Breaking doctor resistance to health IT

Summary:If we can get all doctors using checklists, all doctors working as teammates with nurses and other staff, then accepting the aid of software becomes a lower hurdle.

Kavita Patel (right), a former Obama HHS official now with the New America Foundation, estimates that 58.5% of medical practices are still using pen-and-paper, near the end of 2010.

Why is that?

Dr. Patel suggests fears of malpractice and loss of autonomy are behind the resistance.

The HITECH stimulus, with its meaningful use regulations, aims to break one line of resistance, the idea that gear and training cost a ton of money and time.

That sweet, sweet stimulus cash basically pays for the training and installation hiccups that come with any new system. It can also be used to pay for cool toys like an iPad for every doctor.

But the stimulus doesn't solve these other problems.

The first is a question for lawyers. It should be possible to write an effective "hold harmless" regulation so that doctors aren't liable for mistakes made by software. Damages from this cause should be limited to actual damages -- software won't respond to punitive awards.

If politicians must get involved, how about if Speaker Boehner pushes through a malpractice reform act in the next Congress? At least be willing to negotiate one.

I know, the plaintiff's bar will object. What if the software company knows about a problem and is refusing to solve it, relying on the hold harmless clause to get away with "murder?" There's a difference between malice and mistakes.

If you think you have evidence to prove malice, then sue the software company for malice. Make it a class action. But you need to prove some human acted with intent to cause harm, or reckless disregard. I'd even hold that open to prosecution by ambitious DAs. Make a great TV episode.

The second is more of a cultural problem.

Many doctors still resist checklists. It seems to go against their training, and their instincts, for anyone to question what they're doing in the heat of medical battle.

The solution here, it seems to me, must lie in education. Medical schools should be teaching new doctors to respond favorably to checklists, to be team managers rather than lone wolves. And this needs to become a feature of continuing education.

I suspect the two issues are closely related. If we can get all doctors using checklists, all doctors working as teammates with nurses and other staff, then accepting the aid of software becomes a lower hurdle.

In any case, what seems clear is overcoming these valid concerns needs to be a big concern for the profession, and given the speed with which gear needs to be bought to qualify for that sweet, sweet stimulus cash I have a medical term to add to that.


Topics: CXO, Enterprise Software, Legal, Tech & Work


Dana Blankenhorn has been a business journalist since 1978, and has covered technology since 1982. He launched the Interactive Age Daily, the first daily coverage of the Internet to launch with a magazine, in September 1994.

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