One Doctor’s View of ePrescribing and Meaningful Use Incentives and Penalties

I came upon this comment from Kay Kirchler, MD in regards to the ePrescribing penalties and other government incentive money for health IT. You’ll have to overlook the poor grammar and abbreviations, but I wonder how many other doctors feel the way Dr. Kirchler does.

who made all these rules and why are we just lying down and taking it? the arbitrary requirement for “10 escribes ” by june 30th or “penelty” when our emr ( we have had emr for >>10 yrs) will not escribe due to delay in “retro-fitting ” our emr instead of spending yet another fortune for a new “government approved ” version. the requirement to print out visit note to be available w/i 3 days rule .. rediculous. pts dont want it , not going to pick it up, costly and opens door for pts info to be floating out in parking lots, garbage cans etc .. i could go on for days. i spend more time loading info in emr ( much more w “meaningless use” than i do taking care of the patient .why are we not organizing to stand up and fight this power grab !!!!

The line that gets me is the one where he says that he spends more time loading data into the EMR than he spends with the patient. As a patient, the idea of this just makes me cringe. However, it’s a reality for many.

The other part that is quite interesting is that there really haven’t been many physician voices in all of this. There’s definitely not been any #OccupyMeaningfulUse protests happening by doctors. The closest thing I’ve seen to doctors rising up against Meaningful Use and other government programs for health IT has been at medical association conferences where doctors have gotten quite worked up. However, the message rarely leaves the medical conference. Plus, the majority of doctors in the room just shake their head, but don’t do anything after that.

I imagine many doctors look at it and see EHR software as the inevitable.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the, 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, I do sympathize with what Dr. Kirchler wrote. I’ve interacted with enough providers to have my own sense of what’s going on. Of course, l also see all the stats about EHR Adoption and associated benefits and costs (with a grain of salt of course). I think EHR is inevitable and pioneers like Dr. Kirchler will burden much of the pain as most pioneers of new technologies do. From my personal experience (and supported by many studies), EHR adoption and use is not only inevitable but the right path to take. We HAVE to apply technology to make our healthcare delivery better. Virtually every other industry got better with technology and healthcare will be no different. The next generation of doctors will be the benefactor of the challenges pioneers like Dr. Kirchler is facing today. However, as each day goes by, I am starting to see more and more providers appreciating what the EHR can do for them and their patients. The vendors, consultants and even healthcare leaders, part of our key contribution is to help lessen the transitional pains pioneering providers are experiencing. For my part, that’s helping providers to achieve meaningful use in a “worry free” way.

    One more thing. The specific example about the arbitrary requirement for 10 eRx by 6/30 or penalty… I don’t agree with many of them but you got to set the bar somewhere. I think CMS/ONC has shown that when things are really off from their initial plan, they make the logical and right decisions to adjust. It’s not perfect of course, but given the scope of it, I do think the government is doing a decent job.

  • Our Healthcare IT blog has interviewed a few providers on this subject, and Meaningful Use seems to be a mixed bag. Some doctors see the potential for it to help, but not the actual results at the moment.

  • David Lee,
    I think you could definitely make a great argument that CMS/ONC has done a good job with what they were given. Those that I’ve met are absolutely sincere in their effort.

  • Suck it up, doc. I want my health taken care of, not just the few things you remember about me. So, put it in my file, remind me when I’m due for services, offer me procedures with a proven track record; take care of me! None of this would you do with chart pulls. If you won’t or can’t, I will find a doctor that can.

  • @Ned Fraser – No problem, sir. All you have to do is pay for the time it takes to do as you ask.

    As long as the government/an insurer is paying me a fixed fee for seeing you, I just don’t have that time, and I’m afraid their rules don’t allow me to bill you for the extra work on my part. I’m only able to fill out forms, or provide care, and I choose to provide care; I’m not being paid enough to do both. There are alternatives, however.

    I’m sure that you’ll be able to find a nurse practitioner, or maybe even a primary care physician, who will spend as much time as needed filling out your forms. They will then refer you to a specialist for your actual diagnosis and treatment. They may be able to populate their forms based on information provided by your PCP, and thus able to pay attention to your actual health problem. After several visits, several copays, and several physician payments by your insurer, you should have both a complete EMR and the care you seek.

