Resistance to Change Will Fuel EHR Adoption

Resistance to change is the number one reason doctors aren’t adopting EHR software. Sure, doctors will often give a lot of other reasons why they’re not adopting EHR software, but in most cases those are just shields for the real reason they don’t ant to adopt EHR software: Change.

Doctors are certainly not unique in this arena. None of us like to change. I’m a creature of habit as much as the rest of us. In fact, I just tweeted yesterday that I need to change my method for writing posts. I know it’s the right thing to do and would make me more productive and probably increase the quality of my posts, but I’m resistant to changing the approach that I’m comfortable doing. Doctors are no different and let’s be clear that documenting in an EHR is different than a paper chart. An EHR implementation requires change.

While resistance to change is the current barrier to EHR adoption, I would also assert that resistance to change is going to be the reason why EHR adoption will become the norm.

I’m sure this will make some of you feel a little uneasy. What we have to realize is that most new doctors coming into the medical profession love technology and can’t imagine having to go find a paper chart. They can type faster than they can write and so they idea of writing in a paper chart would be a big change for them. These doctors are use to only reading typed material. They don’t care to learn how to read physician hieroglyphics. These new doctors don’t see carrying around a device as a burden, but as a normal part of life. Taking that device away is a change for them. They won’t want to change their digital ways in order to live in a paper chart world.

In a story I’ve often related, I saw this first hand when my medical student friend told me he hated his current rotation because they used paper charts. He then went on to say, “I hate paper charts because I can type faster than I can write. And…” The glazed over eyes was when I could see that for him he couldn’t see any justification for using a paper chart. He wasn’t quite sure how to articulate why he didn’t like paper charts, but he just inherently knew that he didn’t.

Time is the great healer. With enough time, the resistance to change will be against those who want a doctor to use a paper chart.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

9 Comments

  • A great reminder post to stir the collective consciousness of your readership. I can’t wait to see the comment thread for this post. I have my own two cents to add that I’m worried might stir the shit a little too much but I can’t help myself.

    When I first started my current job my predecessor told me your first priority is not to do your job, but to make sure the finer details of your job don’t fall through the cracks. This means putting diligence and thoroughness in documenting and keeping records of the work one does over the work itself. I swing back and forth on the amount of truth to take from this lesson but I whatever nuggets you take from it, I think it applies to medicine as much as it does anything.

    The idea that keeping a record of the work involved in caring for a patient (in your EMR or paper chart) is more important than caring for the patient is a radical notion indeed. Call me crazy but I think that a lack of substance or quality in the documentation of a patient’s care can lead to equivalent or greater harm than doing a poor job of caring for a patient in the first place. I should clarify this poor patient care is hypothetical and that I’m not a cynic when it comes to the level of care people put into their work. I think most people (especially doctors) have the best intentions for the outcomes of their efforts.

    My point that all of this is leading to is that I think most medical professionals think of the documentation they have to do as busywork that gets in the way of caring for their patients and I think that they’ve got it wrong. The documentation is just as important, if not more, than the patient care itself because they exist in a delicate equilibrium that slide up and down the scale of quality together.

    And please forgive the amount of bearing my comments may or may not have had on the original topic, it’s just how it ended up.

  • Andrew, if doctors could decide what information to collect, you would be right. But 80% of the chart is to meet billing and compliance requirements that do nothing to enhance care. The parts that do enhance care, namely a well-written narrative, are being destroyed by computerized templates. And the reason we need templates is because computers slow us down.

    Doctors want to take care of patients and document this well. These are not mutually exclusive. Both tasks have been undermined by computers.

  • Also, I would add that physicians do not fear change. I have learned entirely new ways of intubating critically ill patients as technology has advanced. And my colleagues and I happily make these sorts of adjustments. What we don’t like is taking a step backwards and using technology that meets someone else’s objectives and not our own.

  • Resistance to change is not the fuel driving EHRs, government regulations is that fuel.

    Prior to the GOV stepping in, demand for an EHR was anemic at best.

    What you are clarifying is newer/younger docs who have been in a college or hospital environment their entire career – and have probably only worked on an EHR – are more apt to want an EHR as that is “all they know”.

    I guarantee, if an EHR actually improved operations, docs would have gone to them years ago.

  • Andrew,
    Brian described well the real reason why doctors generally hate charting: billing requirements. Most doctors realize that charting is part of their job, but when you see the mass of generally useless charting they have to do for billing, then you become more sympathetic to why most dread charting.

    Brian,
    I disagree. Humans fear change and last I checked doctors are human. Certainly when you can change to something that provides a transparent benefit then it makes the change a much more pleasant experience, but even when we know it’s the right thing to do change is hard. Of course, not all change is created equal, so the distaste for change does have varying degrees.

  • Resistance to change is a reason for resistance to EMRs, but it is certainly not the primary reason.

    Surescripts reported that e-prescribing now accounts for well over a third of all prescriptions, and is being used by almost 60% of physicians. It’s a big change, it slows things down dramatically, and it’s inconvenient. But doctors adopted it because they perceive that it improves their patient care. Laparoscopic surgery turned the entire field of surgery on its head but the movement into it was very rapid, because doctors saw that pt outcomes were improved dramatically.

    Doctors see no benefits to the patient from EMRs. I work to support the EMR at a small hospital, and I have a very difficult time coming up with any bright spots to its use. The problem solution/engenderment ratio is about 1:1, and productivity is severely hampered. In small and underutilized large hospitals, they have the luxury of the time to absorb the productivity loss. In the very busiest hospitals, we’re seeing the quality decline, although it remains to be seen whether EMRs are included among the culprits.

    An EMR designed by a doctor for a doctor would be a dramatically different creature than the bloated heaps of steaming excrement on the market today, and that difference has much to do with the resistance among physicians.

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