Last week, I talked about one of the defining characteristics of hybrid EMRs—that they are designed for high-performance, high-volume, and high-revenue practices. They are successful in these practices because physicians find them highly “usable.” I am sending the following letter to President Obama because this critical attribute, usability, has been overlooked in the design of the government’s plan to encourage EMR adoption.
Dear President Obama:
Like you, I place a high value on improving the quality and reducing the cost of health care for all Americans. As the CEO of a successful hybrid EMR company for the past 12 years, I clearly agree that bringing EMR technology to physicians will help accomplish these goals, but it must be the right technology—technology that front-line physicians, who provide the bulk of care to millions of patients each day, will find usable. I and others are deeply concerned that if the failure to align the interests of the government with those of practicing physicians is not addressed, it will prevent the Economic Stimulus Plan’s EHR incentive program from accomplishing its commendable goals.
As the first president to make use of social media to communicate with constituents, you are no doubt aware of the groundswell of concern being expressed by physicians. These front-line physicians are filling the Internet with comments about their failed attempts to implement CCHIT-type, traditional EMRs. They detail the negative impacts these EMRs have had on their productivity and on their ability to preserve the physician-patient relationships that are critical to providing high quality care.
Before spending $19.2 billion to encourage the purchase of failure-prone traditional EMRs, why not first spend a mere $1 million to $2 million of this money to determine which types of EMRs physicians find usable and adoptable? A reading of the CCHIT criteria reveals that “usability” was never a consideration. There are studies that show the positive impact of EMRs on other stakeholders, but numerous landmark studies have documented the negative impact traditional EMRs have on physicians. Even your Budget Director, Peter Orszag, testified before Congress last July that “Office-based physicians in particular may see no benefit if they purchase such a product—and may even suffer financial harm.”
There are EMR models, such as the hybrid EMR, which front-line, high-performance, high-volume physicians have embraced and find highly usable. They deliver the same quality of care benefits and facilitate the reporting of valuable clinical data without burdening physicians with the responsibility of collecting it themselves.
If usability is not one of the fundamental characteristics upon which EHRs are evaluated, the incentive program is doomed to failure. Either physicians will take the bait and buy an EHR, only to find they cannot “meaningfully use” it, or they will ignore the legislation and not implement an EHR. In either case, our goals will not be accomplished.