Remember the penguin problem described by economists?

No one moves unless everyone moves, so no one moves.

Overcoming the penguin problem has a lot to do with creating expectations. A recent writing by Dr. James O’Connor in Physician Practice expresses a voice from the physician community that I’ve never heard before.  His essay is entitled “Meaningful Use — Doctors Have No Choice”.

Physicians Have No Choice Other Than to Adopt EHRs?

Dr. O’Connor argues that physicians are effectively being forced into adopting EHRs.  He cites facts and reaches a powerful conclusion:

1. CMS penalties begin in 2015.
2. What if you won’t or don’t accept Medicare/Medicaid patients (13 percent of practices in 2009, up from 6 percent in 2004? In August, four major insurers (Aetna, Highmark, United Health Group, and Wellpoint) announced that, at a minimum, they will link their pay-for-performance programs to federal meaningful use criteria. Other insurers are likely to follow.
3. Do you run one of the increasing number of “boutique” or VIP practices that work on a cash-only basis? The American Board of Medical Specialties (ABMS) released a statement in August saying that they intend to link meaningful use of health information technology into the ABMS Maintenance of Certification© program.
4. You don’t care about being board certified? (Sound of crickets chirping.) The Final Rule gives states the authority to impose additional requirements that promote compliance with meaningful use. As reported in Physicians Practice, the state of Massachusetts may take away your license to practice medicine in 2015 unless you demonstrate meaningful use of an EHR system. In Maryland, private insurers will be required to build incentives for acquisition of EHRs and penalties for not adopting them into their payment structure.

OK, so technically, we do have a choice. We could stop taking Medicare and Medicaid patients, accept cash only, give up our board certification (and thus usually hospital privileges), and move to a state (or country) that doesn’t impose EHR requirements. But is that really a choice? No.

Revisiting the Penguin Problem of EHR Adoption. What’s Happening Here?

Consider Dr. O’Connor’s comments in the context of the penguin problem of EHR adoption:

…many physicians and hospitals have been reluctant to be first movers because they have doubted others will be following.  Much of the value of EHRs is dependent on achieving network effects —  the creation of a widely adopted network that allows for exchange of interoperable data and collaborative care management processes.

Should Dr. O’Connor’s writing be considered  a sentinel event — a possible early signal of massive changes ahead? Reread his conclusion and consider how the collective actions of the federal government, payers, and physicians associations are creating strong expectations of EHR adoption:

OK, so technically, we do have a choice. We could stop taking Medicare and Medicaid patients, accept cash only, give up our board certification (and thus usually hospital privileges), and move to a state (or country) that doesn’t impose EHR requirements. But is that really a choice? No.

I’ve never seen an article like Dr. O’Connor’s before — a writing by a physician effectively expressing that physicians are feeling tremendous pressure to get off the ice floe and jump into the waters of EHR adoption.

Is that pressure is perceived as a gentle nudge or a painful kick in the butt? Dr. O’s article suggests the latter, but let’s leave that issue for another discussion.

…and either way, you’re off the ice floe and swimming in the ocean of EHR adoption.

One article by one physician probably isn’t enough to get all the penguins into the water…but it’s definitely worth noting and continuing to watch…

Vince Kuraitis JD, MBA is a health care consultant and primary author of the e-CareManagement blog where this post first appeared.

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11 Responses for “The Penguin Problem”

  1. rbar says:

    The more I read THCB, the more I get the impression that EHR is becoming to the health care analysts what bloodletting was to physicians of the 19th century – a panacea with unrealistic expectations. And I am someone who actually does support EHR and who worked with 3 different EHR since residency in 2000.

  2. bev M.D. says:

    If the sentiments in this physician’s post were new to you, then you haven’t been reading the comments from docs on this blog for many, many months. Most feel forced into it, and are kicking and screaming. No, it’s not a panacea by any means,but the alternative is even less appetizing. There are just no silver bullets for any of us, be it reducing the deficit or adopting EHR.

  3. Dan Urbach, MD says:

    It’s still not worth buying a EHR until the network, if there is any, is well under way to declaring itself. The only decisions that can’t be reversed by reasonable people are the ones made by government. (Government isn’t reasonable, and I won’t hold my breath waiting for regulators to be reasonable.) If there are a mess of unconnected, disorganized EHRs out there, do you think the big insurers will continue their policies? Why would they? The Board is an academic bastion, and the AMA can create its own board certification. Rumor has it that they have threatened to do so already.
    So which would I choose as a solo doc? Spend $40,000 on a system that may be obsolete within a year, or wait till more dust settles? If I go out of business, at least I won’t have the $40,000 piece of junk to pay off.
    This reminds me of the mass movement to create large capital reserves demanded by capitated plans, in the 90′s. Many practices voluntarily sold out to big groups, and some of them found themselves victims of financial rape and death by starvation. Then, poof! The reserves requirement went away, because of executives’ boardroom decisions. All those practices, if they survived at all, were now owned by big groups, many of whom then sold out to hospitals, if they weren’t already owned by hospitals.
    Which would a doctor rather live through, big debts and major computer adaptation nightmares, or ducking the wrecking ball by adapting to changes and holding on to his/her wallet? I’ve done well so far by doing the latter. I recommend the same to any who will listen.

