Two years ago Doctor Robert Wachter, Professor and Chair at the Department of Medicine in the University of California (San Francisco), published  “The digital doctor: hope, hype and harm at the dawn of medicine’s computer age”. The book, highly critical of the way EHR work in the US, quickly became a New York Times bestseller. In this moment of transformation, Wachter feels that some technologies are overhyped but others, like Artificial Intelligence, will truly transform the way we deliver care. Wachter, who has been ranked as one of the most influential physicians in the US, will be a Keynote speaker at the HIMSS Europe & Health 2.0 Conference next May in Sitges (Barcelona).

What is going to be the topic of your Keynote?
I am going to be talking about how EHR and healthcare computerisation failed to live up to the hype and the potential in the early years. But now I can see the beginnings of transformation and I will emphasize how important it is to rethink the way we do our work.

Why have EHR failed healthcare professionals in the US?
If we were designing EHR from scratch, we would be having a much more patient-centered and clinician-centered view of the world. The EHR should really be designed around the tasks that are important to patients and clinicians. But they were designed as business tools and their main focus was to be sure that the business functions worked very well, primarily billing and capturing administrative data.

Is this focus on the business the reason why US healthcare expenditure is the highest in the world, but the outcomes are not so great?
There are various reasons. Doctors are highly paid, and this is hard to change. We give more intensive care than other countries due to the incentive system and the patient’s demands – Americans like the healthcare system to “do everything.” But our health outcomes are not very good. That is because we do not spend a lot of money on public health and primary care. Ultimately, an approach that emphasizes prevention is less expensive.

New companies are now entering the world of Health IT. Will they bring the necessary change?
Venture funds and digital giants like Amazon, Google or Apple are entering healthcare with massive investments. They see opportunities to tackle specific healthcare problems, whether it is diabetes, the prevention of heart disease or the management of cancer. Their advantage is that they do not have to begin with healthcare data stored on paper, like it was ten years ago. They can apply new tools to the already digitised data to improve the way we manage specific diseases. It is unlikely that major EHR vendors such as Epic or Cerner will be as effective in doing that, though they will certainly try.

Google and Microsoft tried to enter healthcare in the past and they failed. Will it be different this time?
I was on Google’s Healthcare Advisory Board ten years ago when they failed. Google was dealing with a healthcare system that mostly stored information on paper. The same happened to Microsoft. To create a Google health record, as a patient you needed to type all your information into the system, or create and authorize multiple electronic connections – between you and your hospital, and you and the laboratory, and then each of these with Google. It was way too cumbersome. I do not think they will fail this time because they are working with data that is already digital. These companies will design products that connect to the EHR, pull data out and create new tools that allow for a much better user experience.

Blockchain, Virtual Reality, Artificial Intelligence… There is a big buzz about these technologies transforming healthcare. Will they live up to their potential?
Most new technologies are usually overhyped. Partly because people are hopeful, and partly because companies that sell them have an interest in hyping them. Invariably they do not reach their potential, and everyone is disappointed. Only the good ones eventually become useful.

Blockchain is still pretty new and it has the potential to address important problems, mainly the security of the medical record and how to keep a chain of custody safe. That is a very big issue as we deal with more security breaches.

I think Virtual Reality (VR) is being overhyped, although there are some specific purposes for which it might be useful. In the US, VR companies have been looking for a powerful use-case for ten years. They have now jumped on the opioid epidemic as one possible opportunity. There is evidence that VR works moderately well for pain control, and it might be useful in the training setting, but I do not see it as transformative.

I am most enthusiastic about Artificial Intelligence (AI), which I think has the capability of changing everything in healthcare. Until recently Google, Amazon or Apple did not have access to healthcare data but now they are forging relationships with healthcare organisations. At the end of the day, healthcare is a data business.

When I see a patient, I collect a lot of data, I match it against what I know, or I look things up; then I try to come up with a diagnosis. All those data-driven actions are being done imperfectly by human beings. A computer can do them better than I can. Still, because medicine is complicated, we will take a few steps forward, we will all feel good about it, and then there will be the analogue of the driverless car killing someone. We will take some steps forward and some backward but eventually it will transform healthcare for the better.

What do you think of peer-to-peer connections between patients?
I think they are great. For many patients, finding people like them is as impactful as finding a good doctor. But, while it is largely positive, there can be misinformation. It would probably be better if these patients’ communities were curated to some extent by a healthcare professional or a trusted healthcare organization.

After the success of “The Digital Doctor”, do you have another book in mind?
I have written a book like that every 10 years. I do it when I feel I have something interesting to say. I would not be surprised if I did something on Artificial Intelligence and healthcare because I think it is going to be immensely interesting and ultimately transformational. I am working with some of the big companies entering this space, so I have a bit of an insider’s view of both the potential and the warts.