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Electronic healthcare systems have the potential to improve patient care and save money. In the U.S. alone it is estimated such systems could save $77 billion if implemented properly, and the government has a goal of making all medical records electronic and standardized by 2014. But just because an e-healthcare system is in place does not mean it will be used.

Doctors in particular have been found to be resistant, with only one-quarter to one-third using the technological solutions available to them. As a result, the healthcare system and patients may not realize the full potential benefits of these solutions. There is therefore a great need to better understand the factors that determine the use of e-healthcare.

Viswanath Venkatesh, Xiaojun Zhang and Tracy A. Sykes approach the situation from a social network perspective. They look at not only the doctors but others who work alongside them - paraprofessionals (e.g. nurses and doctors' assistants) and administrative personnel. They also consider the "centrality" of each person in terms of their connections within and outside their professional group, to draw a more nuanced picture of e-healthcare system use.

Some 1,120 staff at a private hospital were surveyed including 160 doctors, 770 paraprofessionals and 190 administrative personnel, who had all received training in a new e-healthcare system. The log of system use was analyzed over nine months, and a survey was conducted on patient satisfaction.

The authors found that doctors who were central and therefore better connected with their peers were more reluctant to use the system, as were paraprofessionals and administrative personnel who were closely connected to doctors. Doctors on the periphery of their professional network were more willing to try out the new system.

"Although it has been long documented that doctors resist e-healthcare systems, this work sheds light on the far-reaching impacts that their negative feelings toward technologies can have on other doctors as well as on paraprofessionals and administrative personnel. With doctors at the top of the clinical hierarchy, the two latter groups act in ways to preserve the hierarchy and defer to doctors' judgments," they say.

"This is a key result given e-healthcare system use has positive effects on various quality metrics that in turn influence patient satisfaction."

With paraprofessionals and administrative personnel, the situation was reversed: those who were central in their professional networks were more likely to use the system because the nature of their advice networks was such that they would get more assistance from peers and super-users.

All of these results impacted the patient's experience. E-healthcare system use was found to have a positive effect on the four quality-of-care metrics - technical quality, communication with patients or their authorized caregivers, interpersonal interactions and time spent with patients.

"Our work suggests e-healthcare systems can greatly help to improve healthcare in many ways," the authors say. "Evidence linking e-healthcare system use to better communication about diagnoses, tests and follow-up care are important metrics that relate patient understanding about their health and safety and have implications for their long-term health because they will be able to better care for themselves outside the hospital setting."

The response of doctors suggests there may be obstacles to implementing e-healthcare systems, though, and that managers need to address these if they are to fully realize the benefits.

The different responses among doctors, paraprofessionals and administrative personnel also suggest that current ideas about social networks need to take into account the fact that network position does not have uniform effects. Being central in one group can have a positive effect on behavior but in another group a negative effect.