Physician use of computers: is age or value the predominant factor?

One common explanation for the failure to achieve broad physician utilization of computer applications has been the suggestion that "We can't teach older individuals to use computers." To investigate this hypothesis, we examined utilization patterns for the Clinical Information System (CIS) at Columbia Presbyterian Medical Center (CPMC). We analyzed CIS usage for 925 attending physicians who were listed as an admitting or attending physician or surgeon for at least one patient during the year 1992. Sixty-one percent (561/925) of the attending physicians used the system at least once during the year. Sixty five percent (186/287) of the physicians who admitted at least 50 cases used the system at least 120 times during the year. The most surprising aspect of our analysis was that physicians in their late 60's and early seventies actually used the system more than their peers who were in their late 50's. Patterns of use by age group were similar for those who admitted many and few patients to the hospital. Using linear regression and chi squared analysis, we found that age is correlated (p < 0.002) with levels of physician use (inquiries per case), although age can explain (r-squared) only 3% of the observed variation in utilization patterns. We also found that there was significant variation in utilization (inquiries per case) by attendings in different departments (p < 0.007). However, the variation within departments was also large. We conclude that age and type of practice are statistically significant but not major factors in predicting which attendings will use the system. Growth rates over time (19% year to year increase in the average number of different users per day) indicate that, if present trends continue, virtually all physicians regardless of age will use the Clinical Information System for results review. We continue to feel that providing value, access and ease of use are the most important determinants for success.