Culture and age as an impediment to the adoption of healthcare IT

Bill Crounse, MD   Photo by Matthew Barrick A friend sent me a link to an article written for by senior editor, Kate Evans-Corriea.  Ms. Evans-Corriea's article entitled "Age Does Matter" reflects on what she says was a common theme at Gartner's recent Symposium ITxpo. That theme is perhaps best captured in a quote from Gartner analyst, Tom Bittman, who says, "It's not the technology; It's not the process that's holding us back. It's the culture".

As I read the article, I couldn't help but think about a conversation I had just had with a colleague who currently serves as a hospital CIO.  He expressed to me his total frustration with hospital culture and healthcare providers.  In fact, he is so frustrated that after ten years on the job he is looking for another position; this time likely in another industry.

His hospital had recently purchased a very advanced surgical management system that included anesthesia scheduling and work-flow automation.  The anesthesiologists at first welcomed these new tools, although one of the docs had initially pushed back because he had designed his own solution that he thought was a lot better than the vendor solution selected by the hospital.

Even so, after a few weeks using the new system, several of the older and most influential members of the anesthesia group simply proclaimed that they didn’t like what the hospital had purchased and would be going back to using their old paper processes.  And, as my colleague noted, "that was that". 

A similar scenario had recently played out in the radiology department.  The mammography unit was asked to start using the hospital's digital PACS system.  They prepared the docs for the fact that their productivity could initially fall by as much as 30 percent until they got used to the new tools and work-flow.  The docs agreed to give it a try, but as soon as their productivity actually did take a nose-dive, they rebelled and refused to use the new system.


I know what you may be thinking.  Screw the doctors!  Tell them they have no choice but to use the new systems.  As a doctor and a former hospital VP/CIO and CMIO, I know it's not that easy.  Those doctors are the life blood of the hospital.  It took years to recruit the physicians who run the mammography unit.  And the anesthesiologists?  They along with their powerful surgeon allies are responsible for most of the hospital’s profit margin.


The CIO also told me about his hospital's struggle to implement an electronic charting system in nursing.  He said the VP of Nursing gives the initiative good lip service, but her first in command is a 50 year old nurse who has never worked anywhere else, and there’s a lot of passive-aggressive behavior going on in the rank and file.  Since the nurses are all employees, you might think administrators could just lay down the law and mandate the use of the nursing documentation system.  But you would be naïve to think that.  The average age of nurses working at the hospital, especially as managers and unit leads, is 50-plus.  There’s a huge nursing shortage with lots of vacancies in posted positions.  They have a powerful union.  It’s hard to tell them what to do.      


I share this because it is so typical of the culture in healthcare, and not only here in America.  It speaks volumes on the issue that Gartner is drawing to our attention; it isn’t so much about the technology as it is about the culture, and the need for more carefully orchestrated change management.


Of course some of these hassles will resolve as the “dinosaurs” retire. But based on what Gartner is saying the age and culture issue won't go away.  Instead of “why must I use this computer instead of my paper?” the argument will become “why must I use this (fill in the blank) instead of my computer?"


Bill Crounse, MD     Worldwide Health Director       Microsoft 

Comments (6)

  1. Very insightful commentary … in fact, your entire blog is thoughtful and well written.

    I’m hopeful that healthcare IT and electronic medical records software follows the path I remember with e-mail and cell phones.  At first, everyone talked about the great potential of these new technologies, and expressed interest in using it, but almost everyone watched from the sidelines, as if the promises were unreal or untested.

    Then, with little fanfare, we reached a tipping point.  In what seems like 6 months, EVERYONE I knew had an email address, and EVERYONE had a pager or cell phone.  Those without these technologies were suddenly forced to explain why they DIDN’T have the latest gadget.  

    Let’s hope there’s a tipping point for healthcare IT, and let’s hope that tipping point is fast approaching!  The promises of greater efficiency and improved quality of care are very real, but they’ll never be realized until we reach the healthcare IT/EMR tipping point.

    EMR Software Guy

  2. hlthblog says:

    Thanks for your comments, EMR Software Guy.

    I truly believe we are already at the "tipping point" if not beyond it.  I see more evidence every day.  That doesn’t mean that we don’t have a lot of work to do.   Solutions are still too hard to learn and use; many slow, rather than speed productivity; most are too expensive.  But we are getting there.

    A more intuitive and standardized user-interface is in the works.  New data input modalities and better devices will lower barriers to adoption.  Commoditization will decrease costs.

    The time is now.  The opportunity is upon us.  

    Bill Crounse, MD   Worldwide Health Director    Microsoft  

  3. Rick says:

    Interesting blog…but I would like to take an exception:

    "It’s not the technology; It’s not the process that’s holding us back. It’s the culture".

    I believe in technology…I am a self taught programmer (.Net) and a physician. But when I recently had the opportunity to use CPOE, implemented recently, at one of the best hospitals in US (Baltimore), life was miserable. It took 20 minutes simply to rewrite transfer orders which already exist in the system. Similarly my colleague (radiologist) who is tech savvy and uses voice recognition to read MRIs hated it when he had to use it to read 400 chest xrays/day (with less than 90 sec available per xray, regular transcription helped avoid time spent on proof reading!)

    I am optimistic…What we need is thoughtfully written software with user friendly UI simulating typical workflow settings. Easier said than done!

  4. Chris Kozloski says:

    The largest problem with healthcare IT is not the technology, it is the corporations that serve that technology.

    I look at it in terms of "Big Blue" they got so big and basically ran the industry for so long that they got complacent. Healthcare is an industry that will always have a customer base and it will always be specific in need.

    Companies like Phillips, Kodak, and Siemens have figured that out. The problem is that there is no standardization from package to package.

    Something as simple as DICOM is not even standardized. Each vendor uses their own flavor of dicom. It makes integration and maintenance a pain in the rear for the IT guys and the software usually ends up very cumbersome and hard to navigate.

    I’m an IT guy and the systems give me a headache. I can surely understand why the clinical staff does not like change. As soon as they figure out one system they are learning a whole new one.

    Technology is in a colossal movement right now. Let’s hope that healthcare can catch that train. I’d sure like to make workflow and patient care a lot more streamlined.

  5. healthtech says:

    I agree that we’re at the healthcare IT tipping point. (Other industries have been reaping the benefits of IT for decades.) In any case, all the new doctors coming out of med school are steeped in the technology. Still, I’m not opposed to mandating the use of technology for the more recalcitrant doctors. We know its better and we know there are growing pains and temporary productivity losses, but the long term gains are certainly worth the pain.

    Of course, what is really needed is accepted healthcare it standards for operation and interoperability. As well, the software needs to improve as to not be so difficult to use!

  6. hlthblog says:

    Chris and Healthtech,

    Thanks for your comments.  You both make a compelling case not only for why we need open standards in healthcare IT, but also for the direction of Microsoft’s Connected Health Framework Architecture and Design Blueprint.  This vendor agnostic whitepaper offers guidance on building world-class, interoperable SOA web services and applications for healthcare.  

    The whitepaper, which more than 70,000 of you have downloaded, is available here:

    Bill Crounse, MD   Worldwide Health Director  Microsoft

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