Massachusetts Medical Society

The Massachusetts Medical Society may be the first to notice that Meaningful Use EHR mandates favor large providers and technology vendors. Control over the Nationwide Health Information Network sets the stage for how physicians refer, receive decision support, report quality, and interact with patients. State health information exchanges and policy makers are caught in the cross-fire over health records interoperability. Are the federal regulations over Stage 2 being manipulated to put physicians and the public at a disadvantage?

On Dec. 7, the Massachusetts Medical Society took what might be the first formal action in the nation. A resolution stating:

“That the Massachusetts Medical Society advocate for a more open, affordable process to meet technology mandates imposed by regulations and mandates; e.g., that all Direct secure email systems, mandated by Meaningful Use stage 2, including health information exchanges and electronic health record systems, allow a licensed physician to designate any specified Direct recipient or sender without interference from any institution, electronic health record vendor, or intermediary transport agent.”

Scott Mace’s column Direct Protocol May Favor Large Providers and Vendors is the first to report on this unusual move by a professional society. Full disclosure: I’m a member of the MMS and the initiator of what became this resolution.

Meaningful Use is intended to support health reform by promoting interoperability and innovation in health service delivery. The Affordable Care Act, Obamacare, is fundamentally a free-enterprise model without single payer or even a public option. Obamacare depends on the market for eventual cost controls and sustainability. Meaningful Use is regulation designed to enable market-driven health reform by reducing interoperability barriers.

Although Meaningful Use regulations have already handed out $17 Billion to drive “voluntary” adoption of interoperable electronic health records, meaningful interoperability is still elusive. Meanwhile, the doctors are chafing about Meaningful Use intrusions and policymakers worry that the regulations will actually increase costs.

Continue reading “It’s Doctors versus Hospitals Over Meaningful Use”

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“I will give no deadly medicine to any one if asked, nor suggest any such counsel.” This is an excerpt from The Hippocratic Oath – the oath that guides my practice as a physician. On the November ballot, the Massachusetts Question 2 about physician assisted suicide, runs contrary to the foundation of medical practice. Since the 5th century BC when Hippocrates crafted the oath, the notion of Physician Assisted Suicide (PAS) has been debated in Western Society and repeatedly rejected as a violation of civilized behavior.

If adopted, MA Question 2 would legalize PAS for terminally ill patients who have fewer than six months to live. The assumptions underlying this question are erroneous. In 27 years as a primary care physician, I have never told a patient how long he or she has to live. An individual lifespan is scientifically impossible to predict with exactness. Time and time again, standards in medical literature that project survival for particular diagnoses are wrong. Today in my practice, I have numerous vibrant patients who have long outlived calculated life spans. This is not only for people with cancer, but diseases like multiple sclerosis, chronic obstructive pulmonary disease, kidney failure and heart failure. I never tell my patients how long they have to live. Why? Because the best prediction is based on old literature and past practice. New therapies combined with preventive and behavioral medicine change the true experience of each disease.

What motivates some people to elect PAS? Those who support Question 2 typically cite the patient’s right to self-determination and desire to avoid pain. But, the little we know from pre-death interviews in states such as Oregon, Montana and Washington shows otherwise. Some patients claim that it is their inability to do what they want to do that motivates their desire for death. Not wanting to burden loved ones can also motivate the choice to elect suicide. For my work as a physician, part of the job is helping patients and families to adjust to new circumstances. People who fear losing control of basic bodily functions can grow to realize that their humanity is about so much more than those acts. Despite new limitations, they can still fulfill significant roles in their communities and families. Furthermore, clinical depression is present in at least 25 percent of people with chronic illness. Depressed people think about suicide. Depression, however, is treatable. Question 2 does not mandate that the patient submit to evaluation and therapy for depression. Furthermore alleviating pain and suffering is the objective of all doctors. Some even specialize in hospice and palliative care.

Continue reading “Vote No On Physician-Assisted Suicide”

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