Breaking doctor resistance to health IT

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.

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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.

Stat.

Topics: CXO, Health, Legal, IT Employment

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  • Added Value

    For a population to embrace a technique you have to give them an incentive, the easier incentive beeing reduced tedious tasks, more time to concentrate on important taks.

    You cannot sell health IT to praticians with cost benefit for insurances, or reduced risk of errors, as MD are not contemplating their potential errors when making a decision.

    If you want to sell them health IT, you have to concentrate your communications on gains they will have from using it, not gains others will have.
    s_souche
    • RE: Breaking doctor resistance to health IT

      @s_souche I agree. The HITECH bill contemplates lower reimbursements for those who don't adopt health IT by the end of the subsidy period. It may be a stick rather than a carrot, but it's an incentive.
      DanaBlankenhorn
      • RE: Breaking doctor resistance to health IT

        @DanaBlankenhorn I tried in earnest just to find a doctor that used digital technology. When I called medical technology companies to ask how I could locate doctors that used their solutions in my area I was told they didn't have any method.

        I could Google up a medical group in San Diego, but nothing near me.

        To your discussion about medical liability/tort reform, I would be more than willing to sign a release not to bring suit as long as the doctors actions and results could be subjected to peer review for determination of proper medical procedures being followed. The entire process could be anonymous and the review held in another state to assure impartiality.
        Desert Navy
    • RE: Breaking doctor resistance to health IT

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  • All wrong..

    The reason so many doctors resist IT isn't so simple.

    1. Lack of qualified IT support. Most of the IT support specialists I know are hacks. They barely know how to cobble together a Windows XP workgroup. These guys have not looked at Windows Server 2008 or Windows 7 yet. To them, XP is the end all be all of the world. They do not spend time or money getting trained on the latest technologies. Setting up a new server running Server 2008 R2 on your network is their way of trainning themselves. They have no idea what a Domain is nor do they know how to manage it. Many of them also used pirated software. One "IT specialist" I know used his TechNet subscription to install an entire network of 5 servers and 20 workstations for one medical group. The group, of course, was horrified once I told them there was $80,000 of pirated software on their network.

    2. Expense. Many of these IT specialists cost $120 an hour or more and then they purchase $8000 servers to run one simple application that uses SQL Server 2005 Express edition and only has to service 5 users.

    3. Complication. Many IT specialists will configure the network in such a horrifed way that only they know how to work with it.

    4. Lack of support. Many of these so-called "IT specialists" charge a monthly rate but still charge and hourly rate when called. You would think for the monthly rate the "specialists" would monitor the network and install the latest updates but they don't. I've personally observed 4 year old Server 2003 boxes that were still on SP1 and IE6 and no other updates installed.

    The reasons go on and on but we should all get the point.

    Doctors don't like HITECH because all they get is SHAFTED.

    JamesNT
    JamesNT
    • RE: Breaking doctor resistance to health IT

      @JamesNT If I'm reading it right your problem is with the industry, not the incentives. Why not use SaaS?
      DanaBlankenhorn
      • RE: Breaking doctor resistance to health IT

        @DanaBlankenhorn

        I am not a Doctor, I'm a computer scientist. But I work with doctors and you will not believe the messes I have to clean up.

        The reason doctors don't go with SaaS are that:

        1. Many EMR's do not support SaaS. You are required to install their software on a server in-house.

        2. The EMR's that are online/web based are horrible. Once your data goes in you cannot get it back out. They do not have export features to export your data to a format you can use. Or, they charge big money to give you a copy of your data back. I've heard stories of one online EMR charging customers (read: DOCTORS) $15,000 to export their data so the customers could move on.

        JamesNT
        JamesNT
    • wow sounds like someone has had some bad experiences...

      @JamesNT

      While i have seen what you talk about a few times, its not an industry wide standard. Not IT guys are hacks, most times people hire the wrong type of person. In this case i would blame both the person mis-representing themselves as well as the hiring party.

      Focus on experience and certifications and you should be able to hire the right person. Heck some guys i know have neither in a professional sense, but have made great techs who stay ahead of the tech curve. Those are the guys a hire.

      I think the biggest problem with IT in healthcare is the providers. While most are respectful, some dont respect anyone without a Dr infront of their name. Some dont like women and think they should stay as nurses.. its amazing. Some refuse to learn.

      I think by offering them monetary incentives, the government can atleast give them a good green reason to move to EHR's. I think insurance companies could also back this up by offering incentives in the form of discounts on mal practice insurance and/or a few more percentage points on ebilling and electronic records.

      Bottom line though, finding an IT guy isnt like hiring a basic employee, you need to find one that fits well in your environment and has proven knowledge. Dont forget to pay them well and ask questions until you feel comfortable with the answers. Hell ask other IT guys on forums if what they are telling you is true. Ask for outside audits. if your IT guy refuses external audits, they are hiding something... its your company, not his.
      Been_Done_Before
      • RE: Breaking doctor resistance to health IT

        @Been_Done_Before

        You are quite correct. Many doctors do NOT have respect for IT. They think computers are nothing more than these infuriating little boxes on the floor next to their desk rather a tool to get their jobs done.

        Some doctors do refuse to learn. The way things were done in the 80's are good enough for today, as far as they are concerned.

        As far as which problem is the biggest re: doctors not respecting IT vs. incompetent IT people - I submit to you that both are equally terrible problems and one feeds the other.

        JamesNT
        JamesNT
  • RE: Breaking doctor resistance to health IT

    In Britain it broke a long time ago. The advantages are obvious once experienced. When I go to my doctor next week for the annual check up he advises, he will have the analysis of the blood tests from the samples the nurse took last week and also my medical history. All of these on the screen in front of him will ensure that his advice and prescribed medication will take all the factors into account in a manner which would be impossible with paper records.
    Of course in UK I pay nothing at the time. Through taxes I pay about a third as much as an American for my socialised health service.
    misceng
    • socialism is great until you run out of other peoples money.

