I was reading a message from a doctor recently that really struck me. He commented about the impact of meaningful use on his EHR use and said that he’s now “trying to figure out what to do next instead of trying to figure out what is wrong with a patient.”
I’m sure some doctors will come on here and argue why the person experiencing this is a bad doctor and why they should always be focused on patient care and not checking the next box. While there’s always a balance in everything we do, the comment from this doctor really struck me because it describes really well the way so many doctors are being trained to use their EHR. They literally have people auditing and tracking them to make sure that they’re checking the right check boxes so they can meet meaningful use. This type of hyper focus on checking the right boxes and punishment when you don’t changes the way someone practices medicine.
I always love when people comment that many doctors didn’t like the stethoscope when it came out. They use that story to explain that many doctors don’t like EHR software, but that they’ll come around the way they did with the stethoscope.
While there’s some merit in this analogy, I can’t imagine there was anyone watching how a doctor used the stethoscope to ensure that it was used in a specific manner. That’s what we have going on in the EHR world today. Meaningful use is so prescriptive in its requirements that it overwhelms a doctor to the point of affecting the quality of care they provide.
Think about the efforts that are being made by EHR vendors and EHR consultants to take the meaningful use load off of a doctor’s back. Everything from changing the design to meet the MU requirements without a major change to workflow to offloading as much of the meaningful use requirements to someone other than the doctor. If meaningful use really was of value for doctors, why would they have to go to all this effort to avoid doing it?
The original stethoscope was a short tube made of wood with a central channel, not dissimilar to an empty toilet paper roll. It had minimal functionality, and was barely better than putting your ear on the patient’s chest.
http://www.antiquescientifica.com/web.stethoscope.monaural.laennec.htm
As such, I think that it is a great analogy for today’s EHRs. They are barely better than paper. Like an empty toilet paper roll, they show the promise of what might be by barely delivering on that promise.
Had government gotten involved in the 1820’s, when the stethoscope was invented, they may have created “Meaningful use” for the stethoscope, telling the Doctor that everything must be done with the stethoscope, and that no alternative instruments, techniques or senses could be used (The way the administration often says that specialty specific software that has tremendous functionality must be replaced with the rudimentary or absent functionality of the EHR.)
The equivalent is if some Office of the National Stethoscope Coordinator in the 1820’s told Doctors to use the stethoscope for everything. Stopping them from using their nose (Smelling the urine), their eyes (Seeing skin lesions), or their hands (Feeling for an enlarged liver)
Laennec’s idea had promise, as do EHRs. But spending $40,000,000,000 to mandate the use of empty toilet paper rolls seems like a bad idea.