Why Be a Meaningful User?

Dr. David Blumenthal | April 27, 2010

As I write, physicians throughout the United States are deciding whether to become meaningful users of electronic health records by 2011 when Medicare and Medicaid start making extra payments to meaningful users.  For some the decision may be pretty simple.  Almost 200,000 doctors already have adopted EHRs and are using them at a basic or sophisticated level.  For these physicians, the journey to meaningful use, and its financial and clinical rewards, may be comparatively short. Many other doctors, however, remain undecided.

I don’t want to minimize the obstacles.  When I started using an  EHR, I found it challenging.  I often longed for a dose of my old prescription pad (confession – I cheated once in a while). I chafed at reconciling medication lists, updating problem lists, scanning through seemingly endless consultant notes. (In the past, many wouldn’t have been available – lost somewhere in the paper world.) It was much easier to use the triplicate x-ray requisition I had used for 30 years than the radiology order entry software required  by my EHR.  My visits were longer and more complicated.  Every time I turned on the computer, it seemed, I had to learn something new.

But I am glad I did it, as are 90 percent of all physicians who adopt an EHR, according to a scientific survey published in the New England Journal of Medicine. My EHR made me a better doctor.  I really knew what was going on with my patients.  I could answer their questions better and more accurately.  I made better decisions.  I felt more in control.

Physicians don’t go into medicine because it’s easy.  They go through grueling training – spending endless days and nights at the bedside or in the OR.  They face tough personal and clinical decisions throughout their professional lives. They constantly have to grow and learn to keep up with the science and practice of medicine. That’s what makes them the professionals they are.  That’s what earns their patients’ and colleagues’ respect and admiration.  That’s what gets them up in the morning knowing there’s nothing else they would rather be doing.

The EHR is just another of the transitions that physicians are constantly called upon to make in the interest of their patients, their professional competence, and their professional self-esteem.  Its advent is inevitable – no more avoidable than the arrival of the stethoscope in the early 1800s or anti-sepsis in the mid 1800s ( both of which some physicians furiously resisted) or the ICU in the mid-1900s.  Positive change is often disruptive, but it is irresistible nevertheless. In 10 years, paper records will be the exception.  Lagging physicians will be seen as quaint throwbacks, no longer at the top of their game,  nostalgic reminders of a bygone age when offices brimmed with manila folders and piles of forms, or when nurses and doctors searched endlessly on hospital rounds for that one essential patient chart that always seemed missing from the nursing station.  (How many millions of hours have clinicians spent wandering hospital floors looking for those elusive missing paper records?).

Still, some physicians may be tempted to put off the inevitable, trying to postpone the disruption and expense.  Why not wait five or six years?  Maybe it will get easier?  Less expensive?

For several reasons.  First, the sooner physicians start using an EHR, the sooner they and their patients will realize its benefits – the ability to share patient data with colleagues and patients, the ability to retrieve old data effortlessly, the ability to access patient records remotely, so they answer patient questions intelligently from home, or even from a medical meeting.

Second, right now, the federal government is making a once in a lifetime, never to be repeated, offer: it will help physicians pay for the transition with up to $44,000 in extra fees from Medicare, or $63,750 from Medicaid.  Physicians can take the leap now with financial and technical help from the government.  Or they can do it on their own (or facing a financial penalty) in five years.

Third, anyone who is building a practice, and wanting to recruit young, talented physicians needs to confront the reality that the next generation will expect and demand that their own medical home have a modern information system. I know this from personal experience.  With two children in medical school, and a daughter in law who is an intern, I know young physicians will never settle for paper records.  Wait, and the cream of the recruiting crop will pass you by.

To me the choice is clear.  Physicians’ professional, clinical and financial interests all point in the same direction.  Become part of the future.  Become a meaningful user of an electronic health record.

–David Blumenthal, M.D., M.P.P. – National Coordinator for Health Information Technology