The Electronic Health Record in Austria: Physicians‘ Acceptance is Influenced by Negative Emotions Werner HACKL, Alexander HOERBST, Elske AMMENWERTH UMIT, Institute for Health Information Systems UMIT, Institute for Health Information Systems
Background and Motivation Methods Results ◦ Generalizing Analysis of Expert Interviews ◦ Recommended activities to reduce anxiety and fears related to EHR Discussion ◦ Discussion of study design ◦ Discussion of results Conclusion and Outlook 2
“The medical fraternity strictly refuses the lifelong electronic health record (ELGA) designed by IBM by order of the Ministry of Health” (Press conference Medical Association Vienna 3.5.07) „E-Health will come, even though the medical fraternity may roar against it.“ (Health minister Andrea Kdolsky, „DiePresse“) 3
„IT-Industry incited incited and pushed pushed monitoring- and espionage system espionage system“ „the intention to cut down to cut down € 400 Mill. 400 Mill. on the health budget is a dangerous dangerous threat threat “ Control, Surveillance Control, Surveillance Financial penalties Financial penalties Dubious future, Heteronomy Dubious future, Heteronomy Fear, Anxiety Fear, Anxiety „risk potential risk potential regarding „Project, coming by by stealth stealth“ data privacy data privacy“ „step into totalitarian totalitarian „undermining undermining of patient/physician surveillance society“ surveillance society confidentiality“ confidentiality „highly dangerous „highly dangerous thing“ 4
Data collection ◦ Problem centric interview (Witzel/Lamnek/Mayring) ◦ 8 resident physicians (7 specialization fields) ◦ Interview guideline, Impuls question: „Emotionally discussed topic – what is YOUR opinion?“ ◦ Theoretical sampling ◦ Mean interview duration: 16 minutes (± 6) Data evaluation ◦ Audio recording of interviews ◦ Literally transcription (40 pages) ◦ Qualitative content analysis according to Mayring (ATLAS.ti) ◦ Quantitative evaluation of qualitative Data ◦ 328 tagged and paraphrased text passages, 139 primary categories, 18 final main categories (in the form of statements) 5
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Physicians are unsettled due to missing missing, insufficient insufficient or negative negative information information (43) Data privacy Data privacy and data protection data protection is not warranted (41) EHRs cause additional workload additional workload and loss of time (36) Unauthorized third party Unauthorized third party will use EHR data (35) Physicians will be other-directed other-directed due to EHRs (21) EHRs lead to a controllable, transparent doctor controllable, transparent doctor (19) Accustomed workflows have to be changed workflows have to be changed by reason of EHRs (19) Cost Cost of EHRs will be shifted to the physicians shifted to the physicians (18) Benefit Benefit of EHRs is not known not known (17) 8
GROUNDED: P 8: DrH P 7: DrG P 4: DrD P 2: DrB P 1: DrA P 6: DrF P 5: DrE P 3: DrC Final Categories Physicians are unsettled due to missing, 43 10 insufficient or negative information 1 1 5 4 8 9 5 Data privacy and data protection is not warranted 41 14 1 5 9 4 8 EHRs cause additional workload and loss of time 36 13 4 8 1 4 6 Unauthorized third party will use EHR data 35 11 13 2 1 5 1 2 Physicians will be other‐directed due to EHRs 21 9 5 4 1 2 EHRs lead to a controllable, transparent doctor 19 1 3 4 4 3 3 1 Accustomed workflows have to be changed by 19 14 3 1 1 reason of EHRs Cost of EHRs will be shifted to the physicians 18 5 1 2 1 7 2 Benefit of EHRs is not known 17 9 1 2 2 3 EHRs lead to a controllable, transparent patient 14 1 6 1 3 2 1 Usability of EHRs will be insufficient 12 10 1 1 EHR data will be used punitive against physicians 11 1 1 3 1 3 2 The time is not ripe for EHRs 11 2 4 1 2 1 1 EHRs lead to two‐class medicine 9 1 6 1 1 EHRs will be implemented imperfectly 7 2 4 1 EHRs will fail due to scarce cooperation of physicians 6 6 Too much information narrows, blurs the vision 4 2 2 causes loss of information. A system change always causes media breaks 1 1 9
Cost-benefit analysis focused on the doctors‘ costs and benefits ◦ Benefit Benefit!! ◦ Costs Required investment Operating expenses Personnel expenses, additional hours of work Impartial information campaigns ◦ Involvement of scientific community Strategic marketing ◦ Only possible with „optimal product“ Make EHRs (ELGA) transparent for physicians 10
Sensitive, „hot“ Issue ◦ Careful, accurate design is important ◦ Detailed literature review at the beginning ◦ Conscientious development of methodology Discussion of methods ◦ Problem centric interviews well accepted by physicians ◦ Exact application of methodology ◦ Audio recording, Software tool for Evaluation: MUST! Possible weaknesses ◦ Selection Bias? ◦ No Generalization possible Remark: Positive comments not analyzed further 11
Study questions are answered ◦ Anxiety and fears exist ◦ Physicians‘ level of knowledge is low / uncertainty is high ◦ Change barriers/resistance develop (cf. [Krüger99]) Acceptance is critical factor for Success ◦ Risks – analyses of feasibility study confirmed ◦ Genesis of barriers against ELGA explained detailed for one Stakeholder (physicians) Acceptance management not yet successful ◦ Recommendations developed (cf. [Lorenzi09]) 12
ELGA-Project must be successful ◦ Google, Microsoft et al. are seizing the day ELGA must provide benefit (Win-Win!) ELGA must be realized at the best ◦ No limitations and half measures ◦ Data privacy, security, confidentiallity Sophisticated acceptance management ◦ Comparable Studies for all stakeholders (foremost: patients!) ◦ Inform, inform, inform! Inform, inform, inform! Involvement of all stakeholders ◦ Stick to the facts !! Stick to the facts !! 13
Contact: Werner Hackl Werner Hackl UMIT, Institute for Health Information Systems werner.hackl@umit.at „The resistances against the novelty are energized for fear of the foreign. Since the foreign becomes only visible in the reflectance in the self, behind the fear of the foreign stands the fear to be obliged to change oneself “ Prof. Bolko von Oetinger Prof. Bolko von Oetinger 14
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