Q: So as doctors try to do these two jobs – healing their patients and trying to improve the healthcare system – what are some ways of getting them on board with all this data we have? Are there ways to improve the technology and the user experience? What role should that play?

A: I think that's a real part of it. I'd start even before that – which is to say that the way to get doctors, who are largely both Type A and used to getting As on tests, to care about data is to show it to them and illustrate how it can be useful to them in ways that are in sync with how they already think:

"You, doctor, want to do the right things by your patients. You care deeply about your patients. Here are data that demonstrate that when we look at this guideline, which you believe in and the data is incontrovertible, when we look at that, you're not doing as well as a.) you think you are and b.) your colleagues are."

Then you have to be ready for the absolute inkblot response, which is: "The data are wrong," or, "My patients are older or sicker."

You have to be able to demonstrate that, "Yes, I knew you were going to say that. And here are analytic tools" – you have to explain it in English – "that adjust for the fact that your patients are older or sicker. We've only compared apples to apples."

To make that meaningful, sometimes it's going to be appealing to their sense of professionalism: "I know you are a good doctor, here is a tool to help you be a better doctor, in the same way a stethoscope does. There's now a whole new set of tools you need to learn in the service of your patients."

Then you get to more of a sledgehammer approach: "Whether you like it or not, you are going to be measured in these ways. You are measured in these ways. You're still going to get paid by Medicare, even if you are not very good.” But look at what's beginning to happen: Those measurements are being publicly reported; they're beginning to influence your payment. They're going to begin influencing whether or not the insurance network wants you in or wants you out.

Maybe you'll be able to survive doing not so well for a while because you're close to retirement. OK. But, by and large, for the physician of the future, these data are really going to be meaningful.

It's showing people the data, showing them it's meaningful, getting their competitive juices flowing. And then once you have all that established, it's showing it to them in ways that work. I think we've come to realize that all the physicians maybe have better numeracy than the average person, in some ways, but not really – and if you show them a raw spreadsheet of data or a bland curve or a bar graph, that may be in some ways less impressive than showing them in some new data visualization.

So, it's how do you get it, how do you make sure it's correct, how do you ensure it's presented in the least painful way, and how do you use it in the service of what you're trying to do?

That becomes tricky because all physicians are different; all people are different. Somebody may like seeing their data presented in one way; somebody may like it another way. I might like seeing a spider graph, and my colleague might like seeing a column or a heat map. It’s going to be important to figure that out and give people data in the ways that are most meaningful to them.

Q: I hear you're working on a book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age.

A: A year ago it dawned on me that the world of healthcare was changing very, very rapidly. This may seem odd to you if you've been working in IT, but for folks like me, who are not IT gurus, it hasn't been at the center of our existence.

That's one of the funky things about healthcare: Until 2010, maybe 10 or 15 percent of doctors offices were truly computerized and the same percentage of hospitals. Because of the HITECH Act and the sprinkling around of $30 billion of federal money, that initiative has been wildly successfully if the goal was to get our system wired. In a very short period of time, we went from an analogue system to a digital system.

And so in all of my roles, as a practicing clinician, as a group administrator, as someone who thinks and writes and speaks about improving quality and safety, I've been waiting for this forever.

All of a sudden we got computerized, and I started looking around, and I saw huge amounts of unhappiness. I saw doctors and patients not looking each other in the eye. I saw changes in workflow that completely flabbergasted me – we used to go down to radiology and have this wonderful conversation with the radiologist, and we each learned something. I didn't realize it, but the reason we went there fundamentally was because that's where our film lived. Now there's no film; there's a digital image I could see anywhere, so I stopped going to radiology.

And then the final straw was at my institution a few years ago; we gave a kid about a 40-fold overdose of a common antibiotic. And as I sat at the cause analysis meeting to find out how that happened, my jaw dropped because it didn't happen despite our computer system, it happened because of it. Subtle little problems in the display of the CPOE, alarms firing and being ignored because there are thousands of alarms a day.

In the old days, an order for 40 antibiotic pills to be taken at one time would have, at some point, gone to a pharmacist who would have looked at it and said, “What the hell?” as he or she was pouring out a bottle of these pills. Now it goes to a robot that says, "You want 40 pills? No problem."

Then it went to a nurse who said, "That's really screwy. But I have my barcode, and it will tell me if I have a problem." But at that point in the medication process, the barcode is essentially set to defend the order. It said, "No, that's the right dose." So just imagine, she gave this kid 39 pills instead of one.

It was the combination of hearing all of that, how technology is changing medicine, and it hit me like a lightning bolt one day: Wow, this is a really unbelievable moment in healthcare, and no one has written the book on this. There have obviously been a lot of informatics books, and I read Eric Topol's book, which I liked but was sort of very futuristic and about how wonderful all this is and is going to be, and that's actually not what I was experiencing: It's harder than it looks.

The book will come out in March. I'm 98 percent done with it. What's been fabulous about writing it – it's been one of the most fun experiences I've had – is that my wife, who's a journalist, said the only way you can make this come to life, this otherwise technical story, is by talking to people and getting perspective. And so I've taken that to heart and have interviewed probably more than 100 people.

It's been just unbelievably interesting. I spent a day at Epic. I spent a day with IBM's Watson. I've interviewed four of the five ONC directors. I spent a day at Boeing seeing how they design cockpits to be safe. I've watched frontline doctors and patients. Because I live in San Francisco and am on sabbatical in Boston, I've had the chance to be in both places where there are a lot of very smart people. I've spoken to a lot of cognitive psychologists and artificial intelligence experts.

It's been extraordinarily interesting. And it's confirmed my feeling: I'm the farthest thing in the world from a Luddite. I think we have to do this. There's no doubt in my mind that care is better now with computers than without them. But it is clear to me that it's not as good as it should be. It's harder than it looks.

This is an unbelievable adaptive change. The (IT) system comes in, but then you have to think deeply about everything around it: What's the sociology of the workplace and how do people relate to each other? Have we screwed that up with computers? And if so, how do we mitigate that and bring people back together in a way that is helpful?

These are things that people in IT have sort of known for years, but I think because we've flipped a switch and all of a sudden healthcare has gone from analog to digital, from 10 percent adoption to 70 percent in a few short years, it's sort of hit us like a tsunami. And I think we're all kind of staggering, like, "Wow, that's not what I expected."

Part of what's fun for me is the story. One of the things I worried about is that I'm not a technical person. But I've realized this is not a technical story. This is a clinical, sociological, political story of the transformation of a very important industry.