Interview with Robert M. Wachter of UCSF

Robert M. Wachter, MD is Professor and Chair of the Department of Medicine at the University of California, San Francisco, where he is the Holly Smith Distinguished Professor in Science and Medicine and the Benioff Endowed Chair in Hospital Medicine. The department leads the nation in NIH grants and is generally ranked as one of the nation’s best.

1) What are your thoughts on the way the pharmaceutical industry has incorporated digital technologies over the recent years?

My sense is that pharma is using data to refine their clinical and business models (expedite drug design, improve their marketing, and the like). But the real power will be in harnessing the clinical data now being collected in EHRs to better understand which patients will – and won’t – benefit from a given medication. The promise of precision pharmacology has been just that – there are a few instances in which we have been able to prove that certain phenotypes or genotypes will predict a patient’s response to a medication. Now that we are collecting rich clinical data from every patient encounter (and, increasingly, from outside encounters such as data from sensors and wearables), the opportunity to fine tune our approach to pharmaceuticals seems very real.

2) Most of the current hype seems related to AI solutions for identifying new molecules or predicting patients’ response to treatments. Less is said regarding clinical operations even though it is an unaddressed pain point for researchers. Do you see relevant digital applications in clinops?

Yes, there will be massive opportunities not only in refining our clinical approaches (predicting responses and the like) but also in improving clinical operations. Which patients do and don’t need to come in to see a doctor? Which patients can be monitored from home? How can we guide a patient to see the best clinician for his/her specific problem? What are the most cost effective approaches – to purchasing, staffing, and more. The use of the now-voluminous clinical and administrative data will make it possible to deliver more evidence-based clinical and business operations. But we need to hire and support the right kinds of people in our organizations, or partner with ones that have such people and processes.

3) What are some digital applications that you identify as fueling the “merger” of clinical care and clinical research? (EHRs, and the like)

The big change here will be the ability to use real-world evidence to improve our understanding of what works. The need for randomized prospective trials won’t go away, but as we accumulate data on millions of patients and get better at adjusting for confounders, we should become more adept at demonstrating that a certain drug works in certain kinds of patients, or that a given approach works better than another. Also, we will be able to expand the data sources that we’re considering – not just clinical predictors but also socio-economic determinants, life habits (exercise, diet) – and be able to look at broader measures of outcomes we care about – not just mortality but also morbidity, quality of life, ability to perform certain activities, economic outcomes. None of this will be easy, and much of it won’t come directly from the EHR vendors – it will require partnerships between healthcare delivery organizations and payers and new organizations that bring forward certain new skills – and some that have been created specifically to solve problems just like this one.


Biography

Robert M. Wachter, MD is Professor and Chair of the Department of Medicine at the University of California, San Francisco, where he is the Holly Smith Distinguished Professor in Science and Medicine and the Benioff Endowed Chair in Hospital Medicine. The department leads the nation in NIH grants and is generally ranked as one of the nation’s best.

Wachter is author of 250 articles and 6 books and is a frequent contributor to the New York Times and Wall Street Journal. He coined the term “hospitalist” in 1996 and is often considered the “father” of the hospitalist field, the fastest growing specialty in the history of modern medicine. He is past president of the Society of Hospital Medicine and past chair of the American Board of Internal Medicine.

In the safety and quality arenas, he has written two books on the subject, including Understanding Patient Safety, the world’s top selling safety primer, now in its third edition. In 2004, he received the John M. Eisenberg Award, the nation’s top honor in patient safety. Thirteen times, Modern Healthcare magazine has ranked him as one of the 50 most influential physician-executives in the U.S.; he was #1 on the list in 2015. His 2015 book, The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Computer Age, was a New York Times science bestseller. In 2016, he chaired a blue-ribbon commission advising England’s National Health Service on its digital strategy.

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