As part of a sweeping effort to address the woes of the current US economy, the government has placed $19 billion on the table for HIT, aimed at containing healthcare costs and creating new jobs. The ultimate instruments for implementing this HITECH bill are America’s physicians and there is much confusion and apprehension in the physician community regarding the net effects of this bill on doctors in particular and healthcare in general. The HIT stimulus effort will not reach its stated objectives without voluntary adoption by our doctors. The government and the HIT community must find a way to draw physicians all over this country into the process of defining and implementing the stimulus package.
In very broad terms, interoperability standards will be defined, Electronic Health Records (EHR) technologies will certify compliance with the standards and physicians will be provided financial incentives to acquire, and meaningfully use, those EHR technologies. The assumptions are that use of these standardized EHRs will reduce costs by reducing medical errors, reducing duplication of tests, improving quality of care and encouraging evidence based clinical decisions. Jobs will be created as the EHRs are deployed across the nation. Experts are already at work “on the Hill”, in the White House, in the boardrooms of HITSP, NIST, CCHIT and other acronym organizations. Technology vendors are feverishly doing their part, from creating websites devoted to the HITECH bill, to making products available at Wal-Mart, to sudden revelations that HIT is really their main business. Everybody is actively involved in making this bill a success. Well, maybe not everybody.
There are tens of thousands of physicians out there, mostly practicing in 1-2 doctor clinics, from Wichita, Kansas to Troutville, Virginia, where waiting rooms are packed with seniors pushing aluminum walkers with yellow tennis balls on their bottoms, some holding Ziploc bags full of medication bottles for Diabetes, Hypertension, COPD, Hyperlipidemia and worse. Doctors are seeing 30-40 patients every day in an insane hamster-wheel race that repeats itself day in and day out. That is where health care is being administered in America. Most of these doctors cannot spell CCHIT, but thanks to the mainstream publicity of the HITECH bill, they are aware that the government will be giving them some money if they buy a certified EHR.
Will the acquisition of a certified EHR increase efficiency so more time can be spent with each patient without loss of revenue? Will it allow reimbursement for much needed coordination of care? Will it make preventive care easier to administer? Will it save time? It’s always about time…. Yes, “time is money”, but time is also quality of care for patients and quality of life for doctors.On the other hand, will this new certified EHR slow doctors down? Will the high learning curve result in significant productivity loss? Will the computer devalue the personal relationship with the patient? Will the physician be required to collect data for unclear reasons and no reimbursement? Where is this liquid data going to end up? Who will be analyzing it? Will it be used to further cut reimbursements? Is it even worth the hassle? The incentive payment doesn’t even cover the outright price of a Wal-Mart EHR, not to mention all the hidden costs and disruptions to practice.
The question really is, will doctors buy into a process in which their voices are not being heard?
Interoperability is a worthy goal, and ability to measure outcomes is a must. Ability to move data across systems has benefits that physicians can and will embrace if placed in the proper context. Doctors transfer data every day using very basic and common tools: fax machines and telephones. Moving data across the internet should only make the process more efficient if the new technology does not impose an onerous burden on doctors. But if we are to improve healthcare, we must be able to measure its outcomes. One cannot improve that which cannot be measured. Doctors will see the benefits of creating a “clinical information highway” that allows for collection of evidence to be used at the point of care. However, physicians must be empowered to shape this information exchange channel and not just be asked to patiently bear the costs of building it.
At the risk of sounding childish and naïve, I am going to address someone that will never read this article: Mr. President, this administration was elected by the American people on the promise of Change and participatory government, by the people, for the people. Surely America’s physicians are people too. Why not take this decision process on the road? Town hall meetings could be an option. I’m sure the same people that ran the most sophisticated grassroots campaign in history can find a way to engage our doctors in this crucial decision making process.The real experts on healthcare delivery are not “on the Hill”, or in boardrooms of IT vendors and organizations. They are in Wichita, KS and Troutville, VA. They are busy seeing patients while public policy pundits and IT experts are deciding what tools doctors should use to deliver healthcare to this nation. Moreover, physicians have ultimate spending authority over most of our exploding healthcare budget and physicians can make or break this initiative by choosing to adopt HIT or not. Costs will not be contained without physicians’ cooperation. Jobs will not be created if doctors refuse to purchase HIT tools. Their voice matters because they will be the ones paying the highest toll for this clinical information highway.
My sincere gratitude to David Kibbe, MD for much needed edits and suggestions.
Margalit Gur-Arie is COO at GenesysMD (Purkinje), an HIT company focusing on web based EHR/PMS and billing services for physicians. Prior to GenesysMD, Margalit was Director of Product Management at Essence/Purkinje and HIT Consultant for SSM Healthcare, a large non-profit hospital organization.