Archive for January 2011

Why have physicians been so slow to adopt electronic health/medical records!

January 24, 2011

The role of medical culture, practices and social structure in the process of adoption of medical computer applications helps explain the differences in adoption between medical computer applications. It has been argued that physicians’ acceptance of technology has to do more with physicians’ cultural values such as quality of patient care, medicine as an art, personal relationship to the patient and professional autonomy. On the other hand, computer infringe on their roles as chief architect of a patient’s management and physicians consider themselves as autonomous, responsible, and self governing, believing that no one but other physicians are competent to judge their actions. Technologies rooted in practical applications that do not disrupt nor change the medical practice (CT scanning, MRI, patient monitoring, and laboratory systems) are readily accepted, while technologies that could change the physicians’ role and work (electronic health/medical record-EHR) are not accepted and are even sabotaged.

Bria and Rydell argue that how slow the physician-computer connection has occurred in the U.S. has to do with the great emphasis placed in the technology itself and the failure of system implementation by and for health care providers, physicians in particular. Shortliffe, I would argue, is more critical in asserting, “Despite thirty years of information technology innovation in health care, the technology has never been embraced, especially when information technology requires direct use by busy clinicians”. Stinson pointedly asserts, “no amount of incentive short of a double-digit percentage figure is going to aid in convincing those practices that are uninitiated to join the ranks of EHR implementers.”

The fact is that sociological, cultural, and financial issues have as much to do with the success or failure of a system as do technological aspects because information technologies (IT) are embedded within a complex social and organizational context. It is amazing that roughly 75% of all large health information technology (HIT) fails basically due to inattention to the problems associated with the introduction of computer technology into complex work environments. There are many unintended and undesired consequences of HIT that flow from interactions between the HIT and the health care organization’s socio-technical system- its workflow, culture, social interactions and technologies. More amazing is that these socio-technical interactions have been richly documented in the literature but, unfortunately, many IT users and even IT specialists, are unfamiliar with these or its practical implications. As technology continues its impact on health care, the adoption of EHRs will depend on the impact of the contextual variables identified.

I would argue that the cultural aspects of the physicians’ milieu are not usually identified as such and not many specific solutions or incentives are presented from that particular perspective.  Cultural factors can be seen as a qualifier to argue for or against adopting the EHRs. If we could identify cultural factors that influence physicians positively in adopting EHRs, then specific strategies to incentivize physicians could be explored, while factors that could have a negative effect could be modified or minimized. On the other hand, if these factors are not considered it is possible that some of the incentives proposed, or already implemented, might not be effective or could even be counterproductive.

A word of caution, although it is important to be curious about the values and attributes of a particular cultural group, there is an inherent risk of generalizing these values and attributes to everyone who shares aspects of that culture. This sort of stereotyping should be avoided.

So the question remains: If the EHR is generally accepted as a tool that can positively affect health care, why then have physicians been so slow to adopt them?

In this blog I would like to engage the community of health care professionals, physicians in particular, in identifying cultural factors that might impact the adoption of EHR by physicians and strategies to affect these.


1. Kaplan, B. The Medical Computing “Lag”: Perceptions of Barriers to the Application of Computers to Medicine. Intl. Journal of Technology Assessment in Health Care. 1987, 3:123-136

2. Kaplan, B., The influence of Medical Values and Practices on Medical Computer Applications. In: James G. Anderson and Stephen J. Jay, eds. Use and Impact of Computers in Clinical Medicine. NY:Springer; 1987:39-50

3. Randeree, E., Exploring Physician Adoption of EMRs: A Multi-Case Analysis. J Med Syst. 2007, 31:489–496

4. Bria, WF., Rydell, R. The Physician Conundrum: Get Over it! HIMSS; 2004

5. Shortliffe, EH., Strategic Action in Health Information Technology: Why The obvius Has Taken So Long.  Health Affairs.2005;24(5):1222-1233

6. Stinson, P. The PQRI Catch 22. Health Management and Technology. Nelson Publishing; Oct 2007:42-44