  4. There is a simple way to meet “meaningful use” requirements without disrupting your practice, the way you keep patient charts, or investing thousands of dollars.
    We have developed the MedKaz™ System, a unique, easy to use — some call it revolutionary — patient-focused personal health record system that meets “meaningful use” requirements and does considerably more, for both you and your patients.
    We aggregate a patient’s lifetime health record on a device, called a MedKaz, the patient owns, controls and carries on a key chain. When your patient gives it to you and enters their password, you can sort, search and read copies of their original records from all their providers. With it, you can avoid mistakes, preclude unnecessary or redundant tests and coordinate your care with other docs also treating your patient.
    It also includes a free, easy to use Patient Record Manager application for docs, an EMR-Lite if you will, that will enable you to manage your patient charts electronically even if they are paper, and meet most the government’s meaningful use requirements. In short order and without having to change the way you keep your charts, you’ll meet 12 of the 15 “core set” and 8 of the 13 “menu set” requirements.
    We’re launching a pilot study within weeks and are recruiting docs to participate. It will run three months. If you’d like to participate — and especially if you are a PCP in private practice and keep paper records — send me an e-mail. If you meet our simple requirements, we’d love to include you. You can read more about our system and find my contact information on our web site, http://medkaz.com.

  5. Craig "Quack" Vickstrom, M.D. says:

    I think “The Lemming Problem” would have been a more appropriate title.

  6. Vijay Goel, MD says:

    This doesn’t sound promising to me.
    It’d be one thing if meaningful use was so meaningful and usable that patients and outcomes made non-compliant docs stick out due to their poor performance in their duty to help patients.
    Its completely another if government and regulatory force is used to make people do things that don’t make any sense…it creates a bubble for some industry that blows up later and we all have to clean up the poorer for the experience (see no-verification housing, federal loan guarantees, Sarb-Ox, etc)
    To date, there is nothing meaningful about the standards being put together for meaningful use. The ASSUMPTION is that all of that data will magically fit together and that payment models will magically emerge from all that data.
    We all know what happens to assumptions…especially when combined with technology and incumbent players…

  7. MedKaz is a patient’s lifetime health record on a device the patient owns, controls and carries on a key chain. When your patient gives it to you and enters their password, you can sort, search and read copies of their original records from all their providers.If the sentiments in this physician’s post were new to you, then you haven’t been reading the comments from docs on this blog for many, many months. Most feel forced into it, and are kicking and screaming.

  8. Dan Urbach, MD says:

    I love the last two posts, so timely and appropos for this discussion.

  9. Earlier this year my colleague Dr. David Kibbe and I wrote a series of blog posts addressing the question “Is HITECH Working”. #2 in that series was
    “Key physicians will sit on the sidelines (at least for now).” http://e-caremanagement.com/is-hitech-working-2-key-physicians-will-sit-on-the-sidelines-at-least-for-now/.
    Dr. O’Connor’s observation (“MU—Doctors Have No Choice”) leads to a dramatically different conclusion, and suggests a POSSIBLE major shift in physician expectations over the last six months.
    To summarize the (possible) six month shift:
    “HITECH is problematic, we’ll sit on the sidelines”
    Vs.
    “HITECH is problematic, but we are being effectively forced to adopt EHRs.”
    The (possible) shift is not so much about mindset toward HITECH, but more about expectations of necessary behavior to adapt.
    So I do want to acknowledge the physician comments (“HITECH is problematic”) by rbar, bev, Dan, Quack, and Vijay. …but I also don’t want to get sucked into defending the merits of HITECH – let’s debate that issue on a different day.

  10. pcp says:

    “HITECH is problematic, but we are being effectively forced to adopt EHRs.”
    I would change “adopt” to “buy and maintain in perpetuity (with no financial return).” Doesn’t make for happy campers.

  11. EMR was designed by IT folks who do not understand what physicians’ needs are at Ground Zero in our exam rooms. Sure, the software does well for coding and billing, but how does it fare in a patient visit? See http://bit.ly/hpxJ4R

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