The Growing EMR Tea Party

I wrote a post a few months ago asking if meaningful use will put medicare in a bad position. In that post, Dr. Borges makes an argument for why meaningful use is going to have a negative impact on Medicare. In the comments, David Swink offered this additional comment about what he calls the EMR Tea Party:

I agree with Dr. Borges. He, and many other physicians of like mind, compose the EMR Tea Party — those who do not object to the modernization of record-keeping, but do object to the top-down “carrot-becomes-the-stick” approach to EMR that is being foisted on them. He is a medical John Galt (of Atlas Shrugged), who is more likely to retire or otherwise deny his talents as a “Giver” to society than to succumb to the diktats of the “Takers”.

The idea of a physician EMR Tea Party is quite interesting. I have seen a number of doctors like Dr. Borges that are leaving Medicare to avoid the meaningful use requirements. I’ve also seen that pretty much every doctor I’ve ever talked to would love to stop taking Medicare. However, I’ve also seen that a large majority of doctors don’t have that option because so much of their patient population is on Medicare. Plus, some percentage of those doctors don’t want to leave Medicare patients high and dry.

With this in mind, I’m not quite seeing the leave Medicare Tea Party getting that much momentum. However, I am seeing an EMR Tea Party that is swelling among doctors that want their EMR software to improve productivity, improve patient care, and allow them to be doctors instead of data entry clerks. This growing movement is much more powerful.

Meaningful use has a major impact (mostly negatively) on these desired EMR results. You might remember my post on the EHR Certification excuse as an example. I think this is also a reason why we have yet to see any private payers requiring EHR certification or meaningful use. They don’t want to anger doctors by requiring them to do many things which are unnatural to their current workflow and provide little value to the payer.

The real question is how big will this EMR Tea Party get over time. Not to mention, as more hospitals acquire ambulatory practices, will doctors have the influence they need to affect these changes?

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.

12 Comments

  • John,

    While absolutely right, you’re also absolutely wrong. You’re right that there’s a growing movement “brewing” among “doctors that want their EMR software to improve productivity, improve patient care, and allow them to be doctors instead of data entry clerks.” But “EMR Tea Party” is a terrible analogy. I hope it does not become a popular catchphrase. It’s just too polarizing. Not sure what a better analogy would be, or that we need one. However, as usual, you’re right about the important stuff. Good on you, for that!

    –Chuck

  • So, you agree with the idea, but not the naming convention. I’m fine with that. When I saw the term it reminded me of the #OccupyHealthcare hashtag that was thrown around for a while. The other day someone was asking about it and what ever came of it. The answer was nothing. Something will come of doctors unhappy with EMR software. I’m just not sure exactly which direction it will take and how widespread it will grow. Reminds me a bit of another post I did today about the Stockholm Syndrome: http://www.hospitalemrandehr.com/2012/11/08/does-the-stockholm-syndrome-apply-to-emrs/

  • dangerously underinformed opinion:

    when your EHR provider will drop support if you attach a non-approved fax server (buildable and robust for <$300 using open source software), and their approved fax server is $50k, if theres no standards adherence or data export capability you have no choice but to comply — they have all your patient data. until medicare mandates meaningful interoperability and data export, physicians will carp about it but management will say suck it up, we have too much money invested in this already.

    there is no possibility of "voting with your feet" or "voting with your dollars" currently. so nothing will change.

  • Not the Droid,
    I think your comments are spot on for doctors in hospital systems. I don’t think that’s the case for ambulatory EHR vendors. Although, they’re doing all they can to not be taken in by the behemoths around them trying to gobble them up.

  • actually, my example comes from a small group practice setting. “even though our support is crap, we’ve put >$1m into it already and cant afford for them to drop what little support they do give us”

    i think it certainly exists for hospitals too — the market i’m in, everyone is on Big-Name EHR Vendor’s software, and despite this noone can talk to each other. there is no incentive to do so (why would you make it less difficult for a patient — read $ — to go to another system?) so the standards need to be mandated. from what i understand this is not the case, and vendors will doubtless strongly lobby against that.

  • If your EHR implementation is up to $1 million+, then it can’t be that small of a practice. Or you got ripped off. Although, you’re right that a million investment in EHR means you can’t walk any more than a $1 billion investment from a hospital can’t walk.

    I’ve said many times before, I wish the incentive would have been for interoperable records. Then, you’d need an EHR to do it, but you could use whichever one fit your clinical needs. Plus, then it would incentivize something that has no incentive now. Too late to go back to that one I think.

    Nothing I’ve seen out there solves the problem of vendor lock in. Switching EHRs is a pain and a lot of practices are about to go through a lot of pain as EHR vendors consolidate, go out of business, shut down, etc.

