Do Physicians Show “Low Levels of Computer Literacy”?
One of my required courses for HIT is “Health Services and Information Systems.” This week, we’re going to be engaging in a discussion on “current trends in the development of health information systems.” Our professor introduced the subject with a question: “What is CPOE and why do you think it has become such a growing trend?”
For those who aren’t familiar with the acronym CPOE, it stands for “Computerized Physician Order Entry,” and claims to be able to reduce the incidence of serious medication errors by over 50%. This calls to mind similar claims made by the proponents of “Computerized Patient Records,” for example:
“Computerized patient record systems can help improve the quality of care provided, for example, by providing real-time patient status reports, test results as soon as they are available, and graphs and flowsheets of test trends. They can help reduce costs by eliminating many manual functions and the supply and staff expenses associated with these functions. Finally, they can provide practices the data necessary to attract and negotiate favorable managed care contracts.”
From: Computerized patient records benefit physician offices
Since the term “CPOE” isn’t mentioned anywhere in our text or lectures, I decided to Google it. I was able to come up with quite a bit of information. One particular web site, The Commonwealth Fund, which describes itself as “A private foundation working toward a high performance Health System.” had an article entitled: “Overcoming Barriers to CPOE.”
Following is how they described the “barriers:”
Barriers and Strategies to Overcome Them
Physician and organizational resistance was one of the top barriers cited in the interviews. Physicians seemed to believe that CPOE systems would create more work and that the traditional paper-based ordering method was faster. Some hospitals abandoned implementation plans, fearing that physician resistance could escalate to a point of “physician rebellion.” The interviewers also noted low levels of computer literacy among some physicians and a lack of user involvement in implementation processes. [...] (emphasis mine)
To their credit, after they proposed “Involving younger, computer-savvy physicians in the implementation process” as a stragegy to overcome the barriers, they also metioned cost, and the immaturity of the systems themselves.
An earlier article in “ACP Online” entitled “Doctors are the main barrier to computerizing records” states: “the primary barrier to adopting EMR technology [...] is physician resistance.”
I find this a bit odd, since most of the physicians I know are computer savvy, and some, like Dr. Bob, have even written their own EMR software … and Dr. Greg P. from Information is Free even builds/rebuilds his lap top!
So then, what’s the problem? Is it as The Commonwealth Fund intimates … that much of the resistance is due to older, technologically challenged physicians? I’m not sure I fully buy that. Without too much effort, I can think of three retired physicians who are computer savvy enough to blog: Dr. Hans Engel of “In a Doc’s Mind,” Dr. James Gaulte from Retired Doc’s Thoughts, and Dr. Maurice Bernstein from the Bioethics Discussion Blog. Perhaps these are rare individuals, but I’m certain that if I applied myself a bit, I wouldn’t be too hard put to find other such “rare individuals.”
So … what is it, really?
Sometime in the not too distant future, I hope to work on writing and implementing biomedical databases. Although many of my fellow students will probably settle comfortably into an HIT transcriptionist’s job, that’s not where I intend to go. I’d like to know why you would, or would not, choose to use electronic media, such as EMR’s and CPOE’s in your own practice. If you don’t use them now, what would cause you to consider upgrading? If you do use them, are you satisfied with them? Why or why not?
Your opinions and ideas will be passed on to my fellow students, and we can carry the information with us when we enter our respective Health Informatics fields. Who knows how far your voice could carry?
July 30th, 2006 at 4:42 pm
Yes many physicians “fear” computerized medical records. I work with a group of physicians that have fought the idea for several years. The change will happen! It is the only logical solution for excellant patient care. One of the physicians in the group is now on the planning committee since he states he is “computer challenged.” I think one thing the many reasons physicians don’t like is CHANGE. I personally think EMR is a wonderful idea and will improve patient care. (speaking as a nurse)
July 30th, 2006 at 6:29 pm
EHR’s in general are excellent, and when ramped up for the physician’s offices , are excellent laborsaving devices, but do add to the work flow if you are forced to scan in reports that no one will send to you electronically – say as word attachments to dedicated e-mail.
The bigger problem is in the adoption of computerized records for the hospital.
1. How many facilities will be willing to put in enough access sites where they are needed in volumes sufficient for peal physician work flow times? Not average, not median, but peak maximum. Anything less and its will not work. I know that no one likes to wait, but you will get NOWHERE if you tell them to have a seat and you can use the terminal in 15 minutes when one becomes available. Will.Not.Work.
2. If the system will not allow multiple screen interactions – if I cannot open an orders screen, lab screen and vital signs or summary data screen all at the same time – Will.Not.Work. If I can do it in the paper chart but not on the computer, then the computer introduces constraints that slows things down; and if I have to scribble data down in order to continue work – your system has just created a major ERROR source to my work flow, just the opposite of the vendor’s proud claims that only he can protect the public from the stupid physicians.
3. I concur with the fact that nurses like these systems, and I like the fact that they do, and have worked in several environments where I felt that the systems really allowed the nurses to do excellent bedside care with excellent documentation. I have not seen that for physicians unless you literally live in the facility – will drive primary care office practitioners out of the medical center – perhaps a sub rosa goal in many hospitals – but it will also aggravate further the very sub-specialists you coax, threaten and sue to keep brining their cases into your facility.
Lots of work to do until it can surpass the chart – access, component availability, cost.
