Dear Farzad Mostashari, M.D.:

I am writing to express my deep concern about the future of the EHR incentive program. I am alarmed to see that the program is plagued by rampant dissatisfaction among physicians. My fear is that at your level of involvement—as the very passionate but national leader at the top of the program—you may be insulated from what physicians in the trenches are saying. As lofty and admirable as the goals identified in the initial legislation are, I worry that the regulations are evolving in a way that will lead to the program’s undoing.

You were recently quoted as wanting physicians to “really embrace meaningful use as not just one more thing that they’re doing. . .now that the financial barriers [to EHR adoption] have largely been removed.” However, for the program to accomplish its long-term goals, it is critical that physicians find it meaningful for reasons beyond the incentives. Financial incentives alone cannot sustain meaningful use—particularly as they diminish sharply over the next few years. One would expect that physicians’ initial objections to the meaningful use requirements would soften a bit as they cash their $18,000 EHR incentive checks. But the results of a recent survey show the opposite. Physicians are angry—and if their anger is tempered at all, it is only by the fact that they are receiving significant reimbursement for their Stage 1 efforts.

The voice of the ambulatory physician is not being heard. To understand what is really on the minds of front-line physicians, I commissioned a reputable, independent survey firm to investigate. 684 physicians responded to an open-ended question regarding their perceptions about meaningful use. The physicians’ comments are disheartening, and must be viewed as a wake-up call to ONC, CMS, and the advisory committees to rethink where the program is heading.

I urge you to read the comments yourself—they are presented uncensored, exactly as submitted. The vehement tone does not bode well for the future of the program. The tables below summarize the prevailing sentiments. First, the comments were categorized according to the messages conveyed. The results speak for themselves.

Dawn of a New and Improved Consult Letter

  • Nearly one third of the physicians cited wasted time and unnecessary work, with an additional 11% mentioning unrealistic expectations and extreme difficulty. This was based on their experience in Stage 1—the increased complexity of Stage 2 will cause these numbers to increase.
  • 12 physicians described the requirements as “hoops” through which they are being required to jump.

To quantify the qualitative data, a relative rating was assigned to each comment using a scale of 1 to 5 (from very negative to very positive).

Dawn of a New and Improved Consult Letter

  • Only 10% offered positive responses, and most of those cited the financial compensation as the reason.
  • 82% provided negative comments, the majority of which used terms similar to those summarized in the first table above.
  • A common complaint was the perceived disconnect between entering data and improving care and outcomes.
  • Specialists commented on the lack of relevance to their practices.
  • Responders felt that the requirements were created without sufficient input from practicing physicians.

Meaningful use has overstepped its intended mission. Exploding complexity, along with a corresponding lack of physician support, will result in the failure of the program. I fear that this downward spiral will be accelerated by the increased complexity of Stage 2 and what is being envisioned for Stage 3. Private practice physicians see this program very differently than academic and informatics-driven physicians do. The average physicians are drowning in the details and feel that their ability to practice is being hampered, rather than enhanced. They will likely abandon what they perceive to be a distracting, box-checking exercise after Stage 1, once they have earned the first—and “easiest”—$30,000.

All is not lost—there is a path toward success. The requirements must be simplified! Focusing on the three initial goals as stated in ARRA—ePrescribing, quality reporting, and interoperability—rather than presenting a complex maze of 23 separate measures on which physicians have to report, would go a long way toward making meaningful use meaningful to physicians.