Idiopathic provider technophobia

Here’s why anecdotal evidence should not be entirely trusted: Of the several doctors I’ve seen for routine matters in recent months, the sentiment among them was universal that Obamacare was an abomination, and that electronic health records (EHRs) were an insupportable intrusion into medical practice and, moreover, an expensive waste of time. So there I was, just another patient, walking out of the doctor’s office wondering whether I’d see a GOP bumper sticker on the good doctor’s luxury car in the parking lot. I never felt so, well, 47%. Except for the fact that I could probably afford a couple of luxury cars on the monthly bill I pay for medical insurance.

This provider pessimism is not hard to find in other quarters. Back in January, the Washington Post ran a story, “Why electronic health records failed.” Nothing forestalls debate so much as a fait accompli.

The Post article went on to describe something a little less than failure. In fact, American docs simply hadn’t taken to EHRs as quickly as RAND researchers thought they would, or as quickly as docs did in the UK or the Netherlands. At that point, about half of US doctors had fully digitized their records, with hospitals lagging back at under 30%.

The Post article elaborated on the anecdote that EHRs may actually increase costs by virtue of the fact that ordering a test may require but a single mouse click. Which ignores the idea that EHRs may actually flag activities not supported by evidence or enhanced outcomes—and that EHR-guided medical instructions requiring just a mouse click were not all that more difficult to achieve than those that can be launched by an illegible scribble on a prescription pad.

In a flourish of journalistic fairness, the Post noted that the Department of Veterans Affairs saved just over $3 billion in unnecessary health-care costs in the 6 years after adopting EHRs system-wide. But it couldn’t resist adding that the “larger American health-care system isn’t even in a position yet to figure out whether cost savings are possible, as a good chunk still hasn’t taken the first step of going digital.”

That was January. In March, according to the National Review Online, the Association of American Medical Colleges predicted that the United States will be short 62,900 physicians by 2015 and as many as 140,000 by 2025. An article in the Review blamed the burgeoning shortage on the growing number of unhappy doctors who are leaving their careers early. Of the physicians who participated in a Deloitte survey reported in the article, 62% said it’s likely that many of their colleagues will abandon their practice in the next 1 to 3 years, and another 55% predict that their colleagues will cut back on practice hours. Not them, you understand. Their lazy, cowardly colleagues.

Forty percent of those surveyed saw a decrease in income from 2011 to 2012, and 40% percent of those with falling income blamed Obamacare. The article continued with dire predictions related to tort reforms and Medicare reimbursements. Don’t even think about becoming a doctor right now. They’re all underpaid and soon will be going away.

This week, the Department of Health and Human Services announced that—of all things—we have exceeded all milestones in reaching digitized health care. Seems that more than half of eligible providers—doctors, dentists, and others—have qualified for and received incentive payments for adoption of certified EHRs, which beats the Department’s goal for the end of 2013. Moreover, nearly 80% of eligible hospitals have reached this milestone.

At this point, an example of digitized medicine (not to mention the constructive use of the corpse of an executed prisoner, who apparently bought wholly into the concept of recycling):


The visible human project

But it’s not enough that we are far down the road to EHRs. Now the question arises: Who will have access to those EHRs? A new Accenture survey shows that most US doctors (82%) want patients to actively participate in their healthcare by updating their EHRs; 31% believe a patient should have full access, 65% believe patients should have limited access, and 4% say they should have no access. No word on how providers feel about EHR access for prospective employers, landlords, or in-laws. Let’s hope that’s a zero.

And so what we have here is the American medical community dragged kicking and screaming into US healthcare reform. Of course, skepticism of governmental oversight is always justified. But knee-jerk opposition on the part of people who consider themselves scientists is distasteful at best. As computing becomes cheaper and moves to the cloud, EHRs hold the promise of near real-time monitoring of patient status and simultaneous shared transparency among responsible healthcare providers. It’s difficult to imagine how such circumstances could lead to anything other than increased cost-effectiveness and higher quality care.

I mean, you’d really have to try in order to mess that up. You’d have to go out of your way, maybe make the third year of medical school into a crucible for the production of greedy, unsympathetic cynics.

Amid the resistant doomsayers wearing stethoscopes out there, however, is a ray of optimism in the form of Michael Painter, MD, who wrote recently in The Health Care Blog about a study (in which he was a coauthor) showing about 40% of doctors with EHR, but only about 10% who have reached a level of “meaningful use” of EHR:

Some might say, “Wake up, folks!” Look at those small meaningful use numbers. Change course, now. After all of this time and tax-payer expense, less than 10% of doctors are actually ready to use these important tools meaningfully. What’s up with that?

To me, though, this study is good news. All who care about health care transformation should be heartened by the progress—but also impressed by the enormous challenge that our health professionals have undertaken…

In this study we see ongoing increases in the rate of adoption of the basic EHR as well as the relatively small numbers of doctors ready to use the technology meaningfully. But nobody should be surprised at what only appear to be low rates of meaningful use. I believe we’re on a series of “change curves”—one for adopting the technology and another for actually using it. We’re at the early stage, maybe even a relatively flat part of that use curve. It is, however, interesting that this study also shows that about 40% of doctors are close—very close—to meeting meaningful use criteria. That means the total for both currently meeting and nearly meeting meaningful use is actually about 50%…

There is obviously no going back. We must transform care—to make it a gleaming American triumph. We cannot do that gargantuan task without using health information technology. While I suppose the nation could have taken a heavy handed, centralized approach, forcing one-size fits all technology on our doctors, nobody wanted or wants that. It would have been the wrong path, and a disastrous one at that. Instead, we’re adopting, learning, creating and innovating—and making progress.

So, take heart, heroes. The journey is long—but we’re right about where we should be.

The end. Of the beginning.

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Posted on June 20, 2013, in Medicine, Science, Technology and tagged , , , , , , , . Bookmark the permalink. Leave a comment.

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