Is Age Just a Number, or Will it Pose a Challenge to Widespread Health IT Adoption?

Health IT has numerous potential benefits, including improved patient safety, lower costs, higher patient and provider satisfaction and healthier communities. However, these benefits depend on wide adoption of HIT across healthcare settings and patient populations. A common belief is that older adults have more difficulty accepting and using technology. Is this true? And if so, how will this affect the success of health IT in hospitals and health systems?

Reasons for adoption
People who have grown up using technology, or "digital natives," tend to adopt technology, at least initially, for different reasons compared to those who are new to technology, or "digital immigrants," according to Ryan Sandefer, chair of the health informatics and information management department, and Shirley Eichenwald-Maki, assistant professor in the department at College of St Scholastica in Duluth, Minn. "Digital natives are more willing to use [HIT] for technology's sake," Mr. Sandefer says. "Digital immigrants are more interested in how this will help them."

The reason older adult healthcare providers may be more resistant to adoption of new technology is because they are not convinced of its usefulness in patient care or their workflows. "I think that a lot of times older healthcare workers get a bad rap for being resistant to change and rigid in their ways and practice, and I think that is misplaced," Mr. Sandefer says. "If you're not a digital native and looking at some of these tech systems being implemented everywhere, they stink. Maybe they have a good reason that they are resistant: because the system doesn't work well."

Improved technology
As technology improves, hospitals and health systems may see greater acceptance by older adults. "For some of us older folks who believe in the use of technology to enhance our professional work, it isn't a big selling job," Ms. Eichenwald-Maki says. In fact, a study published in the Journal of the American Medical Informatics Association in September found that older physicians are more likely to use novel electronic health record functionality than their younger counterparts. "We've been waiting for it for a long time, [but we've been] waiting for the good stuff," Ms. Eichenwald-Maki says. "It's false to say that older adults are not interested in or potentially see value in technology. It is an issue of getting to the point where technology can do something effective."

In addition, in October, the National Institute of Standards and Technology released a draft guidance document called "Technical Evaluation, Testing and Validation of the Usability of Electronic Health Records." Mr. Sandefer says as standards committees start to look more at usability factors and other considerations for the end-user that make real benefits more feasible, older adults may more readily adopt new technology. When the technology is up to par, Ms. Eichenwald-Maki suggests healthcare leaders emphasize the effects of systems such as EHRs, computerized provider order entry and telemedicine on quality of care and patient safety to encourage adoption among older adults. "They are concerned about efficiencies and productivity as well, but that doesn't really sell it," she says.

This proposed correlation between older physicians' acceptance of HIT and their perceptions of the technology's usefulness may be similar among patients. "There has to be a motivating factor to get [patients] to use the technology and also to help them recognize why it's better than [what they] did before," says Christina Thielst, healthcare administration consultant and author. For example, she says if older adults learn that remote monitoring technologies can help them remain at home and avoid going to a nursing home, they would be more motivated to use that technology. "As healthcare providers and leaders, we need to find ways to engage older individuals with technology and help them realize the value of that technology," she says.

Short- and long-term differences
Differences between generations in how quickly and readily HIT is adopted may be more evident in the short term compared to the long term. Older adults may need more time to be convinced of a technology's benefits, and may also need more time to learn how to use the new technology. However, slower adoption does not necessarily reflect differences in capability or long-term adoption, according to Mr. Sandefer. "Technology may not be adapted as quickly by older adults simply because they're digital immigrants and not as comfortable. Having said that, it is a misconception that they can't take it up or can't learn," he says.

As digital immigrants, the training process may need to be longer or more detailed than for younger adults. "Older adults have established habits," Ms. Eichenwald-Maki says. "Younger adults have established their habits [too], but technology is part of those. Every time [older adults] have to change a habit, the way they've done something, they have to unlearn and relearn. It isn't so much that they're older and incapable, but it is the process of making the transition that they have to go through." Mr. Sandefer says other factors like the quality of training and an organization's culture may have a greater effect on long-term adoption of technology than age.

"We need to recognize that a lot of older professionals — nurses and physicians — are just as tech savvy as younger professionals. Some say seniors aren't tech savvy, but just look at trends related to cell phone use: Many seniors, for cost reasons, are switching to only cell phones [instead of having a land line]," Ms. Thielst says. In addition, while the oldest adults may not use new technology to manage their condition or find information, their younger caregivers are doing so on their behalf, according to Ms. Thielst.

Engagement and training
Engaging older adults in the process of planning and implementing technology can help them accept and use the technology. "The more engaged they are in the planning process, in the thinking and planning piece, the easier the adoption will be when the time comes to bring it forward," Ms. Eichenwald-Maki says. Mr. Sandefer suggests healthcare leaders involve physicians and nurses in the decision-making process for HIT. "Having them involved in decision-making, marketing and recruitment internally to get their buy-in is critical because if they see it as administered from above and not within their cohort of folks, it's going to gain resistance," he says.

If hospital leaders do invite physicians and other stakeholders to provide input into HIT decisions, however, they should explain upfront the weight their opinions will ultimately carry. Ms. Eichenwald-Maki says that one organization the college studied asked physicians to help choose a product, but when the physicians evaluated products and made their choice, the administrators overrode them. Ignoring the physicians' input left the physicians feeling abandoned, and they put up major roadblocks to the technology's success, she says.

Peer-to-peer training can also help older adults adopt new technologies. Ms. Thielst says the organization should create an environment where older adults can feel comfortable learning HIT. "Older adults don't want to feel embarrassed that they're having difficulty learning something new," she says. "We may see it as, 'They're just being difficult and they don't want to learn technology,' when in reality they feel threatened because they're having a hard time learning, and they really need more of a safe environment to develop the skills that are necessary to use that technology." She suggests doing one-on-one training to reinforce certain concepts and ensure the physicians, nurses and other staff feel comfortable.  

Workflow
One particularly important part of HIT training is learning how to change one's workflow to optimize the process using technology. Understanding and documenting current processes and designing more efficient workflows is essential to integrating technology into a healthcare professional's practices. "When workflow is interrupted by technology, people get really crazy," Ms. Eichenwald-Maki says. "Workflow has to be a top priority in the planning phase and training phase." For example, Ms. Thielst says using tablets may be easier for older practitioners to adopt because it is similar to holding a clipboard and writing information during patient interviews.

Moreover, workflow training is important not just for older adults, but for clinicians of all ages. "Health IT implementations that don't fit into user workflow(s) are likely to fail, no matter the person's age," Ms. Thielst says. "Older [adults] get frustrated faster, but younger ones get frustrated as well if it's not properly planned out."

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