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The ‘digital dystopia’: 4 thoughts from AMA CEO Dr. James Madara


 Not all digital tools are created equal, and some of these tools are detrimental to patient care. This was the message James Madara, MD, executive vice president and CEO of the American Medical Association, expressed in his address at the 2016 AMA Annual Meeting. Dr. Madara compared the current digital health landscape, “something I might call our digital dystopia”, to the “quackery” of snake oil remedies.

Here are four thoughts from Dr. Madara’s address.

1. Productive and useful digital tools are mixed among products that impede care. “We have really remarkable tools. Robotic surgery, new forms of radiation therapy, emerging biologics. And we live in a time of rapid development in the digital world. Telemedicine is an example, discussed in detail by this house. Appearing in disguise among these positive products are other digital so-called advancements that don’t have an appropriate evidence base or that just don’t work that well or that actually impede care, confuse patients and waste our time. From ineffective EHRs to an explosion of direct-to-consumer digital health products to apps, some of which are poor quality — this is the digital snake oil of the early 21st century.”

2. An effective digital future is not out of reach. “A more promising digital future can be envisioned that enhances the physician-patient relationship, produces better and more efficient care and allows more time for physician-patient interactions, the type of outcome that has been so falsely promised by so much of the current digital snake oil. [This digital dystopia includes] direct-to-consumer digital health devices which only say in the fine print ‘For entertainment purposes only’ to our clunky electronic records to ICUs that sound like primitive swamps abuzz with a cacophony of bells, alarms and whistles. Just as in the mid-19th century when we separated the useful antitoxins and compounds like aspirin from…snake oil remedy, today we’re tasked with separating the digital snake oil from the useful and potentially magnificent digital tools.”

3. Interoperability remains far out of reach. “Digital tools often don’t connect with each other. Interoperability remains a dream. We were told interoperability was the future, but frankly I didn’t expect it would always be the future.”

4. The future role of physicians. “American physicians have become the most expensive data entry workforce on the face of the planet. What a waste. And how frustrating. Let’s face this 21st century digital snake oil the way our predecessors faced their task in the 19th century by inserting ourselves into the processes from which digital tools emanate.

“The future is not about eliminating the physicians. It’s leveraging physicians by providing digital and other tools that work like they do in virtually all other industries — making our environments more supportive, providing the data we actually need in an organized and efficient way and saving time so we can spend more of it with our patients.”