Dr. Mintz Dr. Mintz

Is meaningful use the right incentive to get physician’s to use EMR’s?

Before I took over one of the classes that now teach at the medical school, I asked students why the value of that class was so low.  One of the reasons they gave was that it was so hard to do well in the class, and there were so many other things to study, students only put in enough effort to pass.  In other words, incentives are only good if they are both valued and attainable.

As this related to Electronic Medical Records (EMR's), achieving meaningful use is not easy.  The technology for clinical decision support (a requirement) is not quite ready for prime time.  Nor is there an easy way to share parts of the EMR with patients.  In a study of almost 600 docs who had been using EMR's, most were confident that they would qualify for meaningful use and get bonuses for doing so.  However, the survey also found that the majority of these physicians would not meet some of the criteria.  Thus, though the financial incentive seems nice, the path to getting these incentive may be so unattainable that physicians won't waste the effort or expense.

More importantly, some of the "stuff" that's meaningful in meaningful use, may not have value for physicians. Policy makers that developed these criteria were understandably thinking on a population level (lowering blood sugar in a population of diabetics).  However, physicians are used to dealing with patients one on one.

A recent survey of EMR using physicians was done over at Software Advice regarding the advantages of using EMR's.  Granted 50 respondents may not accurately generalize to most physicians; however, some of the results are telling.  What do doctors like about EMR's? Greater accessibility of charts, easier to read notes, more accurate patient information,  and improved coordination of care by having the ability to share data.  As a user of EMR's for well over a decade, I would concur with these findings. EMR's are far from perfect, but based on these advantages, I could never go back to paper.  What  "benefits" of EMR's did doctors not see as readily? Improving preventative care, opportunity to participate in pay for performance, improving clinical decision making, and reducing errors/improving patient safety.  

Thus, under the current plan to increase EMR use by physicians, the financial incentives may be too hard to achieve and the purported benefits may not be easily perceived.  This combination does not bode well for the adoption of EMR's by most physicians.  Instead, policy makers might want to consider a different approach.  First, rather than create a financial carrot that will be too difficult to achieve for most, use that money to reduce barriers to adopting EMR's in the first place.  Second, instead of focusing on the benefits important to policy makers, focus on benefits that are important to physicians, such as making our work easier and more productive.  This is important because EMR vendors design their products on what they believe will meet their customer's needs.  The first EMR platforms focused on improvements in billing and coding to capture more revenue.  Now, vendors are focused on helping physicians achieve meaningful use.  If vendors focused on making a physicians work easier and more productive (and policy maker made it easier to adopt these tools), EMR adoption would be much greater than it is now.
  • Michael Marlow, DO

    I have used an EMR for nearly 8 years in my practice. It is ONC-ATCB certified and if I wanted to I could comply with meaningful use.

    I don’t plan on even trying to comply with meaningful use.

    I use my EMR in my practice to serve my patients and to make my practice better and my life easier.

    I have no interest in collecting data for the government. I have no interest in giving the government a greater foray into the health care arena. I have no interest in giving the government yet another reason to possibly come and audit me. I have no interest in receiving taxpayer dollars to fund my private practice.

    I will use my EMR and my employees time to meet the needs of our patients, not the government.

    As for forgoing the possible $44,000, I highly doubt it will be worth all the work in the end after 5 years —- it comes to $733.33 per month — I’d rather earn it by seeing more patients than giving data to the government in yet another pointless and ultimately wasteful government effort. I see this as a government step in beginning to construct a single payor national health network.

    As far as the penalty, it is not enough to force me to do the work that will be required to continue to show meaningful use and if it ever becomes too onerous then I would have to consider leaving the Medicare program.

    Before you get on the MU bandwagon, I’d look very closely at how complex the music is going to be that you will have to play.