The carrot works better than the stick for community hospitals trying to get doctors to go from the notepad to the computer, according to a new report by the California HealthCare Foundation and First Consulting Group.
The study, scheduled for release this week and obtained by Modern Healthcare, compiled information from interviews with 10 community hospitals that have made major strides in computerizing their physician order-entry process. Until now, most research focused on efforts by academic medical centers, although they make up only 11% of U.S. hospitals.
Nearly all of the study's participants agreed that involving doctors early in the design process and providing thorough training, technical support and evidence of the system's advantages were key to overcoming physician resistance to the technology.
"By and large, they used collaboration, assistance and encouragement-and a little prodding-rather than direct mandates," said Jane Metzger, research director for First Consulting, Long Beach, Calif.
Indeed, hospitals that have pushed too hard have run into trouble. Cedars-Sinai Medical Center, Los Angeles, aborted its rollout of a multimillion-dollar order-entry system in January after 400 doctors complained the technology was too difficult and time-consuming to use (Jan. 27, p. 12). The 870-bed academic medical center had required all of its 1,800 physicians to prove they could use the system by Oct. 22, 2002. If they couldn't, their medical privileges were suspended.
Staying in doctors' good graces is all the more important for community hospitals, which have "looser" relationships with physicians than academic medical centers. Unlike large teaching facilities, where residents write most of the medical orders, community hospitals are staffed by doctors who aren't employed by the facility, have their own private practices, and often admit patients to competing healthcare systems.
"There's the added risk that community physicians who aren't happy will take their business elsewhere," said Jennifer Eames, project officer for the California HealthCare Foundation, Oakland, Calif.
Hospitals have been under increasing pressure to convert to electronic information systems since 1999, when the Institute of Medicine reported that up to 98,000 patients die each year from preventable medical errors. Even so, the study's participants largely resisted demanding immediate physician adoption.
"Being in a competitive environment, we decided it wasn't worth it to draw a line in the sand," said Donald Levick, physician liaison for information services at 575-bed Lehigh Valley Hospital, Allentown, Pa.