Editor's Note: AAFP members are all over the map in terms of how they feel about the federal government's plan for health information technology, or health IT; electronic health records, or EHRs; and the meaningful use incentive program. Here is the opinion of one AAFP member.
Susan Murphey, M.D.
I started my solo, small-volume "micropractice" about nine months ago. I have no employees and practice in a one-room clinic inside a pharmacy building -- my reception area is part of the pharmacy space. I wanted to distinguish my practice and keep my overhead low so I could serve the uninsured, so I chose a pharmacy as an informal ally and landlord. It's working well.
I take Medicare but don't want the administrative hassle or increased overhead of Medicaid or private insurance.
My practice consultant encouraged me to provide only urgent care, but it wouldn't be the quality of care that would serve my community well. Longitudinal, continuing care will serve the community, and there is a strong need for that type of care here. Our rural college town has lost half of its primary care doctors, and people must wait three to six months for appointments at many practices.
I've had my EHR since this practice started, and I'm slowly learning the features. I'm in favor of the government's plan for EHRs because they are essential to improve the quality of care. We need digital information systems to make full use of evidence-based medicine, decision support tools and the like. Until we incorporate these things in daily practice, we can't achieve the quality to which we aspire.
Experts say there's too much inconsistency without a digital tool like the EHR. Some of us might argue that the inconsistency is caused by our unique experience and intellect, but research shows that's not necessarily true. We need to be humble and say that our unique experience and intellect can use a digital tool just as well as pencil and paper.
However, I'm not planning to go after the government's meaningful use money myself. I'm one doctor alone, so I don't want to hold myself accountable for all the work involved. I also have a happy home life and some hobbies -- and low overhead -- so I don't think I'll do it. It's been hard enough to get Medicare to acknowledge me. I hope to get a payment from them soon.
If I change my mind about meaningful use to avoid the eventual Medicare payment penalties, I'll try it in 2012 after upgrading or switching my EHR.
I'd like to end with a few words about interoperability. EHR stakeholders have been talking about it for years, and its importance gets greater and greater. And yet, in the end, it took the AAFP -- an organization entirely outside of the assembled stakeholders -- to create AAFP's Physicians Direct with Surescripts as a viable solution. I'll start using the service as soon as it's practical for me.
Several health IT people have told me that interoperability is laughable even as a goal because the profits of too many proprietary companies depend on not achieving it. I wouldn't be surprised if some EHR vendors pretend not to notice the AAFP's product, but they eventually achieve the same endpoint because of the pressure the AAFP product has created. This product has established the standard. Now, others will have to match it.
Susan Murphey, M.D., M.H.A.
Solo private micropractice