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If anything has been learned from the introduction of desktop computers into schools since the early 1980s–yes, thirty years ag0–it is that increasing the access of students to machines, from 125 students per computer to currently less than 4:1 does not automatically lead to teachers and students using computers for instruction routinely. Access to an innovation, then, does not mean frequent teacher use in classrooms.
How come? The usual suspect is the teacher. Blaming teachers for infrequent use of electronic machines was common in the past when technological innovations were launched but is clearly foolish today when most teachers constantly use cell phones, laptops, and other hand-held devices at home.
Those hard-learned lessons of abundant access not leading to frequent classroom use and subsequent blame heaped on teachers also apply to the case of doctors and Electronic Health Records (EHR). Consider that under the Obama administration, economic stimulus funds included major funding for hospitals and physicians to convert hand-written charts into EHR (see posts of August 9, 2009 and December 11, 2009). The push for hospitals and doctors to use digital records comes with the promise that EHR will improve the quality of care, reduce errors in practice, and increase efficiency.
Not yet. A recent survey of the nation’s hospitals inquiring whether a version of EHR had been adopted reported an increase from 9 percent in 2008 to 12 percent in 2009. For physicians, 48 percent replied to another survey that they were using complete or partial EHR systems. However, when the federal government’s rigorous definition of “meaningful use” of EHR kicks in this year offering financial incentives to individual doctors, groups, and hospitals to digitize their records and use them daily in their practice, the percentages of use will drop as swiftly as a roller-coaster dip.
Beyond the simple fact that vendors, not doctors, have designed Information Technology (IT) systems that are incredibly complicated (see patient chart above), the rush to adopt EHR to be eligible for federal funds has created some Rube Goldberg responses. Consider the use of scribes as tech support for doctors in hospitals.
Scribes are non-medical staff who use laptops to enter what the doctor has done in taking a patient’s history, making a diagnosis, and prescribing treatment. Yes, another person in the room who clicks away on the laptop recording notes that the doctor later reviews. Why? Doctors were spending too much time on the computer documenting what they heard and did. Solution? “…take the doctors off the computer, put them at the bedside, and let the scribe do the transcription….The physicians love it,” said the chief of a hospital emergency room.
For many doctors, IT-designed digital record-keeping is a Rube Goldberg designed system.
Professor Butt's Self-Operating Napkin
When many doctors raise questions about EHR’s efficiency, cost, and their loss of productivity they do so because there are genuine issues that vendors who design and market proprietary EHR systems have overlooked, neglected, or just stumbled. See here. Consider that few software designers allow for differences in cultures between IT and medical practice. Or few IT designers and physicians collaborate in design of software. Yet doctors get blamed. The title of an Atlantic article on physicians and IT says it all: “Paging Dr. Luddite: Information Technology Is on the Brink of Revolutionizing Health Care–If Physicians Will Only Let It.”
Blaming doctors and teachers, of course, is as American as waiting in line overnight to buy the newest high-tech gadget. How come people who enter their jobs dedicated to serving others get blamed for “resisting” IT? I can think of a few reasons and readers can supply others. Here are mine.
1.Because technology is highly prized in this culture, any roll-out of an innovative hardware or software product raises expectations that once in the hands of doctors and teachers, patients and students will be better off. Such magical thinking inexorably leads to disappointment that abundant access has not led to regular use. Grand hopes dissolve into blaming doctors and teachers for “resisting” the inevitable.
2. Daily practice for doctors and teachers is complex especially in the core relationship of trust and respect between doctor/patient and teacher/student. Without a focus on building and sustaining those relationships–efficiency via 15 minute doctor appointments and online instruction–will come to dominate medical and school practice. Thus, the pushback from teachers and doctors.
3. IT designers of software systems for EHR and developers of educational applications seldom examine the usability of the software by those who actually do the daily work. See Guide_Final_Publication_Version. Developers are driven by different values and often don’t get the complexity of what these professional do daily.
Those reasons help me explain why doctors and teachers get blamed for underuse of high tech devices. Yours?
