Andrew Schwarz

Why would highly trained, intelligent physicians resist the adoption of electronic medical records, a technology touted to provide a number of benefits including improved patient health?

A joint study by LSU and the Louisiana State Medical Society asked that question and found that doctors who have not implemented the technology have their reasons, rational reasons, including:

• Negative views of EMR and the EMR marketplace,
• A lack of impact on physician performance,
•  Initial and long-term implementation concerns, such as the cost for the systems and staff training,
• Distrust of federal and state governments and insurance companies,
• Security and legal concerns.

In reviewing the EMR discussion, Andrew Schwarz and Colleen Schwarz, professors with the LSU E.J. Ourso College of Business and the Center for Computation and Technology, saw “a pro-innovation bias,” an attempt to blame doctors for the lack of EMR implementation.

 “They’re saying, ‘What’s wrong with the doctors?’” Andrew Schwarz said. “The problem is no one’s stopped to ask the doctors how they feel about it.”

The professors found, through an online survey of 594 physicians, that physicians feel that incentives or penalties are being used to make them adopt a technology that they don’t buy into, Andrew Schwarz said.

A National Ambulatory Medical Care Survey published in 2010 showed 39 percent of office-based physicians in Louisiana used an EMR, the second-lowest percentage nationwide.

Schwarz said what’s really needed is “a kind of time out,” stepping back for a minute to give doctors a voice in the process.

Colleen Schwarz said that avenue, working with the physicians and asking them the right questions, hasn’t really been used as much.

Those questions should include: What are the things physicians want in an EMR? How can studies be conducted to prove that EMR will deliver the promised benefits?

Physicians understand research, she said. They want to see the proof behind all these benefits that are supposed to result from EMR adoption.

The problem is that physicians, after talking to their doctor friends and EMR vendors, and seeing EMR for themselves, believe that the technology is not going to provide these mythical, promised benefits, she said.

Andrew Schwarz said there is no national strategy when it comes to deploying EMR solutions.

What there is, is a belief that the power of technology can solve problems that there is no way it reasonably can, he said.

And while the link between EMR, meaningful use and quality of care outcomes has yet to be demonstrated, Schwarz said that hasn’t stopped the government from using stimulus funds and incentives to pressure physicians to adopt questionable technology that hasn’t been proven to achieve the hoped-for outcomes.

The survey respondents were made up of practicing physicians, retired physicians and medical students/residents from across Louisiana and represented a variety of specialties. The physicians split nearly evenly into adopters, 50.4 percent, and non-adopters, at 49.6 percent.

Schwarz said the business professors got interested in EMR because the marketplace is unique in the business world.

In the traditional free market, an organization that invests in new technology can generate the revenue needed by raising the cost of its product, he said. In EMR, the physician is being forced to incur the added cost but with no way to make the additional cash needed to buy the technology.

The government is trying to buy physicians’ cooperation through incentives, but doctors have a deep skepticism when it comes to the federal and state governments, he said.

Physicians also had a high level of distrust toward HMOs, major supporters of adopting EMR.

“It’s a really interesting situation where the person holding the purse strings is basically trying to pressure you, but you don’t trust the one that’s holding the wallet,” Schwarz said.

A lot of physicians told the researchers that they adopted EMR because of the incentives or the penalties, Schwarz said. But a lot of other physicians said if the technology was really that good and provided all the benefits it was supposed to, physicians would be the first in line to buy the product.

“Doctors by their very nature are always embracing new approaches, new techniques, better medicine,” Schwarz said.

The fact that the physicians aren’t doing so with this technology should lead people to ask why doctors oppose it, he said.

Schwarz said the researchers hope their study will allow them to gain the ear of the right people, to help policymakers and physicians craft a better strategy for adopting EMR, one that allows everyone to win in the end.

“I don’t think it’s too difficult to envision a scenario where doctors collaborate on creating a good, solid product out there and a strategy,” Schwarz said, “but not in the way that we’re going right now.”

Tags:

Bookmark:

Digg

Facebook

Technorati

Newsvine

Google

Related: