Doctors find gift of health IT comes with a dose of reality

Too much hype about new technology may result in expectations not being met, according to a study by the University of Chicago Medical Center.

In 2010, soon after Apple released the first iPad, the University of Chicago Medical Center launched a program in which it would hand out iPads to all incoming residents. The program was met with great enthusiasm, with a majority of residents saying in a survey that use of the tablet would improve efficiencies and quality of care. Four months later, most agreed that use of the tablet was beneficial, but it didn't live up the initial hype for many. Researchers blamed inflated expectations and say the same can happen with the introduction of any new technology.

It's not that enthusiastic residents failed to see any benefits in the technology, researchers said. In fact, most still thought it was an important investment. But those who were most enthusiastic found that the technology may not have been the panacea they thought it would be.

“Hype can often lead to increased expectations,” said Vineet Arora, MD, associate program director of internal medicine residency at the University of Chicago and senior author of the study, which was posted online May 8 in the Journal of Medical Internet Research. “And increased expectations can lead to disillusionment.” When new technology is introduced, expectations need to be managed better, said Dr. Arora, the faculty adviser for the iPad committee.

A month before deployment, 34% of residents strongly agreed that tablets would improve patient care, and 41% thought they would improve efficiency. Four months after deployment, 15% strongly agreed the tablets improved patient care, and 24% strongly agreed efficiency was improved. Overall, 84% thought the tablets were a good investment for the residency program.

The survey also found that those who already used Apple products were more enthusiastic about the devices and used them for more purposes. But because the iPad had just been introduced to the public a few months before, no one, even those who already had adopted the device, had much experience using them in a clinical setting.

Lead author Nancy Luo, MD, a resident at the time the iPad program was launched, said that when it comes to new technology, there are always early adopters. But, she added, this research shows that organizations can't force doctors to be early adopters and then expect them to be enthusiastic about it. Use of the devices was not mandatory, so when people started using the devices for certain tasks, some decided that their preference was for pen and paper. Others found they used the devices in ways they didn't think of before deployment.

Dr. Arora said physician champions, who often help guide other doctors through technology deployments, need to set realistic expectations about the technology. They also should look continuously for ways to optimize its use. She said education and support are still needed for programs that allow physicians to bring their own devices.

For Paul Bergl, MD, a third-year resident at the University of Chicago Medical Center, expectations were exceeded after deployment. He was not a tech-driven person before being handed an iPad. He didn't — and still doesn't — own a smartphone. But after spending his first year as a resident with an iPad, he considers it “indispensable.” He uses it to send emails on the fly, for patient education at the bedside and as a reference tool.

Not everyone was so enthusiastic, even though most considered the iPads a good investment. The study was consistent with other research that has found doctors hopeful about other technology, such as electronic health records, but disappointed that the systems are not working as well as expected.

Sources of disappointment

Physician adoption of tablet computers grew from 27% in 2011 to 62% in 2012, according to Manhattan Research's “Taking the Pulse U.S. 2012” survey of 3,015 physicians in 25 specialties conducted in the first three months of 2012. It found that of the 62% who own tablets, half use them at the point of care.

Dr. Luo, who is now an internist and hospitalist at NorthShore University HealthSystem in the Chicago suburbs, said disillusionment often has little to do with the devices but with how they interface with the hospital's information technology systems.

Dr. Luo's hospital does not have a formal program for which physicians are given mobile devices, but she is still an avid iPad user. Even though the tablet computer has become an important tool in her work, she was disappointed that although she could access her EHR from her iPad, the system wasn't optimized for mobile devices. Because of this, it's too cumbersome to use the iPad to access the EHR.

Dr. Bergl, who said the same about the University of Chicago Medical Center's EHR system, said it's important for physicians to understand the limits of new technology and adjust work flows accordingly, which he has seen incoming residents do since the iPad program launched. The medical center continues to give residents iPads for professional use.

A report the technology firm CDW published in December 2012 showed that physicians adjust their work flows by combining tablet use with use of other devices. The survey of 152 tablet-using health care professionals was part of a survey of 610 professionals from various industries. The health care professionals said they spend an average of 2.4 hours per day on a tablet. Eighty-six percent said the tablet makes them better multitaskers, 74% said it improves work flow, 66% said it helps increase collaboration with co-workers, and 91% said it improves their ability to access information on the go. But the time spent on a tablet represented only 31% of total computing time. The remaining time was spent on desktops, laptops and smartphones.

Since Dr. Bergl became a tablet user three years ago, he has seen a significant increase in the number of tasks he can accomplish with the tablet because of the increasing number of apps on the market. He's optimistic these improvements will continue, and he's hopeful EHR systems will be improved for mobile access. Although he stands by his decision not to own or use a smartphone, he thinks use of tablets at the bedside is a trend that's here to stay.