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Physicians are not technology averse

May 7, 2009
by shahid
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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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Comments

Doctors readily adopt simple tools that work.

The issues occur when the tools aren't simple or they don't work, or both.

Actually, just like other knowledge workers.

What often doesn't happen is really negotiating acceptance. It's very real work, requires project management, and skill.

Great post, Shahid.
I agree that too much blame is placed on physicians. I just had an interview yesterday with Dr. Marion Ball, who strongly argues that clinicians are more than willing to utilize technology IF they believe it will help them do their job better. But if it doesn't, why bother? It makes perfect sense to me.

Shahid Shah,

I agree. Physicians are not technology averse -- they are only averse to technology that does little to enhance their practice. Several years ago, I wrote a piece entitled EMRs: Who Benefits, Who Pays?, which addressed your point that it has not been in the interest of physicians to adopt traditional EMRs. In testimony before Congress, before he became Budget Director, Peter Orszag stated that "office-based physicians may see no benefits [from traditional EMRs] and may even suffer financial harm." Several landmark studies back up these points. (For information on these studies, go to http://www.srssoft.com/landmarkstudies.php)

It is unlikely that busy physicians will find $44,000 in government incentives anywhere near sufficient to overcome their aversion to EMR technology that doesn't offer them any additional value. They will likely continue to reject technology which delivers benefits to other stakeholders in the health care system at the expense of their own productivity. They will adopt EMR technology that positively addresses your questions, helping them to deliver the highest quality patient care, grow their practice, and eliminate wasted time.

Evan Steele, CEO SRSsoft

shahid