Health Policy Wonks Confused By Physicians Resistance To Adopting Electronic Medical Records (EMRs).

Stanley Feld M.D.,FACP,MACE

 

Electronic Medical Records (EMRs) for physicians’ offices and hospital systems could be great for patients’ care and physicians’ education. Remember, patients and physicians are the primary stakeholders in the healthcare system.

If the deployment of EMRs were directed toward the benefit of patients and physicians, they would be more readily adopted. If they were used to teach physicians how to be better doctors and patients to be more educated about their disease physicians would accept EMR’s more readily.

Instead, the fully functional EMR is designed to be punitive to physicians and patients. 

President Obama’s motives are obvious to me. He wants to have total control over the healthcare system. Obamacare will be punitive to physicians, hospital systems and patients when fully implemented. The fully functional EMR will be a principle tool.

The government has tried to spin the news about EMR adoption.

 “The most recent CDC data would seem encouraging for EMR adoption. It claims EMR use has finally been adopted by 50% of physicians and hospital systems.”

Actually less than 11% of physicians and hospital systems have adopted fully functional EMRs. The fully functional EMR is so vital to President Obama and his Healthcare Reform Act and government control over the healthcare system.

If the VA systems’ EMR and the Kaiser systems’ EMR were excluded, the percentage is lower than 11%. The administrations of the VA system and the Kaiser system have full control over how medical care is delivered in their system.

Their computer system’s purpose is to direct physicians’ care and tell them what they can and cannot do.

A  “fully functional EMRs mean the payers’ (government or healthcare insurance company) can have full control over the physician’s work-flow.  A fully functional EMR along with 68,000 ICD-10 codes (vs. 18,000 codes in ICD-9) and adoption of the 5010 billing system would put the government in full control of patient care.

I do not think physicians and hospital systems have fully thought out President Obama’s fully functional EMR.

They know from their installation of non-functional EMRs that EMRs are disruptive to workflow at first. They know EMRs do not increase their quality of care and have not decreased the cost of their care.

 A major reason for non-adoption is physicians and hospital systems cannot afford the $60,000 per physician for a fully functional EMR plus the annual maintenance and services fees.

The government is using a carrot and stick to get physicians to adopt the fully functioning EMR.

The stick is the threat of decreasing physician reimbursement if they do not adopt the EMR.

“Important! For 2015 and later, Medicare eligible professionals, eligible hospitals, and CAHs that do not successfully demonstrate meaningful use will have a payment adjustment in their Medicare reimbursement.” 

The carrot is President Obama’s $19 billion dollar  meaningful use incentive program. His meaningful use incentive program will not come close to paying for a functioning EMR.

“Eligible professionals can receive up to $44,000 over five years under the Medicare EHR Incentive Program. There's an additional incentive for eligible professionals who provide services in a Health Professional Shortage Area (HSPA).

Eighty-eight hundred dollars a year for 5 years will not hack it when you have to pay at least $60,000 upfront. The only way it will work is if the government had the ability to take away a physician’s license to practice medicine if they did not comply with the government’s wishes.

President Obama included funding for this program in his economic stimulus package (trick play) and not toward the cost of Obamacare.  

Why? If deployed the meaningful use incentive program is a key element in its ability to control physicians’ behavior and judgment. It will restrict also patients’ access to care.

 Jonathan Bush, the Founder-CEO of AthenaHealth (a major EMR supplier)  said,

 “It’s healthcare information technology’s version of cash-for-clunkers,” and because it is actually all about control.”

 “The goal of EMRs is to wrestle control of healthcare away from the doctor-patient relationship into the hands of third parties who can then implement their policies by simply removing a button or an option in the EMR.”

 If a treatment option is not available in the computer program physicians can’t select it.  If the appeal process is difficult and time consuming the tendency for physicians is to not fight the system.

Patients will only be able to get the healthcare that they “qualify” for according to a bureaucracy and a non-elected committee. (IPAB)

Physicians will become the instrument of government rationing of care by the use of a fully functioning EMR.

It will eliminate physicians’ need to think. It will destroy the physician patient relationship. It will increase the cost of running the practice and in turn the cost of medical care.

The ideal fully functioning EMR should be provided free to physicians and hospital systems. The software should be cloud based with physicians having the option to own the data or keep it stored privately in their offices.

It should be a teaching tool for physicians and not a tool that threatens punitive actions if physicians do not get the coding right.

Most physicians might not have consciously thought out the threat to their clinical judgment and the physician patient relationships. They nevertheless subconsciously feel something is wrong.

Once President Obama understands this reasoning he might understand the resistance of the medical community.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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