare companies of all sizes are maturing and the digital giants (Google, Apple, Microsoft, Amazon) are 100% committed to being major players in healthcare.
The most exciting development for me is the progress we’re making on the second key to productivity: reimagining the work. Here are three examples of how people are coming up with new ways to apply digital tools to everyday healthcare practices.
MD notes and digital scribes – A primary cause of physician burnout is the inordinate amount of time they spend on data entry for EHRs. At UCSF Health, we solved this problem for our 100 busiest outpatient clinicians by giving them scribes to do real-time data entry. Granted, it’s a clumsy and expensive workaround. But those 100 physicians are the ones who have seen the greatest improvements in their satisfaction scores.
More importantly, this concept becomes affordable and practical when IT can digitize these note-takers. Google, Microsoft and several start-ups are working on this now and it may be only a few years before digital scribes can relieve doctors of this time-draining burden.
Subspecialty e-consults – To take advantage of digital capabilities and capacities requires rethinking how we organize work, including interactions between generalist physicians and specialists. At UCSF, for example, we have initiated a service that enables our diabetologist to effectively manage care for every hospitalized at-risk patient with diabetes, every day. By using glucose management criteria that identifies only those patients who may need special attention, the diabetologist can spend about an hour each day reviewing the glucose data and trends for dozens of patients and providing treatment advice as needed to their physicians. We call these consults “TACos”: Targeted Automated Electronic Consultations, and described the concept in a recent article in JAMA.
Since implementing the TACo program, episodes of hyperglycemia for UCSF inpatients have fallen by 39% and hypoglycemia cases have fallen by a similar amount. In the same hour of time it used to take the diabetologist to do a single in-person consultation, we’re now scaling his knowledge to improve diabetic care for the entire inpatient population. This is a prime example of reimagining work by analyzing data in a new way and delivering intelligence that changes the nature of care.
Voalte Story – About a decade ago, I wrote a blog about why the medical record needs to become more like a Facebook “wall” that can be followed by a group of people. One of our UCSF faculty members, Raman Khanna, took that seed of an idea and built CareWeb, a social-networking and communications tool that allows doctors and other caregivers to keep track of a patient’s care in the hospital. It is now being used by hundreds of doctors and caregivers at UCSF Health. Through a co-development venture with UCSF’s Center for Digital Innovation, Voalte is building upon this platform with Voalte Story, which lets care team members send text messages simultaneously to multiple parties, and collaborate and comment in real-time about specific alarms, messages or phone calls.
Seeing Your World with Fresh Eyes
As these examples show, data and intelligence make reimagining work possible. But it all starts by seeing familiar routines and habits with an open mind and fresh eyes. To be ready when healthcare’s Netflix moment arrives, hospitals must first create a culture where everyone constantly asks themselves and others this question: why are we doing what we do in the same old way?
Figuring out creative ways to use new digital tools and intelligence to improve how healthcare is practiced is how you will make digital transformation work for you.
Dr. Wachter, Professor & Chair of the Department of Medicine at University of California, San Francisco, was the keynote speaker at the recent VUE19 conference. This post is adapted from his talk. He has been recognized by Modern Healthcare as one of the 50 most influential physician executives in the United States. He was a co-inventor of CareWeb and has a small royalty stake in it.