Meaningful Use – Doctors Have No Choice

In a recent article at Physicians Practice, James O/’Connor, MD describes well the current EHR climate:

Physicians’ responses are all over the map. A surprising number of our colleagues still don’t know about meaningful use. Some doctors plan to ignore it altogether. (It appears that the fewer the number of years to retirement, the greater the apathy towards meaningful use.) Some practices are optimistically and enthusiastically making plans. Others are revealing their ambivalence, wrestling with the question “should we or shouldn’t we?”

I whole-heartedly support the adoption of electronic health records. I was an early adopter in my own practice and have spent a good deal of time in the industry. I am aware that the majority of my colleagues remain resistant to EHRs.

Nonetheless, the pros and cons of meaningful use are not really the problem. The problem is that, once again, we physicians are subject to a mandate over which we have little control and no choice whether to comply. Is this surprising to you?

He then goes on to make the case for why doctors really don’t have much choice but to comply with meaningful use of an EMR system. His reasons are essentially:
1. HITECH EHR penalties
2. Major Insurer adoption of meaningful use
3. ABMS Maintenance of Certification program adoption of meaningful use
4. Board Certification meaningful use requirement

We’ve talked about pretty much all of these reasons in the past on EMR and HIPAA.

1. The EMR Stimulus Medicare penalties don’t amount to a whole lot.
2. I think major insurance companies are in wait and see mode for commercial insurance adoption of meaningful use. They definitely want more data, but I think they’re not sure meaningful use is going to give them that data.
3. I don’t know much about ABMS and how that works for cash only doctors. Maybe someone can tell me why this matters in the comments. I guess you need this certification to practice medicine on a cash basis?
4. I thought I wrote about this before, but I can’t find the article. I guess it’s possible. Isn’t board certification done on a state by state level? I must admit that it just seems weird that to practice medicine you somehow would have to show meaningful use of an EHR. What about recent grads? I don’t know, this just doesn’t make much sense to me.

Dr. O’Connor describes the choice as follows:

OK, so technically, we do have a choice. We could stop taking Medicare and Medicaid patients, accept cash only, give up our board certification (and thus usually hospital privileges), and move to a state (or country) that doesn’t impose EHR requirements. But is that really a choice? No.

He does then encourage active participation in the discussions of meaningful use so that you can affect it for good. I agree this is a good thing and an important act. I believe Meaningful Use stage 2 will be greatly impacted by 1. public comment and 2. experience in meaningful use stage 1. It’s important that doctors are part of this conversation or I think they’re going to be unhappy with MU stage 2.

About the author

John Lynn

John Lynn

John Lynn is the Founder of, 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,, 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.


  • John… Nice edit of Dr. OConnor’s longish piece.

    Read it in its entirety too in hopes of reading all the positive things he would say about how being an early adopter had improved his practice. Not a peep.

    Very telling is that his lead negative for why docs have no choice are the 2015 CMS penaties kicking in. “Sticks” don’t work on 4 year olds, dogs, or docs … and only 2 get you thrown in jail.

    He closes his piece with 4 suggestions to counter pressure to adopt:

    1. Submit comments to the Office of the National Coordinator (ONC).

    2. Contact your specialty organization and initiate a grassroots movement to push back against the ABMS mandates.

    3. Get your state medical association involved.

    4. Call your state legislators and let them know you expect them to protect doctors’ interests.

    That’s all disappointing and surprisingly negative given that he is co-chair of CCHIT’s Clinical Research Group. For right now anyway.

  • I fail to see how specialty boards could have the expertise or authority to evaluate meaningful use of an EMR. Where did that rumor get started?

  • I agree with Brian and would extend the idea that all of these sky is falling, doctors have no power in the future, bla bla bla predictions of the future sound like a lot of hogwash. Where is he getting the street credibility to make these assertions? Mostly, this just sounds made up. If anything passes into law eventually, it’s usually a very watered down version of the original proposal.

  • John- the state Medical Boards are responsible for licensure. This process varies from state to state. The “Board Certification” process is a national system that is specialty specific and is supposed to ask questions about medically related content. With this MU stuff, they are now embarking on political/medical useless questions which is something relatively new. They will be easy and useless. They will highlight the MU debate, but will fail to get physicians in the sidelines to waste multi-thousands of dollars on the concept of the EHR.

    Barbara Duck yesterday posted an article about what MU will most likely ultimately do to the small office/solo practitioner office. Many will join large groups, many will cut down and work part-time, many will choose to work in non-clinical jobs, some will even retire. The bottom line is that you can’t mandate doctors to for free or for a minimal profit margin. I’ll add several other things that will most likely occur: the medical office will eventually consist primarily of poorly trained PAs and NPs which are hopefully kept from making mistakes by using “smart” EHR systems in what President Obama refers to adding “quality” in our medical environment. I also envision that medical school applications will begin to fall once the current recession goes away. It’s incredible that with one of the worse recessions in over 80 years, and with female applicants at high levels, admissions to medical schools have remained flat. Usually healthcare is viewed as a career which is safe and is associated with a good lifestyle. Not any more…

    To sum it up: doctors do have a choice… many of them.

    Barbara Duck’s article can be found here:

    “Healthcare Reform Survey Finds That 74% of Physicians Will Retire, Work Part-time, Or Seek Other Alternatives”

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