Putting obviously unprofessional behaviour aside, there are good reasons why they have this attitude, although it is disappointing. First of all, as we all know, passwords are actually not a good solution to the problem of authentication. So we are asking people to participate in a system which we don't think is great and has serious usability issues for the non-technical. I know this isn't what doctors are actually thinking explicitly, but the point still needs to be made.

Secondly, doctors are busy and have unpredictable workloads. They also have limited ability to delegate or ask for help if they are oversubscribed. This means if you add 10 minutes to their day, it will actually extend their working day by 10 minutes, and the things they have to do may take them until 10pm at night or worse (I semi-regularly finish documenting things after midnight, and I am not working night shift). They are understandably allergic to things which seem to increase the amount of stuff they have to do.

Unfortunately, if you are a small IT vendor trying to introduce a service or a product to a large hospital (the bigger it is, the bigger the problem), you are going to have a difficult time. This is just the reality, which we can complain about, but there it is.

There are strategies which can improve uptake and reduce resistance, but they only really work for large well-resourced vendors who are doing large projects:

1. Get the hospital to create a role for a doctor to be the clinical lead of whatever IT infrastructure you are trying to implement.

2. Bundle a large number of changes together, including obviously beneficial ones which save time (like an integrated EMR or paperless ordering) with important ones (like proper auth).

3. Make sure the institution has a lot of skin in the game, usually due to a large financial investment, or meeting some performance indicator, or keeping up with another competing institution.

4. Get the institution to reduce the workload when new systems are being implemented. This might sound obvious, but it makes a difference if you give doctors a bit of breathing room to adapt to a new service.

5. Publish some metric of how well each group of doctors is using a service in an email each week that gets sent to everyone.

6. Constantly remind everyone of why things are better after something has been implemented. I get hospital wide emails all the time about bake sales and other useless stuff, nobody sends emails celebrating or outlining why a recent change in IT infrastructure is making a positive difference. The only IT emails that get sent are when something is broken. Not surprisingly, this makes everyone sceptical of any new IT system.

7. Avoid direct face to face contact between doctors and the IT vendors. Doctors don't want to talk to the IT people, and IT people don't want to talk to the doctors. It just isn't useful, and everyone leaves feeling unsatisfied. Disconnect the technical expertise from people that don't understand why it matters. Find some other way to interact, through support staff, clinical leads etc.

This stuff is part of the moat which large EMR providers have, they can actually do this stuff. I have seen it at play with Epic, whatever you think about the software, they have worked out some of the sociological aspects, and they understand that once the EMR is delivered, the process doesn't end.