Comments on: Readers Respond: The Exorbitant Cost of Meaningful Use

By: Paul Knapp, FNP

Paul Knapp, FNP — Tue, 13 Sep 2011 22:50:16 +0000

The spirit of disagreement show, that the EMR systems offer positives and negatives. I have used EMR systems for over 5 years, and like the positives they offer. However, the angst presented by Dr. Schoeffler represent very real frustrations and the other aspects presented by Dr. Wolin regarding the lack of interoperability represent justifiable concerns. While the systems benefits insurers and government most, the move by those in the IT field to use more practitioners in forming systems shows that some of the complaints have been heard. In the end, what do we really want EMR to do for us as providers? Help us take better care of our patients and make things better for us. In a nutshell, that about covers it. On the cost issues side, if it can do that, each of us will have a number in mind regarding what that is worth to us. None of us like having things rammed down our throat. Most of us worked half our lives to get where we are and don’t like someone with an alternate degree lecturing us on how to do our job any more than they would like us telling them how to do theirs. In the end, working together will require greater interoperability among systems, improved security measures to protect our patients (and us) from predators of various sorts, improvements to the flexibility of systems to change to meet our needs, and making it more user friendly both in use and in reporting (so we are not embarrassed when we send our chart to a fellow medical provider for specialty care.) That should sum up our goals and like it or not, medicine and IT need to roll up our sleeves together, wade in this together, and make these goals a reality within a cost that everyone can live with.

By: Frank Cohen

Frank Cohen — Fri, 08 Apr 2011 10:20:11 +0000

Our study showed significant differences between expectations and reality. For example, those who responded that they did not yet have an EMR estimated implementation time to be around six months. Those that had succeeded (whatever that means) in achieving full implementation (whatever that means) said it took them, on average 24 months. I see the biggest benefit to EMR is that it gives the government (i.e., DOJ, OIG), a sole-source and easy access to all of the practices records. Bottom line? It’s not that physicians are not ready for EMR, it’s that EMR is not yet ready for physicians.

Frank Cohen

By: Al Borges, MD

Al Borges, MD — Thu, 21 Oct 2010 09:34:20 +0000

Great job! I got $60000.00 per year when I published a similar column- http://www.hcplive.com/publications/mdng-primarycare/2009/Mar2009/PC_Medicare_HIT_mandate

Our numbers are most likely too conservative, as they don’t take into account other costs (s.a. hardware maintenance).

By: Keith Kriet

Keith Kriet — Thu, 16 Sep 2010 20:37:14 +0000

We are witnessing what the slow slog of a species toward extinction looks like. Physicians as independent operators of medical practices are in decline, as they have been over the past 40 years. There are several environmental drivers of this trend towards extinction, and their influence and significance ebb and flow over time, but make no mistake, they are marching independent physicians inexorably in a single direction.

EHR is a management tool. However, its function is not to serve the individaul doctor or patient, but rather to serve the government and private entities that will benefit from the measurment and control of health care processes at a system level. The “high volume” specialist will not benefit from adoption of a meaningful use EMR. But the entrepeneurial doctor won’t be around much longer anyway. A new generation of doctors is being trained on EMR’s, and they will accept the lower level of productivity and their role as data entry clerks because it will be all they know. For the most part they will become employees of large multi-specialty clinics and healthcare systems, and find either contentment or disaffection with their status as just another brick in the wall.

The pertinent questions in evaluating the ROI of adopting EMR are 1) how close are you to retirement? and 2) if you’re not ready to retire, how driven and adaptable are you to continue to practice independently? To employ a metaphor, this climate change is real. Hardy and adaptive individuals will survive during their professional lifetimes, but independent and entrepeneurial physicians as a population are drifting towards extinction.

As the manager, spokesman and spouse of a solo specialty practioner, I’m persuaded by neither the carrot of incentive payments nor the stick of penalties to adopt a “meaningful use” EMR at this time. We will wait for the vendor market to consolidate, and possibly the pace of change may ebb with shifting political fortunes, but we will either retire or find refugia in some backwater niche within my wife’s specialty before she becomes a data entry brick in the wall of “meaningful use.”

By: Mitchell Jay Wolin, MD

Mitchell Jay Wolin, MD — Fri, 30 Jul 2010 20:54:49 +0000

I was asked recently by a friend why the government is so intent on forcing EMR on all physicians. Since EMR systems that currently exist can not communicate among each other typically (such as getting the patients lab and MRI results from whatever institution did the work – ideally even in the absence of the patient knowing where the study was done which is a frequent problem!), then the most important reason for the government to push EMR does not exist with current systems. In other words, improved communication among medical providers should be the real reason to push EMR, but it is not. Therefore, I can only conclude, as have others, that the primary goal of universal EMR systems is to increase and maximize government control over the practice of medicine. Otherwise, the government would accept that doctors actually have the patient’s best interest at heart, and we do what we feel is justified in regards to adopting EMR or not.