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.
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?
- Why EHRs aren’t meaningful to doctors and hospitals (kevinmd.com)
- Slow Going For The Electronic Health Records Movement (zocdoc.com)