EHRs Represent the 'Widgetization' of Medicine

April 01, 2011 04:30 pm Pepi Granat, 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; electronic health records, or EHRs; and the meaningful use incentive program. Here is the opinion of one AAFP member.

[Pepi Granat, M.D.]

Pepi Granat, M.D.

I've been on an EHR for six years and totally paperless for at least three. I think the primary target of the meaningful use money isn't doctors like me, who already have EHRs, but doctors who don't, to induce them to start.

Also, my idea of "meaningful use" and that of the government/medical committees may not coincide, because they're all very keen on counting what's easy to count by computer and calling that "quality." Some of us think that's misguided. The real aim then is to pay or withhold payment accordingly, once we're all trapped in whatever large "system" is evolving.

My concept of quality of medical practice (and that of many family physicians, I think) is much more individualistic and personal and differs in many ways from the government's whole approach. Quality really cannot be measured their way, if at all. A truly "meaningful," in-depth dialogue on this point would be welcomed by those of us who disagree.

The practical side of these comments is that I may use my computer to serve myself and my patients better, according to my own definition of quality (which is not rogue and is equally based on science and good medicine). But if my way isn't set up to count the beans in the way the government wants them counted, I will at first be disincentivized and later, actually penalized.

This is the sad road that medicine is traveling. It is unsafe for diversity. I call it the "widgetization" of medicine: The ascendant powers conceive the round holes, then we become the interchangeable widgets that fit into them. Can that be healthy for our patients or ourselves?

To make matters worse, the round holes of government programs don't always match. We now have two Medicare programs at odds with one other( The government's own watchdog agency, the Government Accountability Office, has accused CMS of having conflicting incentives and penalties for its electronic prescribing and EHR meaningful use programs. A sad road, indeed.

In closing, I'd like to say that I also don't believe in taking government money. I think the government should keep the meaningful use incentive funds and pay down the deficit.

That might shock you, but that's the way I feel. I'm probably less "successful" monetarily from medicine than many other family physicians, having often practiced -- note I don't say worked -- fewer hours than others do, but I'm still likely as happy as they are. And I'm pleased that the AAFP is willing to publish my heretical ideas!

Pepi Granat, M.D.
Solo private practice