EHR Funding is Great, But the Devil's in the Unintended Consequences

April 01, 2011 04:25 pm Martin Cahn, M.D.

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.

[Martin Cahn, M.D.]

Martin Cahn, M.D.

I think it's wonderful that the government is trying to move physicians to EHR technology by rewarding them financially for meaningful use. However, I'm not sure the program's carrot-and-stick approach -- with incentives for those who become meaningful users and, eventually, penalties for those who don't -- is the best way to go about it. I also worry about unintended consequences.

I've been using an EHR for four years now, and it has completely changed my practice. I'm a better physician because I have so much information about my patients at my fingertips. We're upgrading soon to the meaningful use-certified version of our EHR, and then we'll work on achieving meaningful use under Medicare. I'm glad the government will send me money for doing what I'm already doing, with a few enhancements. God knows we family physicians could use more money!

We've been working closely with our regional health IT extension center, which sent out a very knowledgeable person to go over the nuts and bolts of meaningful use with us. At first blush, I thought demonstrating meaningful use would be pretty easy, but it's actually a little tougher than I thought. I know we'll spend a fair amount of time on it, but I'll count it as time well spent -- that few thousand dollars in return will be very useful. But we'll be jumping through hoops that won't necessarily make me a better doctor.

About those unintended consequences: It's one thing for a doctor like me, who already uses an EHR, to achieve meaningful use. But if I were in a solo or small group practice without an EHR, I'd be daunted by the prospect. They'll have to choose EHR technology that would work well in the practice, install it, iron out the bugs and then meet 20 of the 25 objectives for Stage 1 meaningful use during a reporting period of 90 consecutive days -- and accomplish it all very quickly. And that's just Stage 1. Stages 2 and 3 will be even more complex, and the reporting period will be an entire year.

The question I keep asking about meaningful use is, "What is the problem they're trying to solve?" I think the government is trying to get docs onto EHRs. But is this the best, easiest way? I don't think so. And it might be enough to drive many family physicians to join larger groups, just to have someone else take care of meaningful use. We're already seeing some of that in my town -- we have fewer and fewer solo FPs. Surely the government doesn't want to contribute to the demise of small and solo practices, but this program just might do it.

Martin Cahn, M.D.
Solo private practice