“If you build it, they will come!”
—Field of Dreams, 1989
But what if they don’t?
A consensus is building among physicians that—as HIT pundit Paul Roemer responded to last week’s post—there is a “very real possibility that there is no ROI for Meaningful Use.” Vince Kuraitis, J.D., and David Kibbe, M.D., have suggested that “key physicians will sit on the sidelines“ and that the incentives are too small to motivate specialists. As 2011 approaches, many more physicians will come to the same conclusion—there is no business case for pursuing the government’s definition of meaningful use.
This is not a debate over the value of practices going digital—my position on that is crystal clear. The quality of care, patient service, and economic benefits of implementing the right EMR are substantial. But physicians behave rationally and make decisions that benefit their practices, their patients, and their bottom lines—they realize that purchasing the type of EMR that does not meet their needs just so that they can spend their time satisfying the government’s request for data is not in their best interests.
I am asking readers for their thoughts on how the government’s program will actually unfold. What do you hear from your colleagues? What will happen if very few private-practice physicians participate? What if—like PQRI—only a small percentage of physicians are successful at obtaining the incentives? What do you do think David Blumenthal and HHS should do to increase the odds of success? (I gave Dr. Blumenthal my advice recently in an “Ask the Executive” column in HISTalk.) Please share your opinions by posting a comment.
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OMG, Evan, that “great minds” thing is true….
Back in March, I called it “Health IT Strategic Framework – Field of Dreams”
http://onhealthtech.blogspot.com/2010/03/health-it-strategic-framework-field-of.html
I think you’ll agree with my premise to “please simplify”.
As a Family Physician utilizing IT since 1990.
And having written about this, talked about this and lectured about this. They may be getting it. Physicians won’t and can’t invest in IT without the guarantee and upfront subsidies, when it comes to issues of their bottom line. Especially in Primary Care and especially in view of constant threats and cuts from Medicare, Medicaid and ongoing poor reimbursement and constant heeping on of more and more red tape, paperwork etc by Insurers on physicians.
Physicians won’t be jumping on board this train.
Those of us who have invested and have utilized the technology will also continue to struggle to maintain this investment, support and upkeep and upgrades.
If the Government and the Insurance companies want the data. Let them fund all of us presently on board and let them provide and foot the cost for those others to get on board.
I have yet to discover how the “up to $40,000″ incentives will be determined. I admit my following of the issue is intermittent at best
I assume the stimulus will be a percentage of annual medicare billings paid as a year end bonus paid after the fact.
where is the method of determination of the stimulus amount to be paid to each practitioner defined
are all midicare billering disciplines included? is Optometry included?
Actually, there is another issue that is coming up in the next 3 years that may have even more importance as far as requiring doctors to have EMR.
I have developed an interest in Coding and Documentation such that I am now certified by my specialty society as a Certified Coder. Through this, I have also become aware of the upcoming mandated change from ICD-9 to ICD-10 and the requirements needed to code a chart so that we can get paid for our work. These requirements are so much more detailed than with ICD-9 that I really don’t know how anyone can follow them without having a fairly robust EMR. I belong to/work for a managed health plan that is often considered a leader in the use of EMR and we are already 6 months into our planning for this change and we are on a tight timeline to make sure that, hopefully, we will be ready for the federally mandated deadline of October 2013.
PQRI or Meaningful Use may not be enough incentive to adopting EMR but just not getting paid at all probably is.
Anything Government is going to be nothing BUT Bureaucracy. PQRI is a prime example….Government controlled outcome money, much paperwork and complicated access to data results with no way to challenge results. Exactly why many physicians are holding out on EMR. Government run healthcare will be an invasion in everyone’s life not to mention privacy and choice.
Just like the Government to cut reimbursement to the bone and then implement regulations at costs that are driving many out of business. Personally, and professionally, the working people are being held accountable for the government’s unaccountability for all. Which straw will break the camels back? And at what expense?
The question is not if physicians will embrace EHR technology but when will doctors accept EHR and move forward. American physicians cannot possibly continue the business of practicing medicine with old tools. Why should we use a fetoscope when technology exists allowing better care? Pick your own analogy but the bottom line is we must move forward. Physicians and patients of the future will not suffer the burden of old measures. The exciting time exists now because we can lay the foundation for the future to build upon. Shaping healthcare is an opportunity which exists today. I look forward to sitting at the table with colleagues who are optimistic and can invision a new type of medical practice in America.
