Members what kind of arguments can we bring to the table to help us convince our Public Officials that libraries matter in the community . This is a perfect one to end on because as i write in the first chapter of the book, wrote this book not for the library and the my love in the audience but for other people trying to make the case and specifically for people like you who are Board Members and for people who are in decisionmaking postures around making business whether its principles of high schools or town managers or whoever it may be too tried to decide on a budget. Thats exactly the point of this book and i hope it proves to be useful and you can actually borrow from your local public library. You can use an independent bookstore to buy it. Its the core of my argument that these are extraordinarily important institutions to democracies and i think this is extremely short money for the return you get. I dont have an economic model but i actually think it would be just made up great i think we all know the importance of these libraries to our kids, two are seniors and people seeking jobs the people trying to do creative and innovative things. I think in so many ways libraries serve a core function in our democracy. Right now we are expecting libraries to do things they have always done better physical and analog way and expecting these cool and innovative digital things. We are just giving libraries the same amount that we eyes half. The math doesnt add up. We still have to have collections and more research and development today. I think towns need to step up and individual citizens do and people like me need to write checks to her friends and libraries and institutions that make grants like the knight foundation, this is a moment where we need to put more resources into libraries to get over this transition and really to take advantage of what is in front of us. Bless you for being on our life life the library at board as a nonlibrarian and i wish you luck with that fathers and mothers who oversee the town to the free library of philadelphia. Thanks for the chance to be here. Have a great night. [applause] omagh had a reputation in omaha and the United States as a city that when you came in if you were black you needed to keep her head down and be aware that you are going to be served in restaurants and wouldnt deal to stay in hotels. When the club began their operation the idea and in fact the term civil rights, they use the word since social justice because civil rights wasnt part of it at that time. The idea of civil rights was so far removed from the idea of the creator of the community of omaha at the United States that they were operating in a vacuum. I always like to say they are operating they were not the support groups. They were not the prior experiences and of other groups to challenge Racial Discrimination and segregation. Union pacific is one of the premier road road companies of america. In the Pacific Railway act signed into law by Abraham Lincoln so combined several Railroad Companies to make Union Pacific and they were charged with building the Transcontinental Railroad that connect the east and west coast. They were moving west and Central Pacific started on the west coast and was moving east and they met up in utah. That is really what propels us. We become that point of one of the gateways to the west. Next book on how technology is changing health care at the bedside and whether billions of dollars in federal incentives for health care to go digital have been useful or destructive. Robert wachter is the author of the Digital Doctor hope, hype and harm at the dawn of medicines computer age. This is an hour. [inaudible conversations] hello everyone. How are you all today . Good evening a welcome. We are the nonprofit partner. We are pleased to welcome our speaker tonight dr. Robert wachter who will be in conversation about his new book, the Digital Doctor hope, hype and harm at the dawn of medicines computer age. His book is available for sale upfront and he will be signing after the reading tonight. He will be in conversation tonight with author educator and physician dr. Abraham some quick housekeeping items. Please silence your cell phones but feel free to take pictures to each leave Facebook Instagram whatever it is that you do to make your friends jealous that you were here tonight. Also for q a please raise your hand if i will come over with a microphone since cspan booktv is taping tonight. We want to make sure your question gets reported. Im going to briefly introduce abraham and he will then introduce robert. Abraham is an internationally popular author and a prominent voice in medicine with a uniquely humanistic view of the future of health care. His memoirs and novels have sold millions of copies then translated into many languages and topped bestseller lists while his New York Times articles making the case for greater physician focus on the patient and an air of Technology Advances in medicine have made waves in the medical community. His novel cutting the first stone was a runaway hits topping the New York Times bestseller list for over two years and quickly optioned for a movie. The rumor is he is working on a new book which will be released sometime in the next i think its safe to say five years. Please help me give a warm welcome to dr. There are geese and wachter. [applause] thank you so much that cold for that wonderful introduction. Can you all hear me pretty well . Is such a treat for me to be here with my good friend bob wachter the last time i was here was who someone bob is close to notice his wife a book on mother, daughter and me mean its a treat to be back with bob wachter. I have actually known bob for many years and we cross paths without knowing it. When you were at the Robert Wood Johnson fellow at stanford you are asked to be in charge of the first aids conference and i have a very distinct memory of it. There was a poignant time as you remember