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The electronic health record (EHR) is tangled with clinician burden, extraordinary cost and patient risk. The EHR is also nearly ubiquitous in the U.S. healthcare system, having dramatically spread its grip through a $35 billion 

. Given the wide-reaching adoption of the EHR and the pain it has brought, it’s critical that health systems find a way to make the technology work in the interests of patients, physicians and the enterprise. 

That’s the issue at the heart of this episode of Data Book, the first installment of our fourth season. By the time you finish this episode, you’ll understand some of the potential of EHRs and how they’re failing doctors and patients. Finally, you’ll receive some insights as to how health systems, physicians and vendors can work together to improve the EHR. 

We examine this issue through the story of guest 

, an anesthesiologist and biomedical informaticist who sits on the American Medical Association Board of Trustees. Ehrenfeld graciously takes us through his history with the EHR, technology and the clinic, highlighting several instances that showcase the potential benefits and all-too-real deficiencies. 

 that found unsettling variability in EHR usability and patient safety. Is it acceptable that physicians in some hospitals make 14 clinics to order Tylenol for a patient, while doctors elsewhere must click more than 60 times? Further, are healthcare leaders OK with the consequences of wild EHR variability — patient harm? 

On the other hand, real-time notifications have prevented an unknown number of clinical errors. How else, if at all, might the EHR be used to actually improve medicine and physicians’ lives? 

Healthcare won’t have an answer to that question unless stakeholders from across the industry collaborate to overcome EHR challenges. 

The first thing that must happen, according to Ehrenfeld: Vendors need to follow user-centered design practices. But implementation is also key — and this is an area where health systems and vendors often stumble. Of course, physician and clinician input must influence the set-up of the technology. 

There’s more to this challenge, and we dive a lot deeper in the episode. Be sure to check it out. Come for the insights and stay for the story. And don’t hesitate to let us know your take on 

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The High-Tech Hospital the World Wasn’t Ready For

Podcasts

Jesse Ehrenfeld, M.D., MPH, describes how health systems can unlock the potential of electronic health records. 

Podcast: Breaking Silence and Fixing the EHR

It’s an incredible time to be in the world of health IT. Innovators from inside and outside healthcare are developing solutions that may well change the lives of our clinicians, patients and health systems. Technologies like artificial intelligence (AI), mobile health apps and virtual care are forging new paths to more effective treatments, greater efficiencies and expanded access. And we’re even making progress toward interoperability. But still, 

This week on Data Book, we explore this problem and how it harms clinical and enterprise progress. We also look at the human side of the tech equation — is an innovation worth anything if it flails in the adoption and scaling stages? We examine marketing’s role in perpetuating premature, if not unrealistic, hype. Finally, we discuss ways to see through the noise.

What it all comes down to is a question of value, as displayed in last month’s 

 by Ezekiel Emanuel, M.D., Ph.D., and Robert Wachter, M.D. In the piece, they explore whether AI’s value will live up to all the cheerleading surrounding the technology. And they conclude that behavior change is the key piece. AI’s value lies in its ability to influence decision-making, they argue. But if physicians and other clinicians decline to embrace AI in their work, what good is it?

Clinical validation is, of course, necessary. But the story doesn’t end there. Adoption, implementation and scalability are also critical. If a health IT solution lacks the potential to meet these challenges, it might not be a solution at all.

Now, let’s pivot to marketing. (It should go without saying, but full disclosure: We are 

 the health IT marketing business.) Glitzy, vague, overly confident marketing campaigns provide the fuel that powers the health IT hype train. Speaking to a reporter 

 last year, Wachter underscored this problem when he said, “They came in with marketing first, product second, and everybody got excited.” And when the algorithms entered health systems, he said, adding to a body of 

We could all do better to adopt more restraint. Broadly, health IT’s potential is almost unfathomable, immeasurable. It 

 bring profound change to our healthcare system. We are, however, only in the early stages of this new era. Let’s not lose sight of the important thing — value, in terms of quality care and stronger efficiencies &mdash; because we’re blinded by the bright, shiny things.

By the way, this is the final episode of 

. We’ll return in about a month with new episodes featuring great stories and even better expert guests. Until then, thanks for listening.

Get the best insights in healthcare analytics 

Executive Voices: Michael Hogarth, M.D., Chief Clinical Research Information Officer at UCSD Health

Data Book discusses how leaders can ignore noise and embrace effective healthcare technology.

Podcast: Who Else Hates the Health IT Hype?

