Technology has become an increasingly important part of our daily lives. Ever since the advent of the first programmable computer, attributed to Konrad Zuse in 1936, some have cheered its progress while others struggle with the changes. Regardless of whether you are an avid technology enthusiast or avoid computers as much as possible, the impact is undeniable and growing. Despite its prevalence in our daily lives, computer utilization in healthcare has not met expectations and has lagged behind other industries. Finance, insurance, and real estate historically have been leaders in computer integration, with 81.4 percent usage in 2002.1
Adoption in healthcare settings has been traditionally lower, with less than 10 percent of physicians using an EMR (Electronic Medical Record) in 2006.2
However, there has been much effort promulgating the benefits of computers in healthcare settings. A more recent survey shows that as many as 40 percent of physicians use at least some EMR functionality. While this may seem like a substantial improvement, the same survey shows that only 4 percent use the full EMR functionality and about 17-20 percent use a minimal amount with the rest only using them occasionally.3
Although it may seem that they are being recalcitrant, physicians often are early adopters and users of technology — provided they find it of value. A recent study shows that physicians have tripled the amount of time they spend online since 2002, now averaging about 8 hours per week.4
A 2007 survey of industrial, technical and manufacturing professionals stated that they spend approximately three hours per week online5— substantially less than medical professionals.
While recent studies are encouraging, physicians still are not taking full advantage of existing technology. Rather than simply demand that all physicians fully adopt and utilize EMRs, a better course is determining the reasons for their resistance and finding solutions. Fortunately, there has been significant progress in our understanding of the impact of technology, not only on healthcare, but on complex organizations. This article will review the track record of implementing enterprise systems in complex organizations, touch on some of the benefits and problems of implementing healthcare technology, and outline current thoughts to minimize the problems and maximize the benefits of adopting enterprise level systems.
IT Implementation Track Record
Beginning with a series of important studies, we’ve learned a great deal about the failure rate of enterprise resource planning (ERP) systems. In a survey of 231 organizations, including financial, government, and healthcare organizations, key findings included that after implementation of the ERP, 51 percent of respondents felt that the implementation was a failure. Furthermore, 46 percent of those with a successfully implemented system felt that their organization was not effectively using the system, or that there was no benefit in improving how the organization did business.6
A 2001 survey of 117 companies that attempted an ERP implementation found that over 40 percent felt the effort was an outright failure and an additional 8 percent were very unhappy with the results.7 A larger survey of 365 companies revealed that 31.1 percent of projects were cancelled before completion and 52.7 percent of projects cost 189 percent of initial projections.8
After these results were published, there was an explosion of effort to understanding why the failure rate was so unacceptably high. These efforts included the Bull Survey which found that the major causes contributing to failure were missed deadlines (75 percent), exceeded budgets (55 percent), and poor communication (41 percent).9
A more recent study revealed that vendors often don’t understand how a healthcare organization’s work flows. Researchers determined that this cause contributed significantly to over 30 percent of failed implementations.10
As a result, much more attention now is given to good communication, clear milestones, business process redesign, and change management.
Many articles have been written discussing the potential benefits of computers in healthcare. A simple search on Google revealed over a half-million articles. The authors typically cited benefits including decreased chart pulls, improved efficiencies, reduced transcription costs, improved coding, better billing, improved quality through point-of-care decision support and decreased order errors, remote access, guideline incorporation, less “chart chasing” and better regulatory compliance, among others. While many of these benefits are quite possible, they are dependent upon acceptance by physicians, successful and comprehensive integration of the technology into the complex organization, commitment by the organization, and continued support and effort by the vendor.
Physicians expect technology to make their lives easier and allow them to perform their jobs faster. While some available systems may allow physicians to ultimately perform their jobs better, the improvements may come at a cost of decreased convenience, increased complexity, and significantly more time spent to perform the same duties. Given the increased pressure on time and reimbursement rates, physicians find these negative effects difficult to accept, particularly in dialysis. Physicians demand that technology at least be “time neutral” to them. They point out that if it takes just an extra 4-5 minutes per patient to switch between screens and enter data, compared to what it would take in a paper world, it is too long. If they have 60 patients to round on, it adds 4-5 hours to their rounds. Since most physicians round four times per month, they could lose 16-20 hours, or about half of a work week. The impact on physician time and workflow must be considered when choosing and implementing an EMR. Rather than insisting that physicians adopt systems that impede workflow, systems should be designed to minimize negative impact on workflow, especially time taken to perform charting and ordering activities.