Physicians are not technology averse

As a thought leader in the healthcare IT space I get a lot of emails that blame physicians for not changing their behavior and not more more easily accepting information technology. The IT solutions folks and vendors often complain "if only physicians would just accept our system the hospital would benefit, the government would get data, insurance claims would be processed faster, etc." Because physicians don’t jump to change their behavior and adopt IT immediately they are pegged as being technology averse. However, that couldn’t be farther from the truth.

Most IT systems like EMRs, EHRs, and other medical record capture and retrieval products are purportedly designed for physicians but they really are created to improve the hospital administrators’ lives, get data to government agencies looking for comparative medicine, push paperwork through to insurance companies so that they can deny claims faster, and many other "features" that don’t really do anything for the doctor.

The problem is not that doctors don’t like IT, it’s that they don’t get the same value out it that other participants in the system do. EMRs today are like CASE tools were back in the early 90’s. Think back to the early- to late-90’s and all the talk surround CASE (computer aided software engineering) and how, by automating requirements gathering and coding tasks we would "improve the engineer" and perhaps even get rid of programmers. Pretty soon we realized that programming is a cognitive process not easily modeled or automated — we realized that the training and tasks performed by programmers and engineers can’t easily be improved. Once we gave up on CASE tools (and how to improve programmers’ thought processes) we learned that we could improve significant tasks like editing, compiling, testing, etc and the actual application lifecycle.

The same way CASE tools failed to improve programmers and thus failed as an industry, EMRs that strive to improve physicians’ thought processes or try to change how they treat patients will fail as well. That’s because physicians are trained in a combined scientific and socratic method — based on case studies backed by science. Physicians using EMRs will be no better doctors than lawyers would be better lawyers because they use a case management system.

So, how do we get physicians to change their behavior and adopt healthcare IT systems? Easy. You can’t in the short term.

In the long term, once we figure out that the edges of healthcare (as opposed to the direct patient care) can be easily improved through better operations and automation of routine tasks we’ll end up creating useful systems. And therein lies the rub: physicians will not adopt systems that do not provide clear and easily understandable value to them (not just their employers).

Because most EMRs today have more value to hospitals, government, and insurance firms and little or no innate value across the board to doctors there won’t be huge adoption like we’re hoping (or wishing for). Here are some simple questions that doctors will want answered before they adopt anything:

  • Can I spend more time on my patient’s care versus documenting the encounter?
  • Can I go home earlier because the system helps me finish my work faster?
  • Will my patient be more satisfied because I’m using the system?
  • Will the outcome of care be improved because I’m using the system?
  • How many more patients per day will I be able to see because of the system?
  • How many fewer lawsuits will be filed because I used the system?
  • How can I easily transmit my patient’s medical records in a safe and secure manner without spending all day making copies?
  • How many more lawsuits will I win because I used the system?
  • How will the system be able to increase my patient population or help me market my services better?
  • How much faster can I get paid for my services after I’m using the system?
  • Can I get access to my data while I’m away from home or the office?

 

These are usually the kinds of questions going through physicians’ heads when you’re showing them a system. If you’re not ready to answer them your solution probably has little value to them and they’re not about to change their behavior to adopt it.

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7 thoughts on “Physicians are not technology averse

  1. A very interesting read.
    Another factor that influences the lack of enthusiasm of physicians (and other healthcare staff) to change their behaviour is the often poor usability of healthcare IT systems.
    Most of the systems in the National Healthcare Service (UK) look and work as if they have been “designed” by developers. These are launched without active usability testing in the clinical setting and often add to the time taken to complete clinical tasks.
    Just an example, a commonly used electronic prescription system requires users to actually use Windows Remote Desktop to log into the server desktop in order to use the system. There is also no concurrency tolerance – if one user is even viewing a patient prescription, no other user can login to view it. The reason for its apparent popularity – it integrates with pharmacy stock control systems therefore easing the workload of administrative staff!
    I also feel that if data generated from all the systems is translated into something that is useful in the clinical context (as opposed to just an administrative context) – e.g. demonstrating improved patient outcome – uptake and use by clinicians would be improved.

  2. Thanks for the insightful post . . . sounds dead-on to me. I don’t know that much about how the doctors’ workflow goes in the office. But your post reminded me that you could have substituted “health consumer” for “doctor” and kept the sentiment the same.
    Nobody has really thought about health the way the consumer does, and built a health-tracking tool around it. And until that happens, PHR adoption will continue to be low.
    Thanks!

  3. I whole-heartedly agree that slow adoption is not an aversion to technology, but rather a souring to it because of poor design and misdirected ends. Most systems out there are based on antiquated architecture that is easier to “remodel” than rebuild. The end result is a product, written with ease of development and production in mind, and not necessarily the end user. This is painfully obvious in elongated documentation times, increased length of workday, disenchanted patients – who now feel disconnected, and lack of mobility, even a tablet is no fun to carry around.

    There are however, more modern technologies out there that are taking up more progressive and end-user centric philosophies, available on mobile platforms, such as the iPhone and BlackBerry.

    There are numerous companies that fly under the “mobile charge-capture” banner, and some are blurring the lines between charge capture and EMRs and offering simple solutions to previously painful processes, especially on mundane, repetitive, administrative tasks. However, just like anything else, not all are created equal, and while all offer their software on a mobile platform, similarities end there, at least in execution. Charge capture solutions, as a whole, are not as well known as the EMRs of the world, despite the fact that they address as many or more of the bullet points above.

    Luis

  4. Another interesting thing that seems to be forgotten every now and then is that physicians are not IT workers. Comparing adoption rates to professions such as engineering and so on, where technology is driving the innovation, is inherently flawed.
    Physicians is concerned about curing patients, if a physician don’t perceive a new IT system to help with curing patients, why bother in the first place?

    This is classic information system thinking, one thing is actually benefits from a new information system, but the important issue for securing user satisfaction (and uptake) is whether the users perceive benefits – regardless of whether there actually are any benefits.

    This is something engineers forget all the time, for physicians an electronic process is not necessarily better than a manual process just because it’s electronic.

  5. As a British GP who started work in Family Practice in 1997 and has never worked without an EMR, I’m saddened and astonished by this post.

    The first thing I did when I arrived as a GP in Canada was get my EMR set up. I chose OSCAR because it is open source and you can add any features you like to it for free (or for the hourly rate of a friendly local programmer).

    In the UK, EMRs grew out of enthusiast family doctors who wrote their own systems to help them practice medicine.

    I can’t imagine how family doctors can function without the features I take for granted:

    – chronic prescription handling
    – drug interaction checking
    – drug information
    – patient information leaflets
    – printing of recs with all the patient data on the form
    – tracking of investigations
    – chronic disease management tools/searches
    – audit tools to ensure I am doing what I think I am doing
    – legible notes
    – complete, off site, backup of my patient data should the clinic burn down.
    – ability to do my paperwork from home

    I could go on.

    I can do far more work in the same amount of time with a computer than I can without. In FFS, if you can’t increase your billings by 10% for the same effort (whilst increasing your quality of care) by puting in an EMR, then you are doing it wrong.

    Why do North American family doctors not get that?

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