Saturday, May 25, 2013
11.9.11 One of the most significant challenges facing physicians today is the adoption, or lack thereof, of Electronic Medical Record, or EMR, technology.
 
Despite potential incentives and penalties as dictated by the American Recovery and Reinvestment Act, or ARRA, which are dependent on a physician's willingness to use EMR technology, the medical community is still hesitant to adopt EMRs, according to a newly published study by Drs. Andrew Schwarz, Ph.D., and Colleen Schwarz, Ph.D. Both are professors at Louisiana State University’s E. J. Ourso College of Business and the Center for Computation and Technology. The report, a joint study between the Louisiana State Medical Society and LSU, is titled "Findings on the Non-Adoption of EMR Technology Among Physicians in Louisiana."

“There are a unique set of factors that explain why someone chooses to not adopt a technology that do not explain why they do,” said Andrew Schwarz.

“In our review of the current discourse over EMR, we saw an alarming trend – an attempt to blame the doctors. In our research, we call this ‘pro-innovation bias’ – blaming the individual not adopting the technology instead of taking a critical view of the technology itself. We wanted to uncover what was really going on with EMR from the perspective of the doctor, with our approach being physician-centric.

“We were often asked why two business professors would be interested in understanding the issues confronting the medical community,” Schwarz added. “We are interested because this represents an interesting business case. In the case of the medical community, we have a marketplace where the consumers of the EMR technology (i.e. the physicians) have little to no control over their pricing structure and are being forced to adopt a technology from vendors operating in a free market.”

In phase one of the study, the researchers conducted 15 face-to-face interviews with physicians across the state who had not adopted an EMR. They also interviewed four other physicians who were either users of EMRs or experts on the matter. From those interviews, they came up with 31 factors that were cited as reasons for the non-adoption of EMR technology.

Those led to phase two of the study, which was the development and distribution of a web-based survey that went to 3,324 members of the Louisiana State Medical Society. Twenty- one members opted out of the survey, leaving a sample population of 3,303 physicians. Eight hundred and sixty-six doctors began the survey, a 26.2% response rate, with 594 finishing for a 68.5% completion rate. Those 594 physicians were made up of practicing physicians, retired physicians and medical students/residents from across the state and representing a variety of specialties. Seventy-eight percent of the subjects were male and 22 percent were female. Racial diversity was also achieved with 78 percent of the respondents being white, 2.5 percent were African-American, 2.5 percent were Asian, 2 percent were Hispanic and the remainder indicated "other."
 
The respondents could be broken down into two main groups - adopters and non-adopters. Respondents were almost split evenly, with 50.4 percent being adopters and 49.6 percent being non-adopters.
 
Non-adopters of EMR technology had six over-arching concerns with EMRs:
 
  • Negative views of EMR technology
  • A lack of impact on their performance as a physician
  • Negative views of the EMR marketplace
  • Initial and long-term implementation concerns, i.e. cost and re-training
  • Institutional distrust, including distrust of the federal and state government and insurance companies 
  • Security and legal concerns

Adopters and non-adopters were differentiated based on several factors, including their views of EMR technology, views of EMR impacts, views of EMR vendors, initial and long-term implementation cost concerns, institutional distrust, security and legal concerns and incentives and penalties. Those same factors were used to analyze and compare physicians' views on EMR technology by six regions, which span Louisiana. Each region, it should be noted, had its own views on EMRs, leaving the researchers to conclude that overcoming physician resistance toward adoption will require a differentiated, regional strategy

Interestingly, adopters and non-adopters did agree on one section of the survey: institutional distrust.

Specifically, physicians have a high level of distrust toward the two entities involved in encouraging the adoption of EMR - HMOs and the government. Indeed, physicians do not trust how HMOs will penalize them for non-adoption of EMRs, how the HMOs will use the data, how the HMOs will use the EMR to monitor work practices, and they do not trust the motivations of the HMOs for encouraging adoption. The same can be said regarding their reasons for not trusting the federal government           

Physicians do not trust the government's motivations for requiring adoption of EMRs, how it will use the data, how it will use the EMRs to monitor work practices, and that the government will not alter the definition of "meaningful use of EMRs."

“It is clear to us that there is no national strategy for deploying EMR solutions,” said Schwarz. “This is a case of believing in the power of technology to solve problems that there is no way that it reasonably can. There is no demonstrable link between EMR deployments, meaningful use, and quality of care outcomes. Rather than taking our time and setting a national strategy, stimulus money and incentive pressure is being put on physicians to adopt questionable technology that is not proven to result in the outcomes that we hope to achieve.”

Time, said Colleen Schwarz, is another important factor in all of this.

“Physicians already feel stretched for time and they do not have the extra time necessary to devote to learning how to use the new system,” she said. “In addition, the non-adopter physicians expressed significant skepticism over the ability of the EMRs to improve the quality of their work or their decisions. Therefore, the physicians are reluctant to spend their extra time or money to invest in a technology when they are skeptical of its ability to improve the quality of their work or their communication with their patients.”

To view the entire report, visit www.lsms.org/EMRstudy. To view the entirety of Andrew Schwarz's remarks, click here. To view the entirety of Colleen Schwarz's comments, click here.

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