    Good luck with your health, and enjoy the benefits of your excellent health care documentation.

  • As a concerned dentist who has hesitated from becoming a HIPAA covered entity – even against the advice of respected dental leaders who more than 5 years ago said it is inevitable – time offers redemption. Even as badly as government-approved, one-size-fits-all, EMRs and MU mandates fit small physicians’ practices, just imagine how those socks fit dental practices where we have only 10% of the number of active patients you have, we almost never send out for lab tests, we only bill for procedures in the lower 1/3 of the face and computerization does nothing to speed up doing fillings on squirmy kids.

    What’s more, the telephone, fax and US Mail which don’t require increasingly expensive HIPAA compliancy, have adequately served the dental profession for decades. The bottleneck in dental offices isn’t the paperwork (not yet), it’s the dentists hands… and squirmy kids.

    It is frank, open conversation like Dr. Kirchler’s concerning the hidden liabilities of EHRs that the nation needs right now rather than unresponsive stakeholders’ giddy press releases which don’t allow providers’ concerns to be heard.

    Just this week, following a NextGen Facebook ad for their electronic dental record system, I asked, “Isn’t it true that EDRs are both more expensive and more dangerous to both dentists and patients than paper dental records?” When nobody responded, I asked even more questions about their products’ cost and safety until an anonymous NextGen employee censored my questions and blocked me from posting any more.

    Tell me. Is that any way to treat customers whom NextGen would have purchase evidently lousy EHR products? What happened to transparency with consumers about a product’s cost and safety? And what happened to accountability to the customer, for crying out loud?

    Perhaps it was a misguided moderator acted on her own volition to censor and block me in an unwise attempt to protect her employer. If it were a Wal-Mart store, I would ask to speak to a supervisor, and one would be found. At NextGen, troublesome customers who are thrown out of the store by anonymous employees have no recourse… other than to publicly warn other dentists to stay away from NextGen’s expensive and dangerous EDR systems.

    D. Kellus Pruitt DDS

  • A reminder for HIPAA/HITECH covered entities: The Office for Civil Rights is expecting data breach confessions next week. Be forgiven or targeted.

    Doc, if you are considering ignoring the reporting deadline simply because your practice hasn’t experienced any breaches of patients’ identities in 2011, let me first of all tell you congratulations on your spotless privacy record. Though that’s certainly an admirable accomplishment all providers should strive for, this is not the time or the environment to take a bow. This is a time to blend in.

    Even the most secure practices should be aware that since the frequency of data breaches from healthcare organizations has reached epidemic proportions, ambitious KPMG auditors working on commission for OCR are well aware that virtually all healthcare organizations with electronic records have suffered reportable data breaches in 2011. You can imagine the amount of unwanted special attention a HIPAA success story could attract these days.

    If you haven’t listed any breaches of 500 or fewer of your patients’ identities yet, between now and Wednesday, you might want to help a formerly careless employee or two recall how you sanctioned them for something like allowing a UPS delivery person to accidentally glance at a patient’s digital medical history. Or, maybe for leaving an unattended computer within reach of a patient (I think HIPAA actually protects a doctor from having to reveal the patient’s name). Anything would be preferable to a blank page under your NPI number, and it helps if you get your stories straight with staff members who learned a darn good lesson from the experience.

    You’ll certainly be unpopular around the office for a while, but according to attorney and former OCR official Adam Greene, “… entities that have never imposed an internal HIPAA-related sanction may have a problem.” He added that not having issued a sanction “doesn’t mean you have never had a HIPAA violation.”

    Regardless what triggers a HIPAA audit, suppose a humorless KPMG employee just happens to be having a really bad day. Providers should do everything possible to avoid the risk of obscene fines for willful neglect which easily can bring an end to an honest practice. If you are a HIPAA covered entity, take the former OCR official’s advice and sanction someone if you haven’t already done so, and do it before Wednesday.

    I ask you. If I wasn’t here to warn of these liabilities, who would?

    D. Kellus Pruitt DDS

  • In the Wealth of Nations, Adam Smith argued that unrestrained collusion between government and industry is harmful to the general population. The politics of current healthcare is not unlike the environment during the mercantile era of the late 1800s.

Click here to post a comment