Doctors' Pride: A Hurdle to Digital Medicine

A forerunner in New England found that some physicians would sooner cut ties than see their elite status threatened

Partners HealthCare System, the largest hospital network in New England, provides a valuable lesson on digital medicine: When computerizing records, take into account physicians' pride.

Four years ago, Partners, which is based in Boston and includes the teaching hospitals Massachusetts General and Brigham & Women's, took a radical step. It required that the 4,500 doctors with admitting privileges install GE Healthcare (GE) electronic records systems in their offices that would be compatible with the hospital's own extensive network. Each physician had to pay about $25,000.

The strong-arm tactic worked—for the most part. Use of electronic records by doctors affiliated with Partners rose from 9% in 2003 to almost 100% today. But some 150 doctors cut their ties to the hospital rather than wire up.

According to Dr. Thomas H. Lee, who heads Partners' physician group, the main obstacle was not the price of the technology but the network's emphasis on tying all staff—specialists, primary care doctors, and nurse-practitioners—into a coordinated team. The move violated medicine's traditional caste structure, says Lee. "That doesn't always sit well with doctors who are used to being the top authority."

Partners even required doctors with their own computer systems to switch to the GE version. "I don't want doctors just to work better," Lee says. "I want them to work better with their colleagues."

Doctors are supposed to coordinate a patient's care in a way that happens in few places. A diabetic who needs to see a number of specialists no longer should have to worry about conflicting medications or redundant tests. Primary care doctors stay in the loop when patients enter the hospital for surgery.

No studies have yet been published to determine whether Partners has saved any money since going digital. Nor has the network determined whether care has improved. But it now has the data to carry out those studies, and it plans to do so soon.

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