Another Perspective on Meaningful Use and EMR

Tom’s previous guest post about meaningful use and healthcare IT seems to have struck a chord with some of my readers. Here’s an example of one email (posted with permission) from the always passionate Al Borge, MD, I received in response to Tom’s post. The most interesting part of Al’s email is his last comment about the Medicare penalties that ARRA will impose.

>>> As for the burden of meeting Meaningful Use criteria being too stringent for small practices to meet, this is again an excuse to avoid change.

“Change” for change’s sake is not the way to go… the change that you are talking about is BAD change, and that’s not the way to go.

Look- physicians aren’t just a bunch of luddies that are ignoring high tech out of ignorance. When it comes to technology, we’re usually the first to buy tablet PC’s, the first to buy/significantly use the latest and greatest cell phones as well as have several internet accounts for our homes, offices, and for mobile apps. We buy some of the best cars on the market and cherish a whole host of other electronic “toys” that we use daily.

The problem with the EMR is that most of the EHR systems out there today are simply 1) unaffordable, 2) workflow killers, 3) are being coopted by Big Government in schemes like P4P that later are used against us to pay us less.

The vendor inspired dogma that the EHR saves money, decreases errors, and increases quality has yet to be proven in a side-to-side test against paper and against simple, basic EMRs. Until these claims are proven, most docs will sit on the sidelines. Most of us are not that stupid to believe this crap.

What we see is that a lot of lobbying money is being spent in an effort to get our politicians to enact laws to straddle physicians with the high cost and complexity of an “Obama” HITECH ready EHR, most of which have as high as a 50% deinstallation rate (based on numerous sources) and as has been recently reported by the CDC, owns only a 6% market share among practicing clinicians.

>>> Buying an EMR system and using only half the features will undoubtedly lead to the system not generating the ROI it is capable of providing.

As long as paper records or a “basic” EMR returns a good ROI, it’ll be a hard sell for vendors to force doctors into using a budget and workflow busting EHR.

>>> Being forced to meet Meaningful Use is a way of ensuring offices are using their EMR system in a way that will provide them with the benefits it is designed to provide.

This one is scary- under President Obama are we now living in such a Communist state that Big Government has the power to force its citizens, which in this case are physicians to go against their better judgements and to buy EHR systems that they do not care to use? You have to be kidding me…

This is truly a Healthcare train that is out of control. The day that I get hit with a Medicare 5% tax/penalty I’ll simply pass it onto my elderly Medicare patients as a yearly “Obama tax” thaty THEY, not I will have to absorb. No pay, no see.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

14 Comments

  • to Al in MD … EXACTLY!

    Another tact could be as decided by Mayo Clinic Arizona who simply ousted 3000+ Medicare patients from one of its local primary care clinics as a pilot test to stem Medicare losses.

    Really don’t care if there are Medicare reimbursement cuts if I don’t have Medicare patients.

  • DK Berry,
    Yes, I’ve talked a lot about that possibility. However, the idea of just passing the penalty on to the patients was one I hadn’t heard before. Both options seem likely. Although, that’s why I think it’s unlikely that the penalty will be enforced. Especially the expansion to 5%.

  • This is a passionate topic for the Physicians and its better not touched.

    As a EHR vendor and someone viewing this from other side of the table, I can understand the mis-trust with government and any/all government initiatives.

    At the same time, at some point, paper has to go; whether its now or 3 years or 10 years; so its a question of when and not if.

    There are quite a bunch of EHRs including ehiconnect.com (MDnet-that’s our product) that can customize the workflow to suit the existing workflow of clinic/s.

    ROI: EHR’s, especially SaaS model has become so in-expensive; just the integrated billing and claims alone will generate the required ROI not to speak of other efficincies. Yes, there will be a drop in productivity over a 60 to 90 day period and productivity will take a hockey stick curve.

    Anthony Subbiah

  • I think vendors have a parochial view of EHRs as money-making for them and thus they hope the EHR will prove good for their clients. I have joined a group using a certified EMR some six months ago. Frankly, it remains a pain to this very day.
    Some of the problems with the EMR are klutzy Windows XP problems and some may be traced to the sluggish response from the servers, because it is web-based (in-house server) and 20-30 people are sending and receiving tidbits every minute or two. Additionally, every document scanned goes in and comes out as a TIFF file.
    There may be some efficient EMR/EHR programs out there. The one I left in my solo office was pure cut and paste the last visit and edit/add or subtract for this current visit. But it was clean and clear. I am not happy with my current EMR and few others in the group are happy either. The doc who chose it still believes in it and programs little special parts of it. Nonetheless, it is “in the way” and its “helps” are scarcely worth it. I remain hopeful of improvements, but that hope is gradually fading.

