An Attitude Adjustment

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 - William F. Bria, MD
William F. Bria, MD

The Department of Health & Human Services has declared 2013 the year of implementation of Meaningful Use (MU) and no rulemaking regarding Stage 3 will occur before 2014. While the numbers regarding incentive payments and EHR adoption continue to increase, I would say that many healthcare providers are questioning the whole initiative.

While the juggernaut of EHR rollout continues, we’re still looking at the vast majority of healthcare organizations not completing computerized physician order entry (CPOE), to consider one major indicator of achievement within the MU cascade.

Rather than the year of implementation of MU, I think we’re in the year of the main core of the medical profession finally saying this is hard. They are not experiencing a seamless flow of information. In fact, productivity and efficiency has been ratcheted up just to maintain revenue.

It is not possible to make a one-to-one swap from paper to electronic systems in one day. Significant preparation is needed, along with a reasonable expectation for decreased productivity for a period of time that can slowly return to previous levels.

In the face of such a large, significant change, there is a generational cohort that says they might as well retire instead of learning a new way of practicing medicine. I hear that from some of my old friends but that isn’t happening in leading academic centers and large, competitive, state-of-the-art healthcare systems. Although the U.S. medical profession does not love the EHR revolution, they cannot ignore it.

This transition and transformation of U.S. healthcare technology and infrastructure is undeniable. Although individuals are saying they won’t get on board with the sweeping changes until they are forced to, no one is saying that this shift needs to be reversed. My father, a physician, was never more upset than when a young patient asked for an explanation of the medicine prescribed. My father was absolutely insulted and felt that his patient should take the medication simply because that is what his doctor told him to do. I see some of my colleagues in this era responding with the same attitude to requests for them to use CPOE and EHRs. They act like such tools are beneath them and their practice should not be questioned in any way.

We’re living in an era when we could all be independent contractors. There is no disadvantage to pooling information, identifying outbreaks of disease and using decision support to significantly improve and standardize care. This is a better way to care for patients. The medical profession is in a contract with society. The reason we get respect is because we own the public’s trust. If these tools, which have demonstrated their usefulness many times, have the ability to improve the safety and quality of the care delivered, then we should use the tools. We just should. That’s what our trust equation with the public is made of.