Why Do Physicians Resist Health IT?

Published November 1, 2008

Perceived government meddling and privacy concerns—not money—are the top reasons for physician resistance to adoption of interoperable health information technology, according to the results of a survey conducted by the Association of American Physicians and Surgeons (AAPS).

The study documents various areas of “physician resistance” in solo and small group medical practices.

“A survey of this vital segment of the provider population is key to understanding why implementation of health information technology (HIT) has progressed at a much slower rate than predicted by the industry,” said Kathryn Serkes, president of Square One Media and author of the study. “Those types of private practices account for 79 percent of all office-based practices, and usually serve as the entry point for patients into the medical system.”

Conventional Wisdom Contradicted

The 430 respondents to the AAPS survey, mailed in April 2008 and published in September, directly contradict an ongoing Massachusetts General Hospital/Harvard study begun in 2005.

According to the latter, the number one barrier to HIT is “lack of capital,” followed by difficulty finding a system meeting their needs and uncertainty of return on investment. Doctors were given only four other choices, including general “physician resistance,” which ranked lowest.

“The catch-all ‘physician resistance’ didn’t give us enough useful information, so we included the original questions, but expanded the choices,” said Serkes. “This survey tapped sources of frustration that couldn’t be documented in previous studies.”

According to the new survey, the largest barrier to HIT adoption is “concern about government mandates,” at 78 percent, followed closely by “concern about link to centralized government medical records” at 77 percent. Money is the third concern, followed by a tie between patient privacy protections and government or insurance company interference in clinical decision-making.

Concerned About Autonomy

Almost three-quarters of doctors say they prefer their personal clinical notes over computer-based data entry and filing systems, and 60 percent of those who have installed electronic health records continue to keep paper records.

“The comments are clear—computerized boilerplates simply cannot replace clinical reasoning and the doctor’s own notes,” Serkes said. “In the long run, dual records will wipe out a substantial amount of the projected administrative savings.”

When asked what would be the greatest incentive for adoption, doctors overwhelmingly said HIT systems should not be linked to pay-for-performance or evidence-based medicine mandates.

“Electronic Health Records are designed for outside groups to monitor what is going on in a clinical encounter,” wrote one responding doctor. “Its adoption by my network has been one of the saddest events of my medical practice.”

“The insurance companies benefit the most from the control they can exert with embedded clinical decision support. Patients and doctors who are asked to give up the most get the least from the system,” wrote another.

Proceeding Despite Concerns

“Conventional wisdom has blamed doctors as the laggards when it comes to implementing system-wide health information technology,” said Serkes. “However, this survey shows that the AAPS member adoption rate is 19 percent, well above the 13 percent national average for office-based physicians.”

Serkes notes doctors are concerned about possible intrusions into their decision-making. “[Doctors] have legitimate concerns about the impact of an all-seeing, all-knowing national health information system and computerized decision-making infrastructure,” she said.

A common theme of the comments was that electronic health records interfere with the clinical process. “I would love a system whose only purpose was to increase our efficiency. But I have no doubt the systems will be subverted to reduce payments and increase control over our practices,” wrote one doctor.

Others wrote, “They basically are empty of important clinical data and full of useless recipe lists” and “It greatly increased my charting time and took away from face-to-face patient contact.”

Costly Problems

Estimates of implementation start-up costs range from $30,000 to $50,000 for each physician, but doctors report the financial impact has been much greater, sometimes upwards of $250,000 plus loss of revenues from down time.

“The time for hospital rounds has tripled” and “I see fewer patients because of time on the computer,” were representative comments on the subject.

Serkes said the survey should be an alert to policymakers and lawmakers.

“Doctors’ concerns must be addressed,” Serkes said. “Throwing grants and other financial incentives at the problem won’t push HIT to the tipping point. Patient privacy and physician autonomy must be guaranteed if they want doctors on board.”

Katie Flanigan ([email protected]) writes from Georgia.

For more information …

“Physician Attitudes & Adoption of Health Information Technology,” The Association of American Physicians and Surgeons, September 2008: http://www.aapsonline.org/surveys/hitsurveyresults.pdf

“Electronic Medical Record Use by Office-Based Physicians: United States, 2005,” National Center for Health Statistics, August 2006:

“A National Survey of the Electronic Health Record Adoption in the United States,” Massachusetts General Hospital’s Institute for Health Policy, January 22, 2008: http://www.hhs.gov/healthit/documents/m20080115/04-blumenthal.html