Hope, Hype, Harm: Medicine in the Digital Age

Robert Wachter, Professor and Associate Chairman of the Department of Medicine at the University of California, San Francisco looks at the consequences of electronic health records (EHR) over the past five years in his probing and thought-provoking new book called, The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Computer Age.

In his book, Wachter explores the growing and multi-faceted technological evolution taking place across the medical industry. His findings cast light on how EHR affects physician notes as well as patient experiences in hospitals and care units. Essentially, the book takes a walk through the successes and excesses of technology, the impact of supercomputers and big data on doctors, and the quality of care delivered.

While more and more innovative technologies are used to improve the quality of the care delivered, we are learning that having 100 percent accuracy in technological products is unattainable, especially in the healthcare industry. Although we cannot deny the contribution of computers, mobile technology, and other innovations in improving patient safety and care in numerous ways, we consistently see unfortunate examples where technology related mishaps lead to life-threatening errors, even in some of the world’s best hospitals.

One such example is the case of Pablo Garcia. He was admitted to the University of California, San Francisco Medical Center’s Benioff Children’s Hospital in 2013 for a routine colonoscopy and was administered a massive overdose due to a faulty medical tech process. The teenager, who suffered from a rare genetic disease called NEMO syndrome, was given a 39-fold overdose of a common antibiotic, causing him to have a grand mal seizure that nearly killed him.

There are many such instances where tech-driven medical errors, ranging from major to minor, have exposed the shortcomings of technology. The false alarms associated with computerized medication alerts besiege clinicians. And because many Code Blues are triggered by false alarms, some nurses, annoyed by the alarms, silence them, resulting in patients in distress not being treated.

You could argue these errors are “human errors”, but there’s no question that the technology behind them, and our passive reliance on it, is at their core. According to ECRI Institute, alarm-related problems are one of the top technology hazards faced by the healthcare industry. In fact, The Joint Commission issued an urgent directive in 2013 that requires hospitals to improve alarm safety immediately.

Physicians and healthcare providers are becoming increasingly worried about the adverse effects of medical tech on the quality of care. A 2013 survey by RAND finds that physicians have mixed reactions to EHR systems. A widespread dissatisfaction is also noted. A number of respondents complain of poor usability, needless alerts, time-consuming data entry, and poor work-flow.

A prime reason for computerization of medical data is to prevent medical mistakes. Unfortunately, technology has let us down. The Pablo Garcia case is a classic example. A recent study shows over one million reported medication errors occurred between 2003 and 2010; with six percent directly related to computerized prescribing systems.

However, it is neither possible nor advisable to return to the world of pen and paper and manual records keeping. Evidence shows that, overall, digitization has made care better and safer. What we need today is to find that happy medium between 100 percent reliance on what technology tells us, and the confidence required to question and doubt at times when the data just doesn’t look correct. Technology shouldn’t ever replace the old standby of gut instinct.

You can see Robert Wachter and learn more about his book at the upcoming MobCon Digital Health conference, April 8th, 2015. Register today!

What do you think? We would love your thoughts. Are we becoming to compliant when it comes to technology?