Beyond the Demographics Demon

This entry is part 1 of 2 in the series Let Curiosity Cross the Chasm: Reducing Physician Resistance

In a research paper presented at the Institute of Electrical and Electronics Engineers (IEEE) 2013 46th Hawaii International Conference on System Sciences, 1 Anol Bhattacherjee, Christopher Davis and Neset Hikmet confront a problem all of us in Healthcare Information Technology (HIT) face at one time or another: physician resistance to or non-acceptance of the HIT we all hope will help to solve many of healthcare’s current dilemmas. This crucial human element is a very real impediment to realizing the myriad benefits of HIT, including reducing costs, eliminating inefficiencies and errors reducing patient safety, not to mention complying with very specific regulations to demonstrate progress toward these goals.

The authors suggest that both non-acceptance, i.e., non-use resulting from lack of awareness or incomplete evaluation, and resistance, i.e., consideration and rejection, stem from a variety of causes. While difficult to predict for all potential users, these causes include five different kinds of conflict: object, e.g., the purpose of electronic documentation; tool conflict, e.g., the technology used to document; community conflict, e.g., the definition of different peer groups sharing information; role conflict, e.g., traditional versus modern division of labor; and rule conflict, e.g., norms, conventions and social relations defining how we perform work.

Some of our change management colleagues believe factors like physician demographics play an important role. For example, they predict that as older physicians less familiar with computer technology retire and we replace them with younger providers steeped in the use of the Internet and smart devices, whose training and education is in fact driven by these new means of communication, we will reduce or eliminate many of the above conflicts. There is some research to support this theory. A Health Affairs study found that in 2011 30.8% of physicians older than age 55 were using a basic EHR system, compared with 40% of doctors younger than age 40 and 35.5% of doctors ages 40 to 55. 2

Certainly, non-familiarity with the tools of HIT is a justifiable concern. However, physicians for the most part possess an innate curiosity. Many are quick to embrace technology that directly affects diagnosis and treatment: advances in radiology and surgery, for example, often involve highly complex technology, and their adoption does not face the same kind of resistance as HIT like Computerized Provider Order Entry (CPOE). In addition, these kinds of innovation seem to cross provider demographics, suggesting age is not necessarily the primary cause of tool conflict. In fact, the study referenced above found that while we could draw an age-related conclusion regarding EHR use, it was not necessarily physician age, but the nature and size of older physicians’ practices, that was a distinguishing factor. 3 In addition, applying effective change management techniques regardless of provider age, such as one-on-one training and personalized attention during cutover, can help reduce tool-related anxiety.

The benefits of increased, more timely and accurate information, ultimately resulting in improved patient safety and care, seem more than sufficiently documented to overcome most if not all object conflicts. Likewise, the ability to share information with a larger, more diverse group of peers, implicit in a “big data” sharing environment, merely expands the community of providers rather than change it in any significant way. Effectively exploring and communicating these benefits as part of a comprehensive change management plan can help reduce these kinds of community conflicts. Including physicians in the requirements definition, acquisition, configuration, testing and cutover to a new system also ensures they have a vested interest and a voice in the future of an organization’s HIT.

  1. Bhattacherjee, Anol; Davis, Christopher; Hikmet, Neset, “Physician Reactions to Healthcare IT: An Activity-Theoretic Analysis,” System Sciences (HICSS), 2013 46th Hawaii International Conference on, vol., no., pp.2545,2554, 7-10 Jan. 2013
  2.  ‘Age Is Just a Number’ — Does It Hold True for EHR Adoption?, retrieved on April 9, 2013 from http://www.ihealthbeat.org/features/2012/age-is-just-a-number-does-it-hold-true-for-ehr-adoption.aspx
  3. ‘Age Is Just a Number’ — Does It Hold True for EHR Adoption?, retrieved on April 9, 2013 from http://www.ihealthbeat.org/features/2012/age-is-just-a-number-does-it-hold-true-for-ehr-adoption.aspx
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Posted on July 1st, 2014 in Innovating Health Care IT
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