The Electronic Health Record in Austria: Physicians Acceptance is - - PowerPoint PPT Presentation

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

• rder 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“)

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4

„risk potential risk potential regarding data privacy data privacy“ „undermining undermining of patient/physician confidentiality confidentiality“ „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.

• n the health budget is a dangerous

dangerous threat threat “ „step into totalitarian totalitarian 
 surveillance society surveillance society“ „highly dangerous „highly dangerous thing“ „Project, coming by by stealth stealth“

• Control, Surveillance

Control, Surveillance

• Financial penalties

Financial penalties

• Dubious future, Heteronomy

Dubious future, Heteronomy

• Fear, Anxiety

Fear, Anxiety

 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)

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6

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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

• ther-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)

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Final
Categories



Physicians
are
unsettled
due
to
missing,


insufficient
or
negative
information
 
Data
privacy
and
data
protection
is
not
warranted
 
EHRs
cause
additional
workload
and
loss
of
time
 
Unauthorized
third
party
will
use
EHR
data
 
Physicians
will
be
other‐directed
due
to
EHRs
 
EHRs
lead
to
a
controllable,
transparent
doctor
 
Accustomed
workflows
have
to
be
changed
by
 reason
of
EHRs
 
Cost
of
EHRs
will
be
shifted
to
the
physicians
 
Benefit
of
EHRs
is
not
known
 
EHRs
lead
to
a
controllable,
transparent
patient
 
Usability
of
EHRs
will
be
insufficient
 
EHR
data
will
be
used
punitive
against
physicians
 
The
time
is
not
ripe
for
EHRs
 
EHRs
lead
to
two‐class
medicine
 
EHRs
will
be
implemented
imperfectly
 
EHRs
will
fail
due
to
scarce
cooperation
of
 physicians
 Too
much
information
narrows,
blurs
the
vision
 causes
loss
of
information.
A
system
change
 always
causes
media
breaks


P
1:
DrA


5
 6
 2
 2
 1
 1
 1
 10
 2
 1


P
2:
DrB


10
 14
 4
 13
 1
 3
 1
 2
 1
 3
 1
 1
 1


P
3:
DrC


9
 8
 1
 11
 3
 2
 1
 2


P
4:
DrD


8
 4
 8
 1
 4
 4
 3
 7
 3
 3
 1
 1
 1


P
5:
DrE


4
 9
 5
 5
 4
 1
 2
 1
 6


P
6:
DrF


5
 5
 4
 1
 3
 2
 2
 6
 3
 4
 1
 4
 6
 2
 1


P
7:
DrG


1
 1
 1
 1
 1
 2


P
8:
DrH


1
 1
 13
 2
 9
 1
 14
 5
 9
 1
 2
 2
 GROUNDED:
 43
 41
 36
 35
 21
 19
 19
 18
 17
 14
 12
 11
 11
 9
 7
 6
 4
 1


 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 !!

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„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

• neself “

• Prof. Bolko von Oetinger
• Prof. Bolko von Oetinger

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Contact: Werner Hackl Werner Hackl UMIT, Institute for Health Information Systems werner.hackl@umit.at