I have operated an electronic medical office since the summer of 2002, way before the advent of CCHIT and the HITECH Act. It was obvious to me that a well-implemented EHR would bring immense benefits to both my solo Endocrinology practice, as well as to my patients (notice I did not even think of any 3rd party!).
Even though we started out as a mom & pop operation in a tiny old office building, we took time to research and spent what little money we could spare, to team with a small vendor to create a product that functioned like the third partner in our practice. We were one of the earliest to eliminate the physical fax server, most likely the first in the area to send out consultation reports within 24 hours of an office visit, create HL7 links with leading national laboratories (2006). And, we were one of thirty Internal Medicine/Subspecialty practices that took part in the Center for Practice innovation (CPI) project with the American College of Physicians (2006-07). We even created a unique device that can pull blood glucose data from multiple meters into a single format directly into a patient’s chart. So, one would expect that we would heartily celebrate the concept of “Meaningful Use” that the HITECH Act introduced and the PPACA promoted.
Quite the opposite! We quickly realised that what the government considered as “meaningful” was far from what we had experienced to be meaningful to us and our patients. In fact, the criteria used in the first stage of Meaningful Use were so simple that it took us a few minutes to generate reports. This was utterly disappointing. So whenever another physician called to ask me “how do we get the $44,000 for meaningful use?”, I would dissuade him/her from going electronic just for that reason.
Over the past 2 years, it has become amply clear that neither the government nor the physician practices that continue to provide Meaningful Use data, are doing anything “meaningful”. In fact, this has simply become a data-gathering tool for the policy-makers and the payments for such efforts are proving to be far less than the costs associated with the effort. And now, the distinct possibility of a CMS audit looms above.
So, what has all this done to me, a wholehearted supporter of IT use in healthcare? It has driven me to discouraging physicians from considering an EHR! I am still a believer, but not in a centrally-planned method of digitizing, with fake promises of financial incentive. I support digitizing based on the real-world incentive of using IT to meet each physician and patient need. As we know, banks and airlines did not need government stimulus to introduce ATM’s and Kiosks, respectively. I ask that physicians demand the same freedom – to innovate in a marketplace free of governmental interference and influence. Let our patients decide that a well-designed IT structure at their doctor’s office, one that benefits and is “meaningful” to them, is worthy of a few dollars every year. Let’s say goodbye to “Meaningful Use” as defined by the government and partner with our patients to define what real world meaningful use should look like.
Arvind Cavale MD is an endocrinologist in private practice, you can follow Dr. Cavale on Twitter @endodocPA.