In response to a reader's comments on David Burda's "Reporter's notebook: EHRs put some docs on edge":
I do not disagree that physician's attitudes and participation with the entire electronic medical-record system adoption process could be improved, and I have witnessed recent gains in that regard. Because dollars were mentioned by a fellow reader, I would like to highlight a few points about the economic model that many private physicians fall under in comparison with hospital nurses because it's not as black and white as it may seem.
Unlike the majority of the nurses who are involved in a hospital's EMR system training and get paid for their time, physicians do not get paid for their time. But it's not just the physician's time that one has to consider, but their office staff as well. The physician office is a production setting and his or her staff expect to get paid, as well as the mortgage/rent and utilities. If they are not seeing patients, then it's not only that the physician isn't get paid for his or her time to go and get training for the EMR system, but it becomes a direct expense that physicians themselves must pay to not be in the production mode. In other words, because of soft costs and overheadit's not free to them. Having been involved in automating clinical work flow over the past 15 years, I have yet to see any physicians use these facts as a barrier to not participate, and most agree that they and their patients will benefit by their involvement in the EMR training. Mostly, it's about timing, convenience and methods.
Generally speaking, the majority of hospital nurses practice at one organization, while private physicians may practice at many facilities and have to learn to use multiple EMRs. As for them not showing up for the training, one of my physician friends pointed out that there is a fair amount of unpredictability in their schedules: the 15-minute appointment that turns into an hour-long appointment or the established patient who just showed up to the emergency department.
Coming from the old school that "if you oppose, then you need to propose" philosophy, I would like to see all involved help create solutions to meet the needs all around. These are adults and many of the training methods involved do not necessarily adopt the adult learning model well. Then there is the socio-cultural barriers to address as well.
In sum, there are costs, barriers and benefits. For organizations to be successful, they must address all of these. Not all physicians are dialed into the WIIFM (what's in it for me) radio station and many do the right thing. Just as with nursing, let's not let a few bad ones spoil the lot. A good, sound communication and marketing campaign can go a long way by celebrating the ones that participate by having them articulate the benefits they've gained. Peer pressure accomplishes amazing things.
Laurie Gehrt, R.N.Kansas City, Mo. To submit a letter to YOUR VIEWS, click here. Please include your name, title and hometown.