Bob Wachter

And the paradox is it looks so good on the PowerPoint slides, the ads that were used to sell it to us.

It doesn't work, and it doesn't work partly because the technology needs to get better and all the iterative versions 12.7 need to happen.

But much more importantly, the industry needs to transform the way it thinks about its work, organizes itself, the culture, the governance.

And we didn't do that.

In 2012, JAMA, the Journal of the American Medical Association, published a crayon drawing—probably the first time I'd ever did that—from a seven-year-old girl who went in to see her pediatrician.

What it shows is the girl sitting on the exam table, mom's next to her, sister's in the corner, and in the other corner of the room is the doctor with his back to the patient, typing away—

It's a beautiful drawing.

There's one thing the girl got wrong, which is she portrayed the doctors having a smile on his face.

I can tell you that no doctor was happy about being transformed into a data entry clerk.

And patients noticed it.

They went to see their doctors, and their doctor had the head down, typing away.

And why did that happen?

Because the computer became this enabler of all of these outside entities who used to have no ability to influence what the doctor did because I was scribbling on a piece of paper, now had a way of making me check 12 boxes about did I examine nine body parts and did I ask you if you wear seatbelts?

Do you exercise and all that?

All noble questions, but now there was a forcing function that you could make the doctor record all this stuff, and so people did.

And importantly, when we send a bill off to the insurance company, the amount of money we get paid is partly related to the nuances of how I record the note.

Which creates some perverse incentives right there.

Totally, totally ridiculous incentives to say the right words in order to get the best bill.

And then a few years after that, federal legislation mandated that patients could not only see their basic information and maybe their medications, but actually could read my note and see their x-ray results and see their lab results.

There was absolutely no information to help the patient figure out what any of that meant or even to make an appointment.