“Think of what you spend when you get a home computer,” he says. “Say you spend $1,000 for the PC itself. Then you have to buy software, Internet access, a printer, and other accessories. Then you have to take the time to learn to use it all. Consider everything you spend in five years, and that $1,000 is a drop in the bucket.”
Dr. Zielzinski emphasizes that it’s not just the money that keeps hospitalists and other physicians from using e-prescribing. “Physicians have an intrinsic sociological resistance to change. After all, they are accustomed to evidence-based care and they are expected to have evidence to back up their decisions and actions,” he says, adding that “it takes a new clinical technique, theory, or practice an average of 17 years to get into mainstream practice. So how can we expect to accept new technology just like that?”
I’m part of an eight-hospitalist team, and we could use an e-prescribing system that our medical group has deployed, but we don’t. To use e-prescribing would require an extra step of work for us. We already have to dictate discharge notes and handwrite prescriptions. We don’t have the ability to substitute e-prescribing; it would just be an additional tool—and an additional step that would slow down our discharges.
—Philip Strong, MD
Practical Protests: When Systems Hinder Efficiency
Another barrier to hospitalist acceptance of e-prescribing and other technology is that it sometimes takes longer to use, especially at the beginning.
“I’m part of an eight-hospitalist team, and we could use an e-prescribing system that our medical group has deployed, but we don’t,” admits Dr. Strong. “To use e-prescribing would require an extra step of work for us. We already have to dictate discharge notes and handwrite prescriptions. We don’t have the ability to substitute e-prescribing; it would just be an additional tool—and an additional step that would slow down our discharges.”
Dr. Newman agrees that physicians won’t use time-consuming technology. “Many systems take a lot of time to learn to use efficiently and effectively,” he says. “Physicians are afraid that these systems, such as e-prescribing, will slow them down and hurt their efficiency.”
He says hospitals are concerned about this and are waiting to implement systems they know physicians will use.
Eric Reines, MD, vice president of North Suburban Hospitalists PC and a hospitalist at Beverly Hospital, confesses to being a techie who enjoys this stuff. He says, however, that “most of the e-prescribing systems I’ve seen have been very poor. I like technology, but I won’t use a clunky system.”
Ease of use is essential for hospitalist acceptance of e-prescribing systems. “You can’t have a system with boxes popping up all over the screen and small black and white type that you can’t read,” says Dr. Reines. “Hospitalists and other physicians just won’t use these.”
Implementing systems that physicians don’t like is a worry that IT developers at hospitals think about about continually, confesses Dr. Zielzinski. “The biggest thing that keeps me awake at night is worrying that physicians will say, ‘This takes too long,’ ” he says, emphasizing that it’s important to educate physicians about how to use systems to make the most of their features and maximize efficiency.
While hospitals are concerned about how physicians will react to the implementation of technology, physicians’ general resistance to using e-prescribing actually could be a boon for hospitalists.
“Attending physicians aren’t likely to leave hospitals because they are required to use e-prescribing or other technology, but they might be more inclined to turn patients over to hospitalists at these facilities so that they don’t have to use these systems,” says Dr. Newman.