Gail Zahtz was in New York when she got the call that no founder wants: The money had run out. She had to either sign on a new investor or watch her startup, a health-focused dotcom called Working Weekly, crumble. Soon enough, she was in Houston, meeting with a potential backer about a $5 million investment. They sat at a table, paperwork before them and lawyers at their sides, ready to ink the deal. And that’s when the financier’s lawyer got another horrible call: The Nasdaq had crashed.

That’s where we left you on the last episode of Data Book — with a burning cliffhanger that might have been a bit unfair. But we make amends this week, running full speed ahead with the story of 

 and Working Weekly. Along the way, we analyze the death of the dotcom startup and attempt to draw lessons for today’s healthcare innovators.

If you haven’t listened to the first installment of this two-part series, we recommend you do. 

Now for a quick refresher: Our story began in 1998 when Gail received almost $2 million in funding to jumpstart Working Weekly. It was the glory days of the dotcom boom, and founders like Gail really thought they were changing something — maybe even the world. Working Weekly was a digital-print-hybrid publication that covered all things workplace health. It was supposed to attract high-value readers and higher-value, long-term advertisers.

Things didn’t work out. But the life and death of Working Weekly were curious. They highlighted the ambition and optimism, the passion and risk, the innovation and ingenuity of a startup. Working Weekly, though different from today’s healthcare startups, shined a light on some lessons that may well apply to the innovators and decision-makers of 2019, whether they work for big health systems or small startups.

A big theme in this episode is risk. What drives healthcare leaders to make an impressive investment in data analytics or digital patient-engagement tools? And how about when a health system institutes a value-based payment model?

Well, if you ask Gail, she’ll respond with another question: Why would we be in something as important as healthcare if we weren’t willing to take risks to improve patients’ lives?

The Roles of Health Systems in Sparking Disruption

Data Book details the demise of a dotcom startup and offers lessons for healthcare innovators.

Podcast: When a Startup Goes Bust, Pt. 2

When healthcare communications entrepreneur 

 sat down to meet with her client, she couldn’t have known how much her world was about to change.

“If you had some money, what would you do with it?” the client asked.

“Well, let’s say we start with $800,000 and we cap it somewhere around $2 million.”

Writing on a napkin, Gail sketched out a business plan for 

. The publication would focus on workplace health — mental, physical, emotional &mdash; and make its money from hungry employers with advertising dollars slated for recruiting. It might not seem like it now, but Gail’s project was indisputably high-tech for the era, even requiring the expertise of a chief technology officer and a chief information officer.

The year, after all, was 1998. Websites cost a million bucks. The internet was a new, mostly untapped frontier. The dotcom age had yet to boom, much less bubble up and burst.

And with this stroke of good fortune, Gail secured $1.8 million and launched 

 into orbit. In almost no time, she had a sprawling office in Charlottesville, Virginia, 60 dedicated employees and a burn rate of $250,000 per month.

But it wouldn’t last. In just a few short years, Gail and her project were swept away in the 

What Healthcare Can Learn from Failed Tech Projects

Perhaps the greatest challenge for any writer in health tech is getting innovators to discuss their disappointments or shortcomings. But it’s through these experiences — dead startups, tech implementations gone array and so on &mdash; that healthcare leaders can learn so much. Maybe it’s how to 

 for your health system, or it could be a greater lesson reflecting on the 

frantic, hype-driven state of health tech

This is the reason why we wanted to talk to Gail, and it’s precisely why she agreed to speak with Data Book: What might we learn from the tale of 

Before we go, yes, we understand that a health-focused digital media outlet doesn’t face the same challenges or enjoy the same benefits as, say, a company that develops artificial intelligence systems for clinical use. But this dispatch from the dotcom bubble draws overt parallels to health tech’s continued evolution in 2019.

Here’s another note: This is a very special episode of Data Book. It’s the opener of our first ever two-part series. We even broke our traditional format — you know, story and then interview &mdash; by using all 23 minutes and 48 seconds to tell this cohesive story. Half of the story, at least. Our conversation with Gail is interspersed throughout the narrative. We’ll drop the second and final episode on Friday, June 14.

And we must extend a final thank-you to Shereese Maynard, our friend and colleague, who tipped us off to this story. Thanks, Shereese!

Lost in the CRISPR Hype, a Gene-Editing Giant Is Fighting Back

Data Book examines the story of Gail Zahtz and her dotcom startup, Working Weekly, for insights into healthcare’s digital transformation.

Jack Murtha

Articles

Podcast: Breaking Silence and Fixing the EHR

Podcast: Who Else Hates the Health IT Hype?

Podcast: When a Startup Goes Bust, Pt. 2

Podcast: When a Startup Goes Bust, Pt. 1