The Problem Is the Connections

The healthcare industry is currently adopting EHR to take advantage of potential long term cost control programs. There are two separate forces shaping the current state of digitization:

- The need for healthcare providers and anyone handling patient data to comply with HIPAA and similar health data privacy acts worldwide.
- The push by governments and patients to increase sharing of patient information between care providers (i.e. nurses, doctors, pharmacists), which causes tension with patient privacy.

IT managers must convince the various other stakeholders; hospital administration, doctors, nurses, and patients that EHR serves each stakeholder’s individual needs. While all of these stakeholders must be mollified in order for a smooth adoption, you must identify which stakeholders, in the decision making hierarchy, are blocking adoption and understand how this group can be brought on board. The various stakeholders have unique and discordant wants and needs from digital records. In this report, we will limit the discussion to the over-arching drivers of change, and the main source of slow adoption of digital records.

The main push for digitalization of patient records, i.e. EHR or electronic medical records (EMR) is based on the assumption that this will trigger a number of widespread efficiencies throughout the system. Although there are subtle differences between EHR and EMR, for the purpose of what is slowing adoption of digital records they can be considered as a single type of product.

The main driver of widespread adoption of EMR will be overall cost savings to hospitals and/or physicians. However, the stakeholder beliefs on potential societal benefits cannot be overlooked. Anecdotal evidence from catastrophic events, such as 9/11, hurricane Katrina in New Orleans, and the California house fires, suggests those individuals that have EMR records had better healthcare outcomes; timely prescription refills, care of chronic conditions, etc. This data is a key reason that consumers (i.e. patients), large insurers, and governments are pushing for a quicker adoption of EHR/EMR, which can migrate easily between healthcare providers. Hospital administrators are pushing for IT managers to quickly source and implement EHR to take advantage of government programs to cover the costs. Early adopters of EHR/EMR have seen ineffective and unused solutions due to end-user resistance. This leads to reassessment by administrators on how to proceed with EHR implementation. These same administrators are now cautious to proceed without the consent of the end-users while still pushing IT to quickly implement a solution.

- There is no direct connection between doctors and IT departments at most hospitals.
- Doctors feel that the solutions offered do not meet their needs and refuse to participate.

Why Are Doctors so Reluctant?

It is important to note that doctors, of all the end-users, are the single biggest obstacle to adoption of EHR, as discovered by over thirty-five separate surveys performed between 1998 and 2011. While cost of investment was an issue for this group, the single largest obstacle cited by these doctors was a perceived difficulty of use. Their reluctance is due in part to a belief that it will cost them time and increase their staffing requirement to use EHR. Since doctors do not feel that EHR will benefit them directly, they are reluctant to take on the cost and are not willing to be flexible about taking staff away from patient care to receive the proper training. For this reason it is vital that IT managers have a direct relationship with key care providers to understand what they are looking for in EHR/EMR solutions.

A meta-analysis of twenty-two studies by Boonstra and Broekhuis in the journal BMC Health Services Research shows that physician resistance to EMR is complex but is largely based on cost-related factors. The essential problem for physicians is integration of the different data sources into a legible document that fits the needs of doctors and nurses. For example, in a critical care environment doctors and nurses need access to patient data. While the nurse needs a quick way to look at up-to-the-minute vitals and care schedules, the attending doctor needs timely access to treatments given and the patient response. This information is readily available in the patient charts, which both groups are accustomed to scanning for the pertinent information.

While vendors have a variety of solutions that are IT optimized, the end-users have not felt that these have met their specific needs thereby decreasing the adoption of these solutions.

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