Tyranny Of Reactive Medicine

Will digitalisation make healthcare human again? Ran Balicer, Founding Director of the Clalit Research Institute (Israel), gives a few examples of how AI can influence and change medicine.

Digital health promises to “restore human touch” in healthcare. But doctors are still frustrated using computers and rewriting medical notes from paper documents to EHRs. How to make this digital dream real?

There are many inadequacies in the IT tools currently in practice. They are faulty because there has not been a due emphasis on human-centred design and work-process engineering when IT innovations are created and introduced. In an era where physician burnout symptoms are apparent in a majority of practising physicians, and when many of them point a blaming finger at the EMR software and IT systems as a serious part of the problem, this is a warning sign to be noticed.

What we need is to start every IT project by a work-processes redesign in a way that cares for staff user experience as well as the patient. Properly designed, I fully stand behind the notion that smart digital health solutions can tone down the technical aspects of healthcare and restore human touch.

You said that the digitalisation also brings risks, but they are manageable. The status quo in healthcare is even a more significant threat. Why?

Because evidence suggests that healthcare is plagued with quality and safety challenges that claim the lives of patients and reduce care effectiveness.

We must always remember the statistics of the current statuesque – the rates of harm-inducing errors, the rates of missed care opportunities and of futile care that leads to overdiagnosis and overtreatment. These rates are rarely discounted when we talk about the risks of innovative care processes.

Which mistakes have we so far made when digitalising healthcare. Which of them can be still repaired?

Unrealistic expectations. Too much hype and false promises regarding what currently available technology can achieve, and what it cannot. AI systems are still far from intelligence. Precision medicine tools are still far from being precise. These inadequacies should not be overlooked – these tools always offer significant improvements as compared to the status quo.

Digitalisation is, first of all, change management. How to lead this change to succeed?

I would give a few advises:

• Make sure leadership is 100% behind you before starting.
• Use proven methodologies in your innovation, promoting work processes.
• Make a clear distinction between activities aimed at employee engagement and those which are aiming at the deep work-process transformation.
• Carefully select the first projects that will demonstrate a combination of quick wins and substantial improvements for both practising staff and management.
• No pilots. Have a clear, feasible dissemination plan when beginning implementation in one site/point of care.
• Have a quantitative assessment plan to know if you are moving the needle as expected or not, and cut your losses early if the promise is not fulfilled.

Thank you a lot.

Ran D. Balicer is a public health physician, manager and researcher, Founding Director of the Clalit Research Institute – the WHO Collaborating Centre on Noncommunicable Disease Research, Prevention and Control. This interview was taken during the European Health Forum Gastein 2019.