July 30th, 2006 at 9:02 pm
Getting records into a computer system would be a LOT of work, I can see many many hours of scanning and/or typing, but once they’re in a computer format, it’d be great…
My own doctor has a computer terminal in every examining room, everything she diagnoses and prescribes goes into the computer instead of being written down. You can’t say she’s afraid of it, but then again, she may be either just about my age (40) or a little younger. I assume there’s specialized software for it, just like for any record-keeping. I’m all for it, but then, I’d rather type than write anyday.
July 30th, 2006 at 9:46 pm
Our office and hospital are looking into medical records. These are not new, but here are the reasons for push back in our small community…
1. Startup costs: HUGE up front costs just to purchase the hardware and software. Certainly a primary care office cannot afford this, and staff salaries, and staff health insurance, and rising liability costs, and other rising overhead costs. Offices have made their priorities and electronic records are not it at this point. The federal gov’t, in their infinite wisdom, has pointed the future to electronic records, but its just another one of their unfunded mandates. Finally, it’s kind of like the Betamax/VHS thing or the current Blue-Ray thing — what if you bet on the wrong horse, and your electronic records company goes bust in this competitve environment. Will you be able to convert your records to a new company, or start over from scratch?
2. Transition and Work Flow. Not all docs work the same (DUH). But, even in our office where we are the same specialty, every doc has his particular way of getting things done — still medically sound, but a different style. Transitioning from paper to electronic records can be a painful process, as I have heard from some of my colleagues. I’ve seen the studies on where electronic records will increase efficiency, but how long will it take to get there? One month? Six months? A year? Most docs cannot wait that long for results.
3. Medical errors. We probably all have heard of that infamous Institute of Medicine report in 1999 stating that about 98,000 people are killed every year by medical errors. During a transitional period, many more people may not be killed, but there is a potential for more medical errors. Again, I’ve heard all the electronic records sales people say that it will decrease errors, but again, how long will it take to get there? Any potential increase in liability will send docs running to the hills.
July 31st, 2006 at 9:47 am
Moof,
My office as well as hundreds of others as well as my three hospitals are all linked up by an EMR and CPOE. This has been going onfor 2-3 years now. I was a quick adaptor and am pretty efficient with our system. If I had the choice , however, I would drop it in a hot minute!
Conversion into an emr has been very difficult. Lots of important information from the medical record into the emr is lost becuase of sheer volume as well as the difficulty of archiving it in a way that is easily retrievable. It is also unacceptable to maintain both a written and computerized chart…malpractice nightmare!
CPOE also is a pain. Basically the EMR and CPOE have both allowed my medical gorup to get rid of multiple staff members and transefer menial labor from the lowest payed employee’s in the office to the highest paid (physicians).
I have adapted to our system pretty quickley and it hasn’t added any extra time to my day. However, 3 of the 6 physicians in my office feel that their work load has expanded by 1-2 hours a day and hasn’t improved over two years soley based on the emr and cpoe.
July 31st, 2006 at 1:43 pm
Wow, i wish there could be a combination of the computerized records and written records, but that may be more complicated in the end anyway…I guess theoretically I would think I’d prefer the computerized records but then, that would not address all of my concerns if extra documentation were required since it has to be condensed to be retrievable easily…wow.
I’ll have to learn more about the computerized methods. I’ve always thought I would prefer them, but maybe if I knew more I would not.
July 31st, 2006 at 7:45 pm
As an older physician, I think it’s a combination of discomfort with the unknown, and initial cost issues. Younger docs, I think, have less of a problem with EMR and other electronica. And the older docs I know that have been dragged kicking and screaming into the new age have ended up appreciating the efficiencies. In my clinic (over 200 docs, now) the records including lab and xray are all digitized, available in each docs office, at home, at the hospital. Many have PDAs from which they write prescriptions, etc. It’s a boon to efficiency, error reduction, improved and nearly instant access…
July 31st, 2006 at 8:55 pm
I should have added: thanks for visiting my blog, and thanks for your kind comments. I like this one, too. I’m just figuring out the details. I think blogspot is pretty nice, but I must say some of the lengths to which one has to go are annoying: posting my picture in my profile, for example. Having to use code — which I managed to figure out for my enlarging blogroll — seems trickier than it needs to be. You, judging not only by your posts but by the impressive complexities of your blog, are much more skilled than I.
August 1st, 2006 at 4:16 pm
As a patient, I kind of like seeing information going into a computer. I feel it will make my record more accessible to other providers that work with the hospital that the clinic is, literally, attached too. With the internet, in fact, I feel that it would make transfer of records instantaneous should I find myself injured or ill somewhere far away from my PCP.
Of course, the system isn’t standardized enough quite for that. But it is going to take years, perhaps even a generation of doctors uncomfortable with the system, huge start up fees, and even hazardous, perhaps deadly mistakes to occur for a standard electronic records system and network to coalesce.
Frankly, I’m surprised it has taken so long for it to get started. I think it would have actually been better for it to start back when computer databases and networks were new technology. The integration would have been slower, occuring only as the technology allowed it, more precise since the older technology didn’t allow for so much human generated complexity, and therefore less hazardous. Plus our doctors would be more comfortable with it by now.
I think things like writing pads with macros, rather than monitors and keyboards, will help in the office encounter and perhaps be more comfortable for the doctor as well.
August 3rd, 2006 at 4:03 pm
Very few hospitals are computerized here, Moof. Resistance to change, corruption, and lack of funds are the prime reasons.