Related Articles
- Why EHRs aren’t meaningful to doctors and hospitals (kevinmd.com)
- Slow Going For The Electronic Health Records Movement (zocdoc.com)
Larry Cuban on School Reform and Classroom Practice 
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Fear and uneasiness with technology. As a 45 year old parent with an elementary age child I am witnessing these reasons. My child’s older (middle-age) teachers, with whom I can relate when it comes to technology, have a lot more resistance to use technology, not all, but a majority do, on the other hand, younger teachers (35 and younger) seem to be accepting technology more easily. Unfortunately, how much technology gets to be used seems to also have to do with the district’s leadership and their knowledge, or lack of, of technology.
Nicely said Larry.
Technology is an individual tool to make one’s life easier. If the technology does not make a person’s life easier, it is bad technology (at least for that person).
IT departments, venders, and software/app creators make things that either a) make their life easier, or b) they assume is what the customer would use. There is a disconnect between what is needed/wanted and what is produced, and then WHY it is produced.
Many tools for doctors and teachers make the work of someone else easier. We become data entry points for someone else, usually the people in decision-making positions who are disconnected from the “patient/student.”
It does not make one’s work easier, more efficient, or more effective when venders are not speaking with the practitioners of the profession. Then when we choose not to use their tools, their feelings get hurt, their profits decrease, and they blame instead of improve. Teachers and doctors could help if they knew what they needed, and the blame to place on them may be that we are better at knowing what we DON’T want rather than what we DO want.
I like Ric’s point about technology making someone else’s life easier. It pays into understanding being centered. I was going to apologize for going off topic, but this remark brings my comments into several points of congruence, so here goes: Let’s stay with docs in the ER, since they are emotion neutral here in Ed Land.
The most important thing is the delivery of care to the patient in the ER so we can ensure his or her survival. Communication among the medical team and building a record of what is happening begins with watching or seeing, then proceeds to the spoken word. If the team disperses and returns, a written record is useful. Possibly the most useful record is a scrap of paper pinned to the patient.
Why? Ease of viewing, high contrast, simultaneous realtime view of subject and notes, ease of alteration, and it prevents you from taking germs with you to the next patient. It’s simple and efficient. You think I’m kidding? Our current display technology is located squarely in the 1800s.
Granted, the social nature of computing can help if the team needs to be bigger (consultation) and display of graphics can help the team understand diagnostics. But the fact is, hospital IT grew out of the need to collect money. The heritage of the hospital IT structure is not well adapted to the mission of the organization. (Exception is MUMPS – now WorldVista – the VA Hospital system. If you are interested, I can put you in touch with a co-founder near you.)
Mine is a limited view and not realistic since everybody has to be able to follow multiple missions and there are individual interests as well. However, if you examine successful enterprises, you hear failure stories about “forgetting the core mission”.
In some ways, the social narrative of education reform is about returning schools to their core mission. That’s to the advantage of the reform movement because it is evocative of business reform’s “consultant radio”. On the other hand, education has to balance the real-life demands of multiple missions.
Misunderstanding/misusing the nature of technology is a characteristic of education. Consequently, effectiveness varies from awesome, to mildly interesting, but often “bad for everybody involved” is as good a description as any.
Based on what I’ve seen, I think the largest issue is wrapped in your third point, but goes beyond it. It’s not just that technologists don’t consult with the end users on the usability of the software/hardware. It’s that they’re not designing the product’s core feature set with explicit feedback and input from the end user.
It’s like trying to design a keyboard without knowing how many letters there are in an alphabet – you end up with cases that aren’t based on reality. And that pattern shows up in all kinds of places, not just in edtech and medical tech. Remember Microsoft Vista?
Another problem is due to massive budget cuts…lack of technical support. Teachers are provided with technology and expected to integrate it into their instruction but not taught how to use it or provided technical support when it doesn’t work. There is little more frustrating than having technology and not knowing how to use it or having technology, knowing how to use it, integrating it into your instruction and then having to wait for weeks or months to get it fixed when something goes wrong.
“Here are student responders. You are expected to have students using them daily so that you can engage all students and analyze the data. However, when the batteries run out, you’ll either have to replace them yourself or stop using them because there’s no money for batteries.”
True story.
Depending on the district, cutbacks have certainly hurt school-site technical support. Yet hardware purchases continues to be approved by school boards. On the clicker story, Lea, all I can say is Ugh!
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David,
Thanks for including my post on reasons for teachers and doctors under-using IT. I thought the the other reasons–internal to IT projects within an organization–you gave were on the money.