Looking for trouble in all the wrong places

May 26, 2006

For all their promise, information systems don’t appeal much to my sons’ pediatrician. The system installed in his clinic does not live up to its promise. It doesn’t even come close. Aside from a learning curve that continues to rise, even though it’s been in place for six months, the system that is designed to make his life easier does not. Most maddening is how it restricts him from keying in the dosage he wants to prescribe. This might be understandable, if that dosage veered from the norm. But it doesn’t. So important is the dosage on this particular drug that the manufacturer has actually packaged the drug in specific quantities in plastic, foil, and cardboard. This does not matter, however, to the information system, which robs our doctor not only of his time but ours.

For all their promise, information systems don't appeal much to my sons' pediatrician. The system installed in his clinic does not live up to its promise. It doesn't even come close. Aside from a learning curve that continues to rise, even though it's been in place for six months, the system that is designed to make his life easier does not. Most maddening is how it restricts him from keying in the dosage he wants to prescribe. This might be understandable, if that dosage veered from the norm. But it doesn't. So important is the dosage on this particular drug that the manufacturer has actually packaged the drug in specific quantities in plastic, foil, and cardboard. This does not matter, however, to the information system, which robs our doctor not only of his time but ours.

An article published this week in the Canadian Medical Association Journal titled "Physicians will happily adopt information technology," looks at this problem. The authors contend that the success or failure of a hospital's IS depends on whether physicians accept or resist its implementation. They present case studies of IS implementations at three hospitals to help understand what causes physician resistance. There are several possibilities.

In an editorial accompanying the research article, Dr. David Zitner, director of medical informatics at Dalhousie University in Halifax, NS, believes the deciding factor in physician attitude boils down to whether the IS saves or costs physicians time.

"A boss who insists on a process that dramatically reduces the time to complete a job, without an effect on job satisfaction or financial compensation, is unlikely to meet resistance," he wrote. "On the other hand, a boss who insists that an employee do something that is not in his or her own best interests will be more likely to generate resistance."

This, he wrote, explains why PACS is succeeding.

"PACS improves the efficiency of care because clinicians can easily retrieve and read diagnostic images, including radiographs, from anywhere in the world. There (is) no resistance to the implementation of the system because PACS works!"

Unfortunately, Zitner might be a little hasty there. While it can be argued that the popularity of PACS is growing rapidly, this is a relatively recent phenomenon. PACS was introduced some 20 years ago.

At first the medical community was averse to buying any medical equipment whose use could not be reimbursed. The need for efficiency and productivity came along and seemed to wipe out that concern. Then PACS installations became suspect, given that so much of x-ray based imaging remained on film. But that concern diminished when radiography and mammography started transitioning to digital. Now, although PACS is growing, there is still a good bit of resistance. And I'm wondering, since PACS unarguably improves the efficiency of care, why it isn't a slam dunk at each and every institution in the U.S., particularly considering the increasing pressure being put on reimbursement for imaging modalities? Could it be that the failure of other healthcare information technologies are dampening the growth of PACS?

The decision-making process behind the purchase of medical equipment in the U.S. has changed radically over the last several years. Radiologists and other specialists - even whole departments - have lost influence. Hospital administrators are exerting far more power. Among them is the chief information officer. This raises the question: How tightly linked is the future of PACS to the success of healthcare IT overall? If IT products designed to supply lab tests and handle prescriptions fail to live up to expectations, does some of that rub off on PACS?

While there may be many reasons why medical equipment does not capture the interest of buyers, one that stands out is its failure to live up to promises. If vendors really want their PACS to succeed, it's time they found out who the decision-makers are, under what circumstances they make their decisions, and what keeps them up at night. What are their concerns and how can these concerns be dispelled? If the underperformance of information technologies aimed beyond imaging is holding PACS back, how can this effect be minimized?

Finding the reason for resistance is the key to the future of PACS. But, before that key can be found, vendors have to be looking in the right place.