  • “This is a passionate topic for the Physicians and its better not touched.”

    Those are my favorite topics to write about. I like saying what no one else feels they should say.

  • DocJim,
    Thanks for commenting and sharing your experience. I hope that you’ll join in on the conversation more often.

    The sluggish response you’re talking about is an excuse for a weak software product/EMR implementation. Especially when we’re talking about 20-30 people on an EMR, your EMR should be able to handle that without blinking an eye. It’s another issue if you’re talking about 200-300 locations starting to get sluggish.

    It illustrates how USELESS EHR certification is. It gives doctors the impression that they’re buying an EMR product which has been certified for useful items like speed and scalability of the software. I can certify a spoon to have the ability to dig a foundation for a house, but that doesn’t mean that it’s the right tool to use even if it can do it.

    Sadly, the EMR market is going to be around for a long long time with people switching from these slow poorly done EMR software/implementations to new EMR implementations.

  • Just so I’m clear, I can’t tell where Borge’s comments being our end. Which one of you called America a Communist state?

  • Andrew,
    The comments Al’s responding to are in italics. Al doesn’t specifically call it a communist state. He questions if America’s become like a communist state where it would force doctors to do things.

  • Anthony …

    “This is a passionate topic for the Physicians and its better not touched.”

    Too late. It’s been touched plently.

    “At the same time, at some point, paper has to go; whether its now or 3 years or 10 years; so its a question of when and not if.”

    The issue is not paper versus electronic records. The issue is the governement mandate that will have to be paid for WITHOUT ANY CLEAR assurance that productivity and quality gains will be forthcoming. Beyond that there are potential government administrator instrusions potentially resulting from their oversight of how a physician treats his or her patient that does not match what “they” think is how you should treat your patient.

    “Yes, there will be a drop in productivity over a 60 to 90 day period and productivity will take a hockey stick curve.”

    Do you have a peer reviewed study with statistical significance to back that up? If you did you would have included it in your original post. Can you supply medical journal study details that document a 60 – 90 day turn?

    In my most recent experience the only growth that follows the “hockey stick curve” is the growth in EHR vendors and products since the Stimulus Bill was signed.

  • “Do you have a peer reviewed study with statistical significance to back that up? If you did you would have included it in your original post. Can you supply medical journal study details that document a 60 – 90 day turn?”

    I don’t have a peer reviewed study, but I have tons of empirical data from experience about this topic. Although, from my experience there’s a dual curve. One that’s a 60-90 day turn with the hockey stick curve. The other is an essential flatline where the clinic sees little benefit. The second are the ones that hate their EMR. I’ve seen very few clinics in the middle.

  • Berry,

    ‘Do you have a peer reviewed study with statistical significance to back that up? If you did you would have included it in your original post. Can you supply medical journal study details that document a 60 – 90 day turn? ”

    There is a good study done by MASSPRO some time back; its a rather large document and if you care to share the email ID., I can send it over to you. Just as an FYI. And if I find any other document, I will certainly share it with you.

    Cheers

  • John – agree with you on this. Yes; there are dual curves on productivity. While productivity gains/losses can be measured, the soft benefits that ultimately will enable a paradigm shift in Health Records and the benefits that all patients/providers stand to gain is subjective and will probably be visible 36 months down the road.

    Anthony Subbiah

  • Anthony,
    I’ll connect you with DK Berry so he doesn’t have to list his email address on a website. Then, he can give you his email if he’d like.

  • Hmm, a touchy subject indeed. Money always is, and (un)fortunately (take your pick), it’s a part of everything, including medicine. I tend to agree with John here: if we’re still kicking SGR cuts down the road (fully expect a last minute extension at the end of this month), I don’t see the government making substantial, widespread cuts (that’s of course assuming that 2016 will not, in fact, see “an EMR in every medical home,” to paraphrase Hoover).

    Just to add even more spice to the drama, though, there’s a different, political angle to consider with the HITECH timeline: the 2012 presidential election will have seen two years of this program in action. As tough as this fall’s midterms look, 2012 will certainly be a battle year for both parties. Any and everything (especially relating to the world of health and medicine) will be debated, and you can bet that HITECH’s success or failure (as measured by vastly different sources) will be pontificated on. I make no predictions on what will happen, merely comment that political scene is an ever-changing variable which will certainly come into play as HITECH procedes.

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