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

ISBN10: 0071849467 | ISBN13: 9780071849463

The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age
ISBN10: 0071849467
ISBN13: 9780071849463
By Robert Wachter

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The New York Times Science Bestseller from Robert Wachter, Modern Healthcare’s #1 Most Influential Physician-Executive in the US 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.

Preface xi
Chapter 1: On Call 1
Chapter 2: Shovel Ready 9

Part One - The Note
Chapter 3: The iPatient 23
Chapter 4: The Note 29
Chapter 5: Strangers at the Bedside 35
Chapter 6: Radiology Rounds 47
Chapter 7: Go Live 65
Chapter 8: Unanticipated Consequences 71

Part Two - Decisions and Data
Chapter 9: Can Computers Replace the Physician’s Brain? 93
Chapter 10: David and Goliath 105
Chapter 11: Big Data 115

Part Three - The Overdose
Chapter 12: The Error 127
Chapter 13: The System 131
Chapter 14: The Doctor 135
Chapter 15: The Pharmacist 139
Chapter 16: The Alerts 143
Chapter 17: The Robot 155
Chapter 18: The Nurse 159
Chapter 19: The Patient 165

Part Four - The Connected Patient
Chapter 20: OpenNotes 171
Chapter 21: Personal Health Records and Patient Portals 183
Chapter 22: A Community of Patients 195

Part Five - The Players and the Policies
Chapter 23: Meaningful Use 205
Chapter 24: Epic and athena 219
Chapter 25: Silicon Valley Meets Healthcare 235
Chapter 26: The Productivity Paradox 243

Part Six - Toward a Brighter Future
Chapter 27: A Vision for Health Information Technology 257
Chapter 28: The Nontechnological Side of Making Health IT Work 267
Chapter 29: Art and Science 271

Acknowledgments 281
Notes 285
National Coordinators for Health Information Technology 309
People Interviewed 311
Bibliography 319
Illustration Credits 321
Index 323

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