Physicians and e-health: (how to) lead disruption

It is well recognised that healthcare can prosper from e-health solutions, which hold enormous potential for increasing effective information sharing and communication.

Over the last two decades, policymakers, health officials and HIT enthusiasts initiated numerous innovative healthcare information technology (HIT) programmes. Despite all efforts and huge resources, expectations at the start of many of these projects were not matched by uptake and utilisation in practice[1] and a significant body of research shows implementation is complex and often problematic. Many claim the role of financial, legal, social, ethical and organisational issues as major obstructions. Additionally, HIT project costs regularly appear to be unmanageable, planning unpredictable and an array of barriers on a macro (healthcare system and societal), meso (organisation) and micro (professionals and patients) level seem to stand e-health implementers in their way[2].

Increasingly, professional resistance to new technologies is cited as a major barrier to implementation[3] (Balfour, 2009). These conclusions seem to be affirmed in preliminary findings in current pan-European research, revealing engagement of physicians in sustainably implementing e-enabled integrated care to be most significantly rated as the greatest obstacle by implementation teams[4]. Are physicians the problem? Is this the start of one of those doctor-bashing episodes we see as frequently as changes in the weather? Are physicians the cause of implementation debacles? Or, are they fighting a cause - for example the possible disruptiveness of e-health?

Up to this point in the ‘eHealth Odyssey’, implementation efforts were mainly technology-driven and providing information and user training aimed at increasing engagement of and endorsement by professionals. Such efforts are typically characteristic of change management activities, rather than those tailored to daily work routines. Some would call them ‘sales techniques’. Large implementation efforts like the UK’s Whole System Demonstrator (WSD) project, also known as the largest randomised trial of tele-health in the world, suggest that health care professionals should re-negotiate their roles and responsibilities[5]. HIT enthusiasts might have underestimated the impact of e-health implementation on the day-to-day practise of front lines professionals. The consequences of e-health not only involve healthcare process and patient-physician issues, but also raise concerns about potential role removal, task division and (other) changes to responsibilities that have an impact on staff. These important matters need to be discussed in depth if professionals are to accept e-health[6].

An emerging new era in research will focus on human factors and other ‘soft’ aspects in e-health implementation[7]. It is here that physician leadership comes into the arena. As large-scale e-health implementation projects, like the WSD project, become more prevalent, we must make more effort to investigate and discover the exact implications of e-health on roles and responsibilities within healthcare pathways[8].

Meanwhile, and more importantly, we are obliged as leading physicians, to ask ourselves what holds us back from using HIT as an instrument to deliver optimal healthcare. Are we up for the task of disruptively re-inventing and re-negotiating our long established and well-respected positions in society? The ‘information society’ as we know it, is gradually becoming an ultra complex network of people working together, regardless of hierarchy. It is here and now that we must demonstrate leadership, even if this entails sharing part of our authority.

Through this process we will re-invent our group norms, based on relational re-structuring, our collaborations with peers, with co-workers as well as with informal carers and patients, while truly role modelling new ‘rules of engagement’ in interdisciplinary collaboration. Our leadership will be catalytic to sustainable e-health implementation. MLCF, LEADS and their Dutch equivalent propagate leadership in the e-health domain as important competencies for the current generation of physicians. Moreover, healthcare is in urgent need for transformation and HIT offers the disruptive instrument to make this happen. And, as always, the effectiveness of an instrument lies in the skills of the user. Let's lead e-health.

Wouter Keijser MD is a transformation coaching expert and combines physician leadership development and interdisciplinary team training in complex system transformation processes within healthcare organisations and European regions integrating e-health enabled healthcare, informal and self-care. As a research associate of University Twente, the Netherlands, Keijser is co-founder of the Dutch Institute for Research and education in Medical leadership and Interdisciplinary collaboration (DIRMI) and the Dutch Framework for Medical Leadership Competencies.

This article is based on current research relating sustainable e-health implementation and physician engagement, co-funded by the European Commission and coordinated by Health Information Management, Barcelona, Spain.

[1] May CR, et al. (2011). Integrating telecare for chronic disease management in the community: What needs to be done? BMC Health Serv Res 2011; 11: 131- doi: 10.1186/1472-6963-11-131 pmid: 21619596.

[2] Mair F, et al (2012). Factors that promote or inhibit the implementation of e-health systems: an explanatory systematic review. Bulletin of the World Health Organization 2012;90:357-364. DOI:10.2471/BLT.11.099424.

[3] Balfour DC, (2009). Health information technology — results from a roundtable discussion. J Manag Care Pharm 2009; 15: 10-7 pmid: 19125556.

[4] Keijser W, et al. (2015). Navigating leadership and culture in the healthcare sector: how can we achieve transformational change? Oral Presentation. International Foundation for Integrated Care, conference, Odense, October 2015. [http://integratedcarefoundation.org/resource/dr-wouter-keijse-university....

[5] MacNeil V, et al. (2014). Experiences of front-line health professionals in the delivery of telehealth: a qualitative study. Br J Gen Pract 2013; DOI: 10.3399/bjgp14X680485

[6] Brewster L (2013). Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs. 2014 Jan; 70(1):21-33. doi: 10.1111/jan.12196.

[7] Keijser W, et al. (2015). Navigating leadership and culture in the healthcare sector: how can we achieve transformational change? Oral Presentation. International Foundation for Integrated Care, conference, Odense, October 2015. [http://integratedcarefoundation.org/resource/dr-wouter-keijse-university....

[8] Mair F, et al (2012). Factors that promote or inhibit the implementation of e-health systems: an explanatory systematic review. Bulletin of the World Health Organization 2012;90:357-364. DOI:10.2471/BLT.11.099424.