  • As a frustrated young physician I decided instead of waiting for the EHR vendors to provide interoperability and portability for clinical template content that I would build a company with this mission in mind. We are working to help alleviate some of the pain of vendor lock in. We all know switching EHR is painful and so is recreating all your clinical templates from scratch. Our system also provides a way of accessing your clinical templates (or stamps as we call them) in remote settings when working on locums or when in hospital based clinics without requiring remote access to your full EMR. We think it is time for solutions designed with physicians for how we actually work and want to work.

  • Paul,
    I think Chuck hit the biggest challenge you’ll have. Getting EHR software to accept a solution like yours is going to be a huge challenge. If you can overcome it, you might be on to something valuable. Reminds me a bit of the open source UI I saw someone once creating. They were trying to just create a universal UI that could be used regardless of EHR. Not sure where that went since I haven’t seen it forever.

  • Paul,
    I’m curious about your project. I have an open-source EHR (NOSH ChartingSystem – there was an EHR and HIPPA post several weeks ago about my project) that aims to have similar fundamental design goals – primarily designing the interface for the physician in mind. I’m currently adding templating features to my EHR but I’d like to see if there is any potential for collaboration or interaction between my project and yours. Have you heard of the Direct Project – which aims to bring interoperability between EHRs? I’m hearing consistently that one of the problems with making interoperability a reality is that the EHR vendors are moving at a snails pace to participate – most likely for reasons that are economic and their aim of taking over the marketplace.

  • Hi John, Paul and Michael,

    A group of Rhode Island physicians is creating a EHR, PHR and HIE platform-neutral “Universal Interface”, but designed specifically as a point solution to enable the much more efficient reporting, viewing and sharing of cumulative diagnostic test results than is now possible using the antiquated, variable reporting formats that display only incomplete and fragmented data.

    Creating a proprietary or open source Universal Interface that includes all of the 350+ EHR functions CCHIT certifies would be an even more challenging, but potentially very valuable disruptive technology innovation project.

    Since February 2011, I and over 1,861 other volunteers have been participating in the Lab Results Interface (LRI), Lab Orders Interface (LOI) and electronic Directory of Services (eDOS) standards initiatives and other S&I Framework initiatives sponsored by ONC. (1)

    Based on this experience, from my perspective, the unprecedented combination of the S&I Framework’s portfolio of interoperability standards (for data transport, vocabulary and content exchange) (2), the federal certification of over 1,682 complete ambulatory and inpatient EHR products from more than 700 vendors (3) and the three stages of MU objectives and measures are already creatively disrupting HIE 1.0. (4)

    However, what is still mostly overlooked is that in order to overcome the longstanding healthcare interoperability challenges that were really never fully addressed in the fee-for-service, unaccountable delivery system marketplace, since 2009 these initiatives have been based on a collaborative, open source, private/public sector innovation model using ARRA/HITECH funds. In the seller-dominated, proprietary data silo era, the health IT sector and its 250 EMR and EHR vendors had no incentives to be concerned about physician complaints about products that were grossly overpriced, clunky and cumbersome to use and disrupting to workflow and productivity.

    The positive news in 2012 is that with successful implementation of fee-for-value, accountable delivery system (ADS) models, the successful vendors of EHR, PHR and HIE platforms will be forced to dramatically improve the usability, functionality and price of their products and also ensure that they provide seamless, “plug and play” interoperability with other certified products.

    The negative news is some recent evidence that the nationwide interoperability advancement efforts are being inhibited by some ambulatory EHR companies who are still quoting excessively high interface development fees. (5)

    Within the expanding, but fragmented and immature markets for EHR, PHR and HIE products, it’s probably a good idea for competing vendors to consider the marketing implications of the 16 multi-stakeholder coalitions working to advance interoperability and the joint efforts underway to standardize, commoditize and test EHR-HIE and HIE-HIE interfaces by the EHR-HIE Interoperability Workgroup (IWG), Healtheway and CCHIT.(6)

    I’d be happy to discuss these issues with you in more detail as they evolve at any convenient time.

    Bob Coli, MD

    (1) http://wiki.siframework.org
    (2) http://www.youtube.com/watch?feature=player_embedded&v=s8wj4JAmSJM
    (3) http://oncchpl.force.com/ehrcert
    (4) http://www.slideshare.net/jasnaani/emerging-standards-and-the-disruption-of-hie-10
    (5) http://chilmarkresearch.com/2012/10/12/moving-to-hie-2-0
    (6) http://www.nationalehealth.org/ckfinder/userfiles/files/Workgroups/interoperability_coalitions_v2_082212.pdf and http://www.hieanswers.net/a-layer-above-it-all-healtheways-value-prop

Click here to post a comment
   

Categories