      @misceng

      While my quote there is somewhat mean, it brings up the point i wish to convey... "where is the money coming from to pay for this?"

      I watched sicko and alot of it made sense. It assumes everyone takes on the burden of paying for healthcare, but it doesnt answer how it will be paid for. I like the idea, but have many reservations.

      Besides money, what about the government telling me what i can and cant do to my own body? Penalties for smoking, drinking, eating too much fast food, drinking soda? While thats ok in the UK, this doesnt mesh well with the US foundings.
      Been_Done_Before
      • RE: Breaking doctor resistance to health IT

        @Been_Done_Before The British pay roughly half what we do for health care. And cover everyone. The Canadians pay about two thirds what we do. And cover everyone. The Germans and Dutch and French and Italians, the same. All of them have different systems, but they all cover everyone, and they all cost much less than our system.

        But all politicians had to do here was scream "socialism" long enough and loud enough and we ignored all that.
        DanaBlankenhorn
  • RE: Breaking doctor resistance to health IT

    Why does this Brit love the UK's National Health system? Because my practitioner does use IT systems, does use statistically valid measures of probability in his diagnoses and prognoses, and because the quality control in his local treatment centre is second to none. Everything from the pre-operative briefing to the post operative discharge protocol shouts out "Check list in use!"
    Profit is not the motivator. The motivator is keeping me healthy so I don't cost them by coming back.
    And there is nobody getting rich on the back of my illness - except the drug companies.
    Private medicine presents the practitioner with potential conflict of interest issues. Patients are not always in the best frame of mind to be objective about things when they need to consult a practitioner, and this potential can erode confidence even where there is no reason for concern. It just does not work as well as the universal nationalised insurance system that has no get-out clauses for the health care system.
    PassingWind
    • RE: Breaking doctor resistance to health IT

      @PassingWind Can I bring this back to IT?

      Mandating a standard within an industry holds both advantages and disadvantages. You have to upgrade everyone at once, so things can stagnate. But you do get the numbers you need to drive change, in both behavior and treatment.

      What's interesting about the HITECH stimulus is that it's leading to mandating of interoperability based on HL7. More on that tomorrow.
      DanaBlankenhorn
    • RE: Breaking doctor resistance to health IT

      @PassingWind Two mistakes

      First you assume MDs have free schedules, waiting for you to come back because they did not treat you correctly on purpose. I don't know how this is in te US, but in France, UK, germany ... MDs t have more often too much patient rather than too little.

      Second assumption : if you are well treated you won't come back; The exact opposite. If you are well treated you will come back when needed, and you will share with friends, familly about your experience. Thus MD-patient relationship will be more trust based and as a reasult both more pleasant and less dangerous on a legal point of view ( reduced chances of beeing sued in case of mishap
      s_souche
  • Usability is the Problem

    Now that HITECH incentives and low-cost SaaS-based EHRs have removed the cost barrier, the problem is that most EHRs aren't designed to be usable. An appallingly few number of EHR vendors have usability experts on their staffs, and SaaS-based one-size-fits-all approaches have great difficulty accomodating unique workflows for certain specialties like OB/Gyn and Oncology. It's going to be an uphill climb until word gets out on the street that EHRs are out there that have cracked this nut.<br><br>Glenn Laffel, MD, PhD<br>CEO Pizaazz<br>www.pizaazz.com
    glaffel
    • RE: Breaking doctor resistance to health IT

      @glaffel Yes! Too many EHRs have been built from the outside-in, that is from the computing perspective, rather than inside-out, from the health care giver's perspective. But most EMR vendors do have chief medical officers on the payroll. Maybe these people are too wrapped up in marketing.

      One more point in the makers' defense. The creation of great software is based on a feedback loop. Windows was crap at Version 1.0. If you participate in the feedback loop you can improve any software product.
      DanaBlankenhorn
      • RE: Breaking doctor resistance to health IT

        @DanaBlankenhorn - it's interesting that in response to @glaffel's post about usability being the problem, and very few vendors having usability experts on staff, you say "most EMR vendors do have chief medical officers"...

        This is *not* the same thing as having usability experts on staff. Getting usability and UI right in a complex EHR app (whether installed locally or browser-based SaaS) is very challenging - and there are very few people out there who have both the usability & UI design skills and sufficient healthcare domain knowledge to do a good job. The danger of having physicians design EHRs is that they design for themselves rather than for the communities which will use their software. The danger of having uninitiated UI designers and usability experts design EHRs is that they don't get the time to learn the domain, and underestimate the challenge of doing so.

        The only way to get it right is to bring healthcare-savvy usability & UI experts together with a multidisciplinary domain expert group, in the right kind of agile, iterative development environment, and to combine that with a lot of contextual user research and testing. In my experience very few vendors have that combination.
        KitLewis
  • RE: Breaking doctor resistance to health IT

    A couple of points here:

    1) "Breaking" is not the best choice of words. Nobody needed to "break" doctors' resistance to iPhones, fax machines, stethoscopes, MRI, CT, etc. If I were a doctor and discovered that someone is out to "break" me, I would not take to this very kindly either.
    2) Some doctors may lack respect for other people, but not all and not even a majority. Probably the same as the general population.
    3) SaaS may be sexy, but it's not cheap. If you calculate 5 year TCO for SaaS it comes up very comparable to a license model.
    4) The incentives do not cover the total costs of EHR and there is definitely nothing leftover for cute iPads.
    5) Agree with Glenn on usability. Fortunately, I am seeing vendors' effort in that direction, so I am guardedly optimistic.
    Margalit Gur-Arie