Cognitive Dissonance and EMRs

A new CDC study has documented what’s pretty much old news to us EMR watchers, that more than half of U.S. doctors have taken their charts digital. The study also concluded that most are pretty happy with their EMR, heaven help us, and that it’s improved patient care.

According to a study by the CDC’s National Center for Health Statistics, 55 percent of U.S. doctors have adopted some type of EMR.  More interestingly, for folks like me at least, 75 percent of those who have have met Meaningful Use Stage 1 criteria, something I might not have predicted if I hadn’t read the study.

This seems a bit strange to me, honestly. I’ve talked to countless doctors about their EMRs, both hospital- and practice-based, and I’ve only met a couple who actually felt satisfied with the system(s) they use. I haven’t met any that felt the systems have improved patient care, though I admit my sample isn’t drawn scientifically. (Vendors, I’m not saying that *nobody’s* happy, just that these numbers sound high, to be clear.)

The best explanation I can come up with for such results, which came from 3,200 doctors completing a mail-in survey, is the impact of cognitive dissonance.  Let me explain.

Doctors are being  pressured with thumb screws to make the switch, and it’s hardly surprising that most have come around.  So they’ve gone ahead and spent what in some cases are huge sums of money to make the leap.

The thing is, when you’re forced to use something every day, you can’t just keep on hating it more and more. Nobody has that much energy.  So over time, you resolve the cognitive dissonance — the battling “EMR painful” and “EMR necessary” thoughts — by learning to love Big Brother EMR, or at least believe that you do.

Then again, though I’d have trouble believing this, maybe there’s hordes of satisfied doctors that never come to the attention of a cynic like me. What do you think?

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • I think the reason that this NCHS report doesn’t jibe with your personal observations is not in the head of the respondents.

    The report, which appears to be based on a carefully developed statistical basis, omits a series of critical numbers. It doesn’t say how many practices by type that it includes. For example, only 29 percent of solo practitioners have an EMR. However, we aren’t told what percent of the sample they comprise. Similarly, the category of practitioners in a large setting also has the greatest percentage of EMRs.

    Until the proportion of each class of practitioners in the sample is known, it will be difficult to know how EMR adoption is going.

  • To clarify, I believe that the study found that of the 55% of the physicians who have adopted “some type of EMR”, it is 75% of the EMRs that meet the meaningful use Stage 1 (certification) criteria, not 75% of the physicians. According to the government’s statistics, as of May, 58,530 physicians (approximately 12% of eligible professionals) have earned an EHR incentive by successfully demonstrating meaningful use. (See CMS website, Data and Reports section.)

  • What I find most interesting about the studies on EHR is that “satisfaction” and “earned incentive” by demonstrating MU, don’t mean actual benefit, i.e., improved patient outcomes, or quality. When we can start to show this, on a larger, cross-platform (vendor) scale, then we may see some change in attitudes around adoption. As a researcher I see some incredible value in the data driven aspect – but as a practitioner, I don’t know that EHR helps in actual care.

  • Daniel,
    That’s a very interesting comment. Do you really think that improved patient outcomes or quality is why most physicians are still using paper and not EHR? I know it’s a little different way of looking at it, but I’m not sure that EHR will ever show measurable improvement in patient outcomes that will push EHR adoption. Or at least I believe we’ll have EHR adoption well before we see the measurable improvements in outcomes and quality.

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