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

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

• URL

• The book is about how health IT has fallen short despite of the US government’s $30 billion investment in EHR.

• The author worked at the Department of Medicine at the University of California, San Francisco

1. EHR changes the Doctor-patient relationships
   • IT interferes with the doctor-patient relationship.
   • Radiology was the earliest specialty to adopt digital IT.. from 2000, only 8% to more than 75 percent of U.S. hospitals were using digital imaging and by 2008; However, clinicians now rarely meet to discuss cases in the radiology department.
   • The author projected that AI based virtual radiologist will diagnose a myriad of diseases.
   • EMR and computerised prescribing took a difficult start than digital imaging in the U.S. due to poor user interfaces and connectivity.
   • doctors are making less eye contact, less personal exam touch, and forming less emotional connections with patients due to spending more time on their computers;
   • The author emphasized: “ At the heart of medicine is human connection, compassionate care, and empathic interaction with individuals who are vulnerable and ill.
2. EHR might induce Medical Errors
   • Digital prescribing may help pharmacists more easily read the prescription.
   • The technology designed to reduce medical errors and increase patient safety may actually cause harm. For instance, a serious prescribing error occurred in UCSF hospital when a 16-year old patient was mistakenly given 38 and a half tablets of sulfamethoxazole-trimethoprim instead of one tablet. This happened though there existed several checkpoints (including the technician, pharmacist, robot, and nurse) before the medication finally made its way to the patient. Partly because all related are experiencing alert fatigue ( too many previously unnecessary alerts in digitized healthcare system due to poor interface design of the EMR software).
   • This certainly indicated blind trust in technology is wrong. Need to encourage hospital staff to speak up not only when something is wrong but also when not sure that something is right.
   • Big data analytics in healthcare is still a work in progress. May be useful, e.g., in determining staffing patterns, monitoring and preventing hospital infections.
   • Privacy has to be maintained when big data is analysed.
   • the productivity paradox (productivity has not increased but remained stagnant following the computerization )
3. Deficit in Interoperability
   • One of the biggest issues: healthcare IT deficit in interoperability (connecting EHR systems used by different hospitals and clinics, patient information from one provider to another.)
   • Some discussion about EPIC
   • OpenNotes, the history of how patients gaining the right to view their medical records. Some history about improving the doctor-patient relationship by advocating for the patient’s right to have access to own medical record.
   • “Patients possess a body of knowledge about themselves that we can never hope to master, and we have a body of knowledge about medicine that they can never hope to master. Our job is to bring these two groups together so we can serve each other well”;