Teaching old docs new e-health tricks proves difficult

Computerworld - Before the rollout an all-electronic health records (EHR) system about a year ago, only about half of the doctors and nurses in West Virginia's state hospitals were familiar with medical computer systems. So when technology rolled in, staffers pushed back.

"We actually had some nurses who were completely computer-illiterate. They didn't use a computer at work, and they had no use for it at home," said Jerry Luck, director of facilities systems administration at the West Virginia Department of Health and Human Resources.

West Virginia is not alone. Hospitals across the country are feeling pressure to implement more efficient IT systems in light of President Barack Obama's plan to establish a nationwide EHR system in the next five years. Under the Health Information Technology for Economic and Clinical Health Act (HITECH), physicians would be eligible for between $40,000 and $65,000 if they show they are using IT to improve the quality of care.

EHR systems are expected to streamline health care workflow, improve the quality of care and cut costs, according to experts. But medical facilities could also find themselves at loggerheads with some of their own staffers, which are far more familiar with pen and paper than a keyboard or tablet PC. Adding to the problem: the bulk of HITECH money will be awarded beginning in 2011, according to current legislation pending in the House. That doesn't give hospitals much time to prepare, and organizations that aren't ready won't receive funds.

West Virginia is a rarity: Its state government health care system has an all-electronic record-keeping system spread across seven medical facilities.

Younger docs prefer tech

"Probably the most difficult part of our technology rollout was teaching the old doctors new tricks," Luck said. "With younger doctors, we did not experience a problem at all. In fact, [using technology] was their preference. [For] the older and more senior doctors, who for years only dealt with paper, it was a far more difficult transition."

West Virginia began rolling out OpenVista, an open-source software version of the Vista medical records system from U.S. Department of Veterans Affairs (VA), about two and a half years ago. OpenVista, from Medsphere Systems Corp. in Aliso Viejo, Calif., was the brainchild of two physicians who submitted a Freedom of Information Act request in order to get the source code for Vista, which is used at 1,300 VA facilities to maintain health records for 5 million veterans. Vista is seen as the most advanced EHR system in use because it has been around for 20 years.

Luck said all personnel were offered basic computer training. They took a two-hour course in using the new EHR technology and had to pass a test ensuring they knew how to use a keyboard and mouse. Getting doctors and nurses to adopt the technology, however, required more than a bit of peer pressure from younger doctors, interns or trainees who readily accepted its use.