Gawande and Bates, in their series just published in MedGenMed, provide an excellent summary of the promise and state-of-the-art of doctors and computers.[1,2,3] However, in their attribution of the effect of the physician's full and hectic schedule upon technology adoption, they do not pay sufficient attention to several critical factors responsible for the slow adoption of computers and the Internet by this group, nor do they focus on 2 very critical factors that will ultimately ensure widespread adoption of electronic medical records (EMRs).
The "unmentioned" factors resulting in very slow or, in some cases, nonadoption of these technologies are:
Many physicians 35+ years old do not know how to use computers and often do not even know how to type;
A significant amount of time is required to learn how to use new computer programs (even programs like Microsoft Word, which seems elemental to those of us who have been using it for a while, but daunting to those who have no experience with it at all!);
Most systems (EMRs) do not yet hold out the promise that they will in fact reduce the amount of time spent "charting" by the physician, nor reduce or simplify their work flow.
Understanding this, one is then left to ask, what is the inducement for the physician to adopt new technology? Further complicating this discussion is the question, "Is the physician the 'prototypical guy'"...ie, will he/she be able to even "ask for directions"?
Before answering that last question, I would like to review an example of another, less complicated and successful adoption of an older "new technology issue": the advent of the "dictation via phone" systems in the mid-70s. The adoption of this technology, intended to replace the "writing by hand" of admission, preop, operative and discharge notes, allowed the physician to simply pick up the phone, dial a number, and then use different numbers on the keypad as prompts to "go back, listen, erase, and continue." Resistance to this as new technology was easily overcome after it was quickly demonstrated that it would "save time," as it was faster than sitting and writing and/or having to rewrite notes. The fact that the physician was used to already "thinking" in a particular order (ie, chief complaint, pertinent history, physical exam, diagnostic considerations, orders, etc) made the adoption of this technology much easier, as alluded to by Gawande and Bates in their discussion on variables that impact technology adoption.
The other issue, that most physicians 35+ years old have poor typing skills and are computer illiterate and therefore challenged by technical systems, forces us to appreciate what is required to achieve technology adoption: considerable instruction and time. The physician's incredibly hectic schedule and demands on his/her time has, in large measure, accounted for this failure of adoption of new technology.
For many of us, the wonder of the Internet did not become apparent until we observed our children surfing and finding an assortment of intriguing and fascinating sites that not only helped them in their schoolwork but also enabled them to win arguments with us! How many of us finally "got it" by sitting next to our kids, marveling at what they were doing and asking, "Hey, can you show me how to do that?"
In addition to this "offspring" (no relationship to the new rock group)-related phenomena, there are 2 important factors that this writer believes will ultimately make the difference in the speed of technology adoption and utilization of EMRs and the Internet by the entire medical community.
The first, for the 35+ crowd, is the advent of voice recognition systems that will enable physicians to "talk" their notes into an EMR system, which will remove the "keyboard barrier." Some of these systems are already in use in ERs. This is not to say that there aren't a lot of 35+ physicians who are already very sophisticated at using computers extremely well, but this technology will also, along with increased computing speed, demonstrate a decrease in work flow and represent actual time saved! The Holy Grail for EMRs!
The second critical factor is that of the natural evolution due to "rising" medical students, fellows, and residents. They have grown up using desktops, laptops, and the Internet. For the most part, they are already comfortable using hospital-based EMRs and even skilled at using Palm Pilots and cruising the Internet and impressing attending staffs at the bedside.
What does this mean? It means the promise of the Internet and computer technology described so well by Gawande and Bates in their series is at hand!
© 2000 Medscape
Cite this: Understanding Adoption of New Technologies by Physicians - Medscape - Feb 07, 2000.