The ABCDEs of Technology Adoption

Every day, doctors have to make decisions about whether or not to adopt a new technology and add it their clinical armamentarium, either replacing or supplementing what they do. In doing so, they run the risk of making a Type 1 or a Type 2 adoption error.

A type 1 error occurs when they make a “false positive” error and use or do something that is not justified by the evidence. Type 2 errors, on the other hand, are “false negatives” where the practitioner rejects or does not do something that represents best evidence practice.

Unfortunately, there are many reasons why there are barriers to adoption and penetration of new technologies that can result in these errors. I call them the ABCDEs of technology adoption:

Attitudes: While the evidence may point one way, there is an attitude about whether the evidence pertains to a particular patient or is a reflection of a general bias against “cook book medicine”

Behavior: We’re all creatures of habit and they are hard to change. Particularly for surgeons, the switching costs of adopting a new technology and running the risk of exposure to complications, lawsuits and hassles simply isn’t worth the effort.

Cognition: Doctors may be unaware of a changing standard, guideline, or recommendation, given the enormous amount of information produced on a daily basis, or might have an incomplete understanding of the literature. Some may simply feel the guidelines are wrong or don not apply to a particular patient or clinical situation and just reject them outright.

Denial: Doctors sometimes deny that their results are suboptimal and in need of improvement, based on “the last case.” More commonly, they are unwilling or unable to track short term and long term outcomes to see if their results conform to standards.

Emotions: Perhaps the strongest motivator is fear of reprisals or malpractice suits. But technology adoption errors can also be driven by: greed (using inappropriate technologies that drive revenue), the need for peer acceptance (wanting to “do what everyone else is doing”), or ego (the need to be on the cutting edge and win the medical technology arms race or create a perceived marketing competitive advantage).

Economics: What is the opportunity cost of my time and expertise and what is the best way for me to optimize it?

Research indicates that doctors make these kinds errors frequently. Moreover, we are witnessing the development of digital health technologies like medical mobile apps, most of which are not clinically validated. So, how should a clinician decide when to adopt new technology? How much evidence is sufficient for an unsophisticated physician to begin adopting or applying a technological innovation for patient care? How do you strike a balance between innovation and evidence from a patient safety and quality standpoint? Here are some suggestions:

1. Recognize that, like most customers, surgeons buy emotionally and justify rationally.

2. Surgeons should be introspective about how and when they adopt new technologies and try to minimize Type 1 and Type 2 errors.

3. While an initial step is to be sure that surgeons are aware of new information that might drive an adoption decision, research indicates that simply presenting them with that information does not change behavior.

4. Doctors should be skeptical about digital health technologies that might be technically and commercially validated, but not clinically validated.

5. Doctors will have to resolve the conflict between best evidence and personalized medicine. We face the opportunity to individualize care yet are faced with the challenges of delivering mass customized care when it is becoming increasingly commoditized.

6. Technology adoption, diffusion, and sustainability vary depending on the product offering like drugs, devices, digital health products, care delivery innovation, or business process innovation.

7. Doctors often have nothing to do with choosing which technology is adopted or, more importantly, paid for by a third party.

8. Doctors, particularly those that are employed, have to concern themselves more and more with making the numbers add up, which involves implicitly or covertly rationing care, as irrational as it may be.

9. Conflicts of interest hide, in some instances, the motivation for technology adoption.

10. Doctors have high switching costs when it comes to including something new in their therapeutic armamentarium.

There are many barriers to the adoption and penetration of medical technologies. The history of medicine is full of examples, like the stethoscope, that took decades before they were widely adopted. Hopefully, with additional insights and data, it won’t take us that long.