As we recieve yet another delay in the implementation of the ‘Red Flag Rules’ I can only scratch my head at the chances of success of PQRI, PCMH, ICD-10 coupled with meaningful use. Looks like the perfect storm facing the medical community.
I agree. I currently use my own emr, written out of desperation. As a cardiologist there were no products that had adequate reporting capabilities, particularly web based, and customizable on the fly. Now I’m told that because my program is not “recognized” it is not suitable for HIT.I have invested over 10 years time in its development and over 40,000 dollars. I have picked what I consider the best off the shelf programs as a suite to completely integrate my system. That’s American ingenuity and innovation. I am solo. We as small but powerful providers of health care need open platforms and choice to stay in business. The government will only take our information and use it against us and our patients.
While I am very tech savvy, and I usually am an early adopter of technology, I will be one of the LAST to adopt meaningful use of EMR. I have yet to see an EMR system that is cost & time effective for a 2-person orthopedic group. Once everyone else has made the change, then maybe the costs will start to become viable. By then maybe the gov’t will have actually determined what “meaningful use” is and isn’t.
I have read through this thread and it needs to be addressed that there is NO way around the technology and EMR. HIT and and future healthcare issues will all be tracable and helpful. I know of a major player in the healthcare industry that is making use of this technology and law. If you can get into a solid EMR and receive all your money back from the goverment in 4-5 years why would you not do it? the day of paper is already gone in just about every other industry. And would it not help keep the few patients that are out there from going Dr. to Dr. getting scripts if everyone has EMR?
Hi,
It was really good post lot of useful information. On the point of usability and defining the term ‘meaningful use’, I would add further that the medical practitioners are looking to avail of this federal incentive by trying to comply with the definition of meaningful use but at the same time EHR providers are looking at their own set of profits.
This misunderstanding is mostly I believe as a result of wrong interpretation of the federal guidelines. The EHR providers need to look at these guidelines from the prospective of the practitioners who deal with different specialties.
Each specialty EHR has its own set of challenges or requirements which I believe is overlooked by most EHR vendors in a effort to merely follows federal guidelines. This is resulting in low usability to the practitioners, thus less ROI, finally redundancy of the EHR solution in place.
I think ROI is very important factor that should be duly considered when look achieve a ‘meaningful use’ out of a EHR solution. Though one may get vendors providing ‘meaningful use’ at a lower cost, their ROI / savings through the use of their EHR might be pretty low when compared to costlier initial investment. Found a pretty useful ROI tool [http://www.waitingroomsolutions.com/wrs/emr-ehr-roi-calculator] that is pretty customizable and easy to use. It also accounts for the different specialty EHR’s too.
There are other good references on the topics of:
Usability/meaningful use http://www.waitingroomsolutions.com/wrs/arra-stimulus-money-44k-arra-emr-stimulus-bill-arra-ehr-stimulus-incentives
Certification criteria for EHR:
http://www.waitingroomsolutions.com/wrs/arra-stimulus-money-44k-arra-emr-stimulus-bill-arra-ehr-stimulus-incentives#Certification_Criteria_EHR
Regardless of whether physicians choose not to go after the meaningful use benefits, I think most, if not all physicians, are motivated to at least look into them very closely now. The amount of very good EMRs plus the government publicity will, I’d imagine, make some doctors get an EMR. I think there is a pretty large ROI, if only for being able to let go of a worker who, say, filed things for 35,000 dollars a year. There is also the indisputable fact that it makes a physicians’ life easier; no more lost files, no more wasting time sifting through cabinets.
Anthony, I do not blame you. EMRs are expensive right now. It will be the hospitals that adopt first and you’re right, towards the end prices will go down as companies try to scoop up the last physicians interested in meeting meaningful use.
I am a solo practitioner in the specialty of ophthalmology. I use Apple computers. 23 years ago my clinic started development of an Apple based multiuser platform known as 4D. Over the years the interface and reporting has been improved and now offers real time savings for me.
I have achieved meaningful use as it applies to my clinic but my system does not fully capture the the required elements that are required for FedGov meaningful use. At this time my clinic efforts are maximized and data that I need is readily available over 17 computers in my clinic and 5 more a my surgery center and efficiency in my own terms has been highly improved. This includes menu driven clinic input and pharmacy direct prescription writing. The above mentioned items are real time savers
Presently I am not to concerned with FedGov meaningful use since I have achieved personal/professional meaningful use for my limited environment. I probably will not do any further development to interface with government mandated systems.