Which Physician Practices are Early Adopters of Productivity-Enhancing Technologies in Radiology and Which do Without?

Rationale: With health costs increasing rapidly, adoption of efficiency-enhancing operational technologies should be pursued, but adoption of such technologies (for example, electronic medical records) has been disappointingly slow, especially outside the hospital setting. Objectives: To investigate what types of physician practices are early adopters and what types lagging adopters of operational technologies, using established hypotheses about early adoption and using several radiology technologies as the subject of study. We conceptualize operational technologies as being distinct from direct care technologies (such as drug eluting endovascular stents), and more likely to affect efficiency with relatively little effect on patient outcomes, and we study the former. Methodology: We carry out logistic regression on data from the American College of Radiology's (ACR's) 2003 Survey of Radiologists, a stratified random-sample survey that achieved a 63% response rate with a total of 1,924 responses. We investigate three hypotheses about early adoption: 1) "Organizational culture" drives it, in which case we expect academic practices to be the early adopters. 2) Strong cash flow or profits drive it, so private practices and those in suburbs should lead, and government practices and those in main cities lag. 3) Scale economies in new technologies and in acquiring reliable information about them are important, so large practices should lead and small practices and practices in non-metro areas should lag. Our examples of new technologies are PACS (picture archiving and communication systems) and voice-recognition software. Both are relatively new, "high-tech" because they are electronic, and limited in dissemination (34% of practices and 13% of practices, respectively). To study the phenomenon of seriously lagging in technology adoption, we study two burdensome modes of operation that practices may have: (1) having the radiologist him/herself manually hang and take down the films to be interpreted and 2) having nighttime coverage possible only by being on-site, rather than at a distance. In both situations, (a) two technologies, one old and one newer, are available to eliminate the burden, and (b) the burdensome mode of operation is uncommon. (It involves only 21% and 13% of radiologists, respectively.) Results: In logistic regression, solo practices and practices in non-metropolitan areas have decreased odds of having PACS; academic practices and medium-large practices (11-14 radiologists) have increased odds. Academic practices have enhanced odds of using voice recognition. Practices in the West and those serving only hospitals are particularly likely to have the radiologist him-/herself hanging films. Academic and medium-large practices are particularly unlikely to be in this situation. Practices serving only non-hospital sites (which typically don't function after-hours) are likely to have no mechanism for coverage at a distance. Medium to medium-large practices (size 5-14) are particularly unlikely to be in this situation. Conclusions: Scale economies and, even more, organizational culture seem to explain early adoption of new technology. Surprisingly, we do not find evidence of any effect of practices' finances. Determinants of being a serious laggard with respect to even established technologies are less clear, but substantial size seems a deterrent.