Removing barriers to technology.

Physician adoption has long been considered "the holy grail" of clinical information systems: critically important, but elusive. And with these systems at the top of most hospitals' technology agendas, overcoming physician resistance is a major question on the minds of many health executives.

More than 60 percent of hospital CEOs plan to invest in some type of computerized physician order entry (CPOE) system in the next two years, according to one survey. And most of those would probably report concerns over getting physicians to use the new system. They know that they cannot possibly hope to recoup their investment if the system sits idle, gathering dust.

How can health executives encourage physicians to use clinical information systems? First and foremost, they must recognize that physicians do NOT inherently resist new technology. Physicians are not technophobes. Rather, they love gadgets. Physicians were early adopters of cell phones and home computers. The majority use PDAs. Medical device manufacturers have long capitalized on their love of new surgical devices, robotics and endoscopic instruments.

Yet by and large, physicians as a group have not yet embraced clinical information systems. So what's the problem? In a nutshell, health executives have failed to take advantage of the attraction to technology. Rather, there have been several barriers to physician adoption:

1. Clinical information systems aren't proven to be more efficient.

Physicians will resist anything that impedes (or does not enhance) how they spend their professional time, their most precious commodity. In the past, many clinical systems had awkward user interfaces and required a good deal of training to use. They had the appearance, at least, of slowing physicians down--with no tangible benefit to their practice.

For physicians, efficiency is the primary driver. Cell phones, PDAs, etc. help speed up the processes of getting test results and ordering prescriptions. They are accessible, reliable, easy to learn and portable.

In contrast, most clinical information systems did not offer these benefits. Even if the systems offered the potential for efficiency enhancement, most physicians could not see past the initial learning curve.

Physicians are interested in patient safety and supportive of the concept of clinical technology. But if they feel that technology will waste their time, they won't embrace it.

2. The technology has not appealed to physicians' desire for professional independence and autonomy.

As a result of both self-selection and medical training, physicians are not generally aligned with organizational thinking. They are uncomfortable when someone acts like they know more than they do about one of their patients. They are reluctant to take instruction from others, especially a simple computer system.

For many physicians, clinical information systems represent a "Big Brother," watching and making judgments about their practice patterns. Physicians fear that they will lose autonomy with clinical information audit tools.

They also, quite appropriately, resist overly simplistic "cookbook medicine." They see clinical information systems as trying to tell them how to practice medicine. Many systems have only very basic rules, alerts, order sets and significant gaps in functionality.

As far as clinical information systems are concerned, we are more likely to remember the one time an alert is poorly designed than 10 times that it serves us well.

3. Clinical information systems are expensive.

Physicians are reluctant to make capital investments in new technology for their practices. By and large, physicians run their office practices with very low margins and will resist any increases in their overhead.

They are particularly reluctant to invest in technology for noncore functions--not directly linked to billable revenue like a new ultrasound or X-ray. Clinical information systems are not directly tied to new services for which physicians can charge. For their office practices, physicians often see little evidence of a return on their investment for clinical information systems.

How can health executives overcome these barriers and encourage physicians to use clinical information systems? There are several strategies to consider:

* Capitalize on physicians' love of new machines.

Executives can make clinical information systems appealing to physicians by making the presentation exciting. They should install the clinical information system on newer laptops or tablets rather than old desktop terminals.

Even if the differences--in terms of actual functionality--are somewhat artificial, they are very important to overcoming any physician resistance. Executives can give physicians a flavor of the technology by providing them with a tablet, wireless or laptop computer for training and demonstrations.

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* Make sure that the technology is designed with efficiency in mind.

Interface design and workflow optimization are the keys to getting physicians to use clinical information systems. Interface design is a lot more than just cosmetic appearance. It directly affects the usability of the system.

For example, designs that minimize the number of clicks for frequently used functions will save physicians a lot of time. In contrast, poorly designed interfaces will seem tedious and laborious, causing physicians to quickly resist the technology. Health executives also need to think about how to optimize physicians' workflow experience using the technology.

They should think about how physicians' work throughout the day. They need to consider where the physicians will use the functionality, when they review laboratory and radiology results and how they put together orders.

The technology interface should be seamless through those processes. For example, they may want to consider creating easy remote access from physician offices and homes.

* Appropriately communicate with physicians about the system.

Physicians need to hear accurate information about the tool, how it will be used and the implications for their clinical practice. Communication should be peer-driven in order to generate mutual trust and respect. The medical staff, rather than hospital administration, should lead and champion the effort.

Expectations of the clinical information system must not be oversold. Communications should emphasize efficiency and physician practice benefits, as well as the pure clinical gains.

* Assist physicians administratively.

Within the constraints of federal and state regulations, there are many ways that hospitals can help physicians in the acquisition and implementation of clinical systems for their office practices.

They can engage in joint venture opportunities. They can provide financial and business planning expertise. They can help direct physicians toward bank financing opportunities. In short, there are many legal creative solutions to minimize the barriers physicians perceive in acquiring clinical systems.

Clinical information systems are expensive for any health organization, in terms of both money and staff time. Implementation is also a risky proposition. Not only is patient care affected, but hospital administrators can quickly lose the trust and respect of medical staff members when the technology does not perform as promised.

Health executives need to take every step possible to maximize the return on their investment, and ensure a high probability of success.

IN THIS ARTICLE ...

Health care executives need to take every step possible to overcome barriers to adoption of new technology by physicians. Through just a few relatively simple and inexpensive strategies, they can enable their physicians to use the clinical information system and bring value to their patients, health system and medical staff.

Check out ACPE's Successful IT Change Management course for more on the challenges of information systems implementation.

www.acpe.org/interact

Manuel T. Lowenhaupt, MD is a vice president at Cap Gemini Ernst & Young and is based in Andover, Mass. He can be reached by e-mail at [e-mail]

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By Manuel Lowenhaupt, MD