Will IT And Clinicians Ever Get Along?

Cultural differences are partly to blame; experts offer ideas to bridge the chasm.
The truism "Culture eats technology for lunch" surfaced during a recent InformationWeek Healthcare Webcast. Jared Quoyeser, director of healthcare marketing at Intel, one of the Webcast's sponsors, mentioned it during his presentation on mobile devices, and it reminded me of a similar maxim: "Policy changes from funeral to funeral."

The point here is no matter how useful a new healthcare technology is, whether it be a mobile device or an electronic health record (EHR), it's not going to take hold unless it fits in with the mindset of clinicians. And that mindset can sometimes be inflexible.

So how do you overcome the roadblocks set up by an entrenched medical culture? If you've been working in health IT for a while, you already know how important it is to find a clinical champion to encourage colleagues to start using a new IT tool. But Casey Helfrich, chief architect at the University of Pittsburgh Medical Center's technology development center and one of the presenters at our Webcast, emphasized the importance of getting a clinical champion during the design phase of your project as well.

When Helfrich's team was designing a mobile app for emergency medical technicians, for instance, it enlisted the help of EMTs to shepherd the project to fruition--and doing that made all the difference. During every step in the process, those clinicians were deeply involved, and the result was a mobile app that was well received by UPMC's EMT community.

[Legally, EHRs are double-edged swords: They protect clinicians from malpractice litigation but also put them at greater risk. See Will Your EHR Land You In Court?]

Debra Wolf, PhD, associate professor of nursing at Slippery Rock University in Pennsylvania, would certainly agree with that approach. She told me in a recent email: "Unless point-of-care clinicians are leading the design and integration, then a disconnect occurs ..." So is it possible your doctors and nurses complain about the IT tools they're asked to work with because they weren't enough involved in their initial design?

Karen Bell, MD, chair of the Certification Commission for Health Information Technology, strikes a similar chord in a recent article in iHealthConnections: "[The] recipe for failure includes: no one individual in a leadership role; staff who feel marginalized from the process; staff who are not well prepared, trained, and comfortable with new job descriptions ..."

Bell suggests a few novel incentives to help clinicians come around, like folding EHR training into continuing medical education or requirements for re-licensure.

Since most states require doctors and nurses to take a certain number of continuing education courses to maintain their license, this approach can kill two birds with one stone. And if the IT instruction has the seal of approval from their state medical or nursing associations, it may help remove deeply held cultural beliefs.

G. Daniel Martich, MD, the chief medical information officer at UPMC, has his own insights on why doctors resist IT innovations. Their training has taught them "a fair degree of self-regulation and trusting oneself to make the 'right' decision for the patient," he said in an email.

Taking that observation a step further, he pointed out that "evidence-based medicine is a relatively new phenomenon and the art of medicine is still practiced by many--maybe even most--physicians. When you put in place a system--computerized or on paper--that challenges that autonomy and suggests that it knows more than the time-tested model of education, training, and care, you will see doubt, pushback, rebellion, and maybe one day acceptance."

UPMC has found effective ways to deal with this cultural resistance. It makes a concerted effort to understand the skeptics' workflow and look for ways that the IT tools can improve their workflow--or ways that the workflow can fit into the IT process.

It also provides clinicians with what Martich likes to call "academic detailing," which is similar to drug detailing, but in this case, it involves telling doctors about the features and benefits of their IT products.

Rebecca Armato, executive director of physician and interoperability services at Huntington Hospital in California, has a different perspective. In a recent email to me, she said one reason clinicians aren't enthusiastic about EHRs is because the programs are not intuitive enough. She said, "What we need is an 'Angry Birds' EHR that can connect and exchange with other EHRs and that's easy and intuitive to use."

She rightly pointed out that physicians have adopted technology "when it excites and interests them," a fact that's borne out by the number of iPad/iPhone/Android apps they download.

That point of view dovetails with what Stephanie Reel, CIO at Johns Hopkins Hospital, told me. "Some of our best EHR solutions still seem to insert a barrier between the physician and the patient at a time when both would prefer to work together seamlessly ... Not until our solutions are intuitive, our information is integrated, and our systems are easy to use will our physicians (and nurses) enthusiastically embrace the suites of applications we provide to them."

In the final analysis, a good IT/MD relationship is like a good marriage. It requires a lot of give and take, compromise and patience.

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