With the end of the comment period approaching for ONC’s proposed “meaningful use” standards, it seems safe to say that the majority of groups representing healthcare providers have significant concerns about the impact of the proposed standards.
While observers and policymakers may be tempted to dismiss at least some the concerns as merely an attempt to reduce the number of new regulations, stories from the “front lines” of healthcare strongly suggest that the concerns are very valid.
The most recent voice to enter the “concerned” chorus is the Medical Group Management Association (MGMA). It recently announced that “new research conducted by (MGMA) suggests that the changes in practice operations necessary to meet the 25 "meaningful use" criteria proposed as part of the Medicare electronic health record (EHR) incentive program would lead to decreased provider productivity.
According to the press release announcing the findings of a survey MGMA conducted, “More than two-thirds of respondents (67.9 percent) said that physician productivity will decrease, with 31 percent stating that physician productivity will decrease more than 10 percent.”
The release goes on to highlight some of the particular concerns, including proposed reporting requirements which respondents say would be “difficult” or “very difficult” to achieve.
While these concerns might be perceived as being overly cautious, rather than founded in actual experience, this regular observer’s report from a visit he recently paid to a clinic in Vermont bears out precisely what the MGMA respondents fear.
“This past weekend I spent some time with a nurse who works in a primary care/pediatrics clinic in Vermont. Their facility, part of a network of several clinics, recently adopted and went live with a new EHR system (about 18 months ago). According to the nurse, this EHR, from one of the big names in ambulatory systems, has been a complete disaster for the clinic. Productivity is way down, countless glitches have occurred, whole system crashed during a recent upgrade and the list goes on. For 2009, this clinic, which has been in operation for a few decades, had its first ever loss last year, the year they went live with this EHR. The clinic puts the blame squarely on the EHR, which has severely constricted their ability to see patients and as all readers know, clinicians get paid for seeing patients, not trying to use a complex and difficult to use EHR.”
While no one has suggested that the transition to new HIT won’t take considerable time and effort, it’s easy for policymakers to get swept up in the vision of things to come and overlook the reality that exists today.
Take, for example, some of ONC Director Dr. David Blumenthal’s remarks at last week’s HIMSS10 convention.
"The idea you can be a competent professional without being able to manage information in a modern, effective way defies belief,” he said. “I don't think our larger society will continue to embrace the social contract it has with processionals unless they demonstrate they can use and move information in the most modern way.”
The very real experience of that Vermont clinic suggests that there is much work to be done before “society”, or the policymakers who have been hired to help providers move forward, can make such sweeping judgments.
Jeff Rowe blogs daily at Priming the Pump.