sitting and watching it sit in at the hyatt in seeing randy shultz off to the side looking at this. His book is a book that got me so committed to the hiv story. Bob trained at the university of pennsylvania and his residency at the university of california san francisco. He is a Robert Wood Johnson fellow as i mentioned and has gone on to a distinguished career in the field that he invented so to speak on a very important article. He coined the term hospitalist and he is truly the leader of the Hospitalist Movement in america. Its interesting bob i think any times people have hated us against each other. I am the luddites which i dont think i am but certainly writes about the dangers of technology and ive always viewed you as someone who very much embraced more than i did so this book was a bit of a surprise. I loved it and a tack on technology that completely took me by surprise. I would like to begin by asking what the motivation was to get you to this point . First of all thank you abraham for doing this and we go way back and i dont know if you recall that i reviewed that journal. Luckily i loved it so that helped her friendship along the way. Abraham is my role model as an author so thank you. Those of us practicing medicine and teaching have been waiting for years and computers and our world and the rest of our lives because of their iphones and they were so magical so transformative that it was quite logical to me that computers in medicine would make everything better. Particularly for someone like me my main academic interest has been patient safety. I cant tell you the number of mistakes analyzed in csf where we sat there and said we just had computers. Someone misread the doctors handwriting, likeminded indecipherable or didnt realize the patient was allergic to a medicine on a computer database. I think the combination of the wonders of computers in the rest of our lives and the desire for computers to fix the problems we have had led us to anticipate this moment for many years. Medicine did not go on its own. It required 30 billion of federal incentives but then assure period of time it really went and logged digital very quickly. Almost like a tsunami of digitization of the Health Care System that happen assure period of time and i was shocked by how badly things were going. Those of you who are physicians or nurses know this data change the work in ways that often there were positives to it but often made harder and less efficient. It screwed up the work was of all of us who have had the experience of going to see your doctor and you ask a the question in the doctor does that and ask another question and the doctor does that. In fact you turn the bird i patient. So at the end wondering why was it so bad and the beginning and my wife katie right through next hands and she began writing stories about technology and medicine and they were interesting. One day it ucf david hit a 39 overdose of a common antibiotic. It does was supposed to be one pill and we gave him 39 pills. Luckily he didnt die but as i listened to the stories during the meeting and it was a simple airport alerts were ignored ignored pretty mil basin technician would have seen an order for 39 pills and said whats this about and tap someone on the shoulder but that person has been replaced by a robot. A young nurse said this is really weird but i know to get to me it must have gone through computer and a person and i have my bar code. She bar codes it in the computer and she gives the kid 39 pills the equivalent of seeing a sign that i am a highway someone going 5 miles an hour. I came home that day and i said to my wife can you write about this and katie said you must do this journalistically. I said what does that mean . He said he will have to get out and talk to people. I said i hate people and she said i know that. [laughter] the only way you will get this right is basically going around the country and talking to vendors and policymakers and doctors and patients. That is how i spent the last year. By the way he is kidding when he says he hates people. I mostly like them. Theres a section in the very end which even though that mistake the metal mistake is when he talked about as you embark on this book i was pleasantly surprised to find you didnt begin the book with that. He began with a completely different idea. Would you mind sharing that with us . I thought that book might be the story might be the core of the book and i therefore wanted to in some ways be the anchor of the book. The story that i start the booklet is the story of faith position surgeon at the mayo clinic who i happen to happenstance ran into when i was a professor there. Some colleague said to me theres a surgeon here who switched gears from being a surgeon to being a computer expert and i said thats interesting. My colleague said why did you do that and she said one night when he was on call his errand turned at medical school, there were four patients who had code blue meeting their hearts stop within an hour. That might not strike you as weird if you watch tv where that happens in the every hour in the er but i can tell you in 30 years of clinical practice i have never seen that. There were 30 code blues so it happened to him. Three of the four patients died and as he came to think about this he recognized part of the problem was they didnt have Computer Systems that could guide them to do the right thing and he decided to leave the field of surgery to improve computers and health care. As i was interviewing him and hes telling me the stories of big macho guy, muscular guy he is telling me the story and he stops and starts crying. I said this is so profound. The experience he went through and then at the end i said you must be thrilled now we finally are computerizing health care because the government got involved and put stimulus money behind it. This must be a great ruling for you and he said they are selling it as snake oil. I said its