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Doctors Push Back Against Health IT's Workflow Demands

Doctors are angry that accountable care organization workflows seem more like manufacturing, less like healthcare, say panelists at eHealth Initiative conference.

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There's a powerful force working against the spread of health IT: physician anger, as doctors resist adopting workflows that can feel to them more like manufacturing than traditional treatment.

This was one of several big ideas explored during a panel discussion at the eHealth Initiatives annual conference in Orlando, Fla. Anger within the physician community is creating "significant backlash" in furthering the use of health IT within an accountable care environment, said Simeon Schwartz, MD, president and CEO at Westmed Medical Group, one of the panelists.

Schwartz was joined by Keith Hepp, CEO at non-profit HealthBridge, and Matt Hoffman, medical informatics manager at Utah Health Information Network (UHIN), in a panel titled "Current Health IT Practices in Accountable Care." But the focus quickly shifted to challenges healthcare organizations face under federal accountable care organization (ACO) rules with regard to the implementation of IT to drive down costs and changing physicians' mindsets.

[ Meaningful Use adoption makes slow progress against docs' resistance to change. Read Meaningful Use Slowly Increases EHR Use In Hospitals. ]

"We understand now that we have to change workflows," said Schwartz. "Physicians have to put in pathways of care that look more and more like manufacturing in terms of accountability." Schwartz said organizations need to transition from a guild-like mindset to that of a "manufacturing organization," where physicians can use their skills in combination with data at the point of care. When that happens, Schwartz said, "that change is going to be profound."

The resistance to changing workflows among physicians was echoed by Hoffman. ACOs move healthcare from a workflow model to where it's the physician's job to treat a disease as quickly as possible. "If they can get information from IT ... then they can intervene and get treatment as soon as possible," he said. This also enables physicians to prevent large-scale events, such as heart attacks, that cost money, Hoffman said.

Hoffman added that behavioral change is a key factor in the use of health information exchanges in meeting accountable care requirements. Physicians aren't quick to connect their electronic medical records to an HIE, he said, since "they don't get a lot after that." Instead, physicians and clinics need to have incentives to connect these tools and, at the same time, be shown how connected data can result in better and easier care for patients. "We're working with physicians to show them there is benefit," he said. "But there is resistance to changing workflows."

Patient engagement remains a prominent challenge facing organizations trying to meet accountable care standards as well. The process for caring for patients is broken, said Schwartz. When it comes to addressing workflow issues and patient involvement, "you can fix as many pieces as you want, but until you bring those pieces together into a new workflow, that won't change the patient experience ... Experience isn't synonymous with customer service, and it's not synonymous with IT or doctors or providers." Instead, he said, the patient experience should be centered on solving problems, which occurs when "we're direct with [patients], and that's where we're failing," Schwartz said.

Instead of presenting patients with clear, timely information in regard to diagnoses, for example, said Schwartz, physicians tend to sugar-coat. However, in a day and age when patients can turn to alternative means of gathering information, like the Internet, it's pertinent that a patient-physician exchange meet the new, more direct demands of the patient. "We're [still] not creating the experience they want," Schwartz said.

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User Rank: Author
2/19/2013 | 9:33:33 PM
re: Doctors Push Back Against Health IT's Workflow Demands
Comparisons to "manufacturing" are useful because they're both powerful and threatening -- it's a warning how strong the backlash against extensive analytics use could be.
User Rank: Apprentice
2/18/2013 | 6:19:03 PM
re: Doctors Push Back Against Health IT's Workflow Demands
We have been seeing physician resistance to health IT ever since the first system was implemented. There will always be resistance; we just have to work with the physicians in order to create systems that they not only feel comfortable using, but that also improves the quality of care they are providing. Physicians are reluctant to change, providers just have to show them the upside to using these systems and eventually they will learn to use and appreciate the potential in EHR systems.

Jay Simmons
Information Week Contributor
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