I repeatedly see articles blaming physicians for the poor adoption of technology in medicine. As a tech nerd and a physician who is frustrated with the lack of good medical software (mostly EMRs), it was nice to see an article putting the blame where it mostly belongs: regulation and hospitals.1

E.J. Boyer for the Nashville Business Journal (subscription only):

[A] growing number of physicians are taking a cue from their personal lives and using mobile devices to make their jobs more efficient.

Just like “normal people”, physicians want their life to be easier and when they see how technology improves one aspect of their life, they want to see similar improvements in other aspects.

But industry experts predict the road to adoption won’t be easy, as data security, IT integration and looming federal regulations come into play.

A constant problem in all areas of medicine, regulations continue to choke the life out of medical practice.

But even as physicians continue to see the benefits of mobile apps in practicing medicine, experts warn the road to full adoption will be long. For starters, health apps and mobile devices present a new privacy and security challenge for hospitals, which operate under tight regulations and strict federal patient privacy laws.

Physicians are driving the need for it. They want to be able to see the data on the phones and iPads, but the hospitals are not jumping on it as quickly.

When I got the first iPad, I was told by hospital IT that it “couldn’t connect” to the system. When I figured out how to get it connected, I was told it was “not allowed”. They refused to explain how accessing the system from my laptop at home (fully supported) was different than accessing the system from my iPad as we rounded on patients. Eventually, as more higher level attendings bought the devices for themselves, seeing how useful they were to the residents, the policy changed to “not supported”. I wonder if that’s changed any since I left?2

Another road block to mobile adoption is integration of apps into a hospitals IT system.

This is because the EMRs that hospitals use are closed, proprietary systems. They are built on old architectural standards. The database systems are closed and or proprietary. There are no APIs. The EMR companies want to keep the system closed to stifle competition. They want to be the only one that can make an app for their system and they charge astronomical prices for mobile apps for their EMRs, often a large percentage of the original cost all over again.

I still remain optimistic that one day cooperate medicine will have and use decent technology, although I’m realistic enough to know this may never happen in my lifetime. Until then, I will continue to develop my own private systems for my every day practice.

As for the truly luddite physicians out there: eventually they’ll die3, and if the technology is good enough to provide substantial benefits to those physicians using it, the luddites won’t be able to compete.

  1. Poor quality software is another driving factor. 

  2. I was also told that Macs were not able to be used as the technology wouldn’t work. Within 2 months my fellowship program had switched to Macs, but I had had to do most of the work. At one point I tried to talk to the Mac guy in IT had was repeatedly told “There isn’t one.” It ended up that he was on vacation, and when he got back he responded to the long email chain saying “Hey, I do exist. I’m right here!”

    I think a lot of the resistance is aversion to more work, interestingly, coming from the technology people, not the physicians/users. 

  3. “I mean, when I started in this business one of the biggest challenges was that people couldn’t type. And one day we realized that death would eventually take care of this. - Steve Jobs