interesting to hear someone who has devoted his life to computer medicine is tremendously disappointed. I wanted to point out the tensions between we are not insiders, between these two worlds of clinical medicine and those who see and take care of patients doctors and pharmacists and the people who designed a computer system. I cant believe part of the problem is those worlds are not working together and operating the same silos. Matt burden is the surgeon who became an icon for this effort to try to bridge the field. That was part of it and part of it i wanted to demonstrate to people i hope that even though this is a book being written by a doctor about technical field and how this is so still defying leap warring. I thought this story was not boring. Theres actually huge amount of drama and part of its funny and it really has some life to it are the characters were really adjusting. So that was why started that way and i felt like it was the right way to get into the story and raise some of the key points of contention in the story. Seeing as theres a section and if you wouldnt mind reading that horace. While bob is finding the page i want to say what it pleasure just to see so many of you turn outside i want to especially thank cap players. I have a special relationship with keplers. I came there for my own country in 1994 and i never thought id be living in the neighborhood and being able to basically cycle over and walk over so thank you so much for being the host for this. All the folks who work here are like family and they are often recommending books to me. Thank you all for coming. Its delightful to have you all here. This is part of the other issue. I wanted to frame my own point of view and my worry was people was see part of the reisner brode worth the books i saw about computers and health care were either highly technical or relentlessly hype painting a picture of this Wonderful World that maybe we will get to eventually but not feel like youre affected my daytoday reality. And yet i had a feeling that someone would read the subtitle say hope, hype and harm at the dawn of medicines computer age and say this is a luddite screen. There were people who would say that the pullout the wires and bring back a threering binders. We can do this digital thing lets go back to paper and pencil. I think they are crazy. We have have to make Health Care Digital periods Health Care Digital. Its only lead Health Care Digital periods only way to write that we have have not gotten a price i wanted to frame my own point of view here. The last paragraph i will tell you why i wrote that. While this is a book about the challenges we are racing at the dawn of health cares is digital age if you are looking were dr. Luddite you have come to the wrong place. Part of the reason we are experiencing so much disappointment is that in the rest of our lives Information Technology is so astonishing. Ive no doubt even a medicine are bungling adolescence will ensure productive adulthood. We just have to make it through this stage without too much carnage. Of course if he picked up his book looking orb reckless hyperbole you wont find that here either. Where late to the digital carnival but there are markers everywhere telling us to transform everything and the answer to all of Health Care Sales is being developed even as we speak by his soontobe billionaires 20something tinkering in a garage. Some of it may be real but for now despite some scattered rays of hope the Digital Transformation of medicine remains more promise than reality. Like a bike shorts that take her pulse counter steps in reader moves are pretty nifty but they arent the change we need. Making this work matters. Talk of interoperability federal incentives bar coding and machine running can make it seem as if health care Information Technology is about well the technology. Of course it is. But from here on out its also about the way your baby is delivered, the way your cancer is treated, the way you were diagnosed with lupus are reassured you werent having a heart attack the way when it comes down to whether you will live or die you decide until the medical system that you do or you dont want to be resuscitated. Its also about the way your insurance rates are calculated in the way you figure out whether youre a doctor is any good and whether you need to see a doctor at all. Starting now and lasting until forever your health and health care will be determined through a remarkable and somewhat disquieting degree by how well the technology works. That last paragraph did not appear in the print and make even the first version that you were nice enough to look at. Our daughter read the preface and she said this is really good and its good writing but the book doesnt have anything to do with people and it needs to. You need to tell folks why this matters and that is where the paragraph came from. Im very glad for her, she graduates from college in a week week. One of the things that strikes me as we have been very Fortunate One of the things that strikes me is we have been privileged to watch this transition and for many of our younger colleagues who are at the reception earlier today it has always been computerized in a sense. I was charmed by the book when he talked about the shoebox routine where you went through the shoebox looking for lab results. Talk a little bit about that. I see some physicians in the audience. One of the fun parts of the book is people coming up to me and saying oh yeah i forgot about that and the young folks have no idea what that is. In this case it was the russian russian recollection of my time at the va hospital in the way we got our Laboratory Results was known as checking the shoebox. The shoebox that on the card table outside of the Clinical Laboratory and all of that lab tests the blood counts and all that were filed roughly in alphabetical order although not perfectly in a shoebox outside laboratory. Every day that was part of th