You Say Physicians Don't Like Technology?

Many in the healthcare IT industry generally believe that physicians don't like technology. They cite years of research that shows physicians do not adopt the technology that is ostensibly purchased for them. The research, it turns out, is true - fewer than 10% of hospitals have achieved significant physician adoption of Computerized Physician Order Entry (CPOE), and fewer than 5% have achieved adoption of electronic documentation. Most of the"successful" adoption comes from Academic Medical Centers who employ physicians and residents, and therefore, can control system use to a greater extent. But 90% of US hospitals are community hospitals with largely voluntary staff comprised of independent practitioners - physicians who can and do practice elsewhere including multiple offices and even other hospitals. I would argue these community hospitals are the true test bed for physician adoption of IT.

The notion that physicians don't use technology simply because they don't like it is incorrect. Healthcare is replete with examples of physicians incorporating ground-breaking technologies of all kinds into their practice of medicine. From medical devices like implantable defibrillators to the most sophisticated imaging technology, physicians have shown a willingness, indeed a penchant toward adopting technology. These examples are not limited to technologies that involve direct patient care - witness their adoption of smartphones. The number of physicians using smartphones surged to 64% in 2009, and this number is projected to grow to 81% by the year 2012. This adoption rate out-paces that of consumers, among whom 65% are expected to own a smartphone by 2012.

"Usability" is often cited as the main culprit behind meager physician technology adoption statistics. Calls for improved user interfaces and screen layouts often lead to attempts at trying to weave these constructs into EHR certification criteria, for example. Indeed, the talk in the industry of late is around trying to impart usability as a requirement of Meaningful Use certification. As with prior attempts to legislate usability, however, these efforts are largely doomed to fail as the color, size and location of a button or a screen is not the primary culprit behind historically poor physician adoption.

The primary reasons for poor adoption have more to do with utility than usability. Simply put, if the technology is of no real benefit (or worse a detriment) to the physician and their practice of medicine, they will not use it. CPOE is the poster child for this challenge. Since before the Institute of Medicine's landmark 1999 study "To Err is Human," the industry has tapped technology, namely CPOE, as the keystone for reducing medical errors. Despite broad agreement on this as a chief benefit of CPOE, physicians have shown no real inclination to use these systems. Do physicians not believe in reducing or avoiding medical errors? Of course not. Instead, physicians struggle with systems that do not support their logical workflow and require them to provide information and respond to alerts that are better suited to other clinicians such as nurses, pharmacologists, radiologists, etc. These systems consume additional time on their busy schedules - time they cannot spare (a 10% reduction in physician productivity results in a 20% reduction in revenue).

Ask yourself, would you use something that provided no direct benefit to your daily work, or worse, provided no benefit AND took more of your time? What if that "something" wasn't even designed for your use, would you use it then? That's essentially what we are asking physicians to do - use technology that wasn't designed for their benefit, but we feel is worthwhile nonetheless.

You say physicians don't like technology? I say they don't like technology that does not benefit their practice of medicine.