One of the great challenges for physicians when adopting Information Technology and EMR is clearly understanding the value proposition, particularly when physicians may be at the different levels in terms of their current level of IT use and willingness to adopt the technology. In September 2004, a group of physicians working with Vancouver Coastal Health on a primary care IT strategy were faced with this exact issue. How does one assist physicians with the adoption of technology as we move down the pathway towards widespread implementation of Electronic Medical Records without a clearer understanding of the current state?
As a result of this early thinking, Drs. Morgan Price, Jan McCaffrey, Jim Busser, Peter Richards and myself developed a model to better understand the clinical adoption of IT by physicians. Click on the image to see more detail. In this model we essentially divided physicians into 4 categories. Level 1 physicians were those who rarely used technology in their practices. A computer may be used by staff for billing or scheduling, but this would generally be in the front office and a physician would use a computer on a rare occasion when not being used for administrative purposes. Level 2 physicians were those had access to a computer plus the Internet in their offices for access to reference information and clinical practice guidelines, but did not access clinical patient information such as lab results. Level 3 physicians were ones who worked in a hybrid setting, using some clinical tools manage patient care e.g. online diabetes management tools. However the practice was still essentially a paper based practice. Level 4 physicians were those who had implemented an electronic medical record system and were managing patient information within their EMR.
In each category we realized that there were a number of sub-categories e.g. in practices that had implemented an EMR there existed a wide range of users of those systems from physicians who were just beginning down the pathway to those who were sophisticated in their use and were using their EMRs to identify and manage patient populations more effectively.
A clear understanding of these levels and the use of technology is important in that different levels of use may exist within the same practice. In addition, the levels 3 and 4 physicians essentially represent the early adopters. It is not as difficult to move from level 3 to level 4 than from level 1. However a physician may decide to jump from level 1 or 2 to level 4 without going through a step-wise implementation process.
I would like to encourage debate on these levels and this approach to understanding physician use of technology. Are you a level 4 physician? (using EMR in your practice) Or are you currently a level 1 or 2 physician in your medical office? Do you have thoughts or comments about these levels? Has your region or organization adopted a similar approach? How could level 1 and 2 physicians be encouraged to move to level 3 or level 4?
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