Editor’s note: Doctors in private practice were innovating to provide top-flight electronic medical records (EMR) and electronic health records (EHR) long before the federal government’s Meaningful Use program imposed counterproductive reporting requirements on physicians in 2011, distracting them from providing patients with the highest quality care.
Health Care News asked Dr. Mike Koriwchak, vice president of Docs4PatientCare Foundation and cohost of The Doctor’s Lounge podcast, to explain how Meaningful Use killed electronic records innovation and how lawmakers and the Centers for Medicare and Medicaid Services can help revive it.
Hamilton: How have you personally been involved with developing innovative EMR and EHR systems to help physicians serve patients better?
Koriwchak: Since 1995, I’ve had the pleasure and the privilege of being with a group of doctors in my practice that have always wanted to be innovators. They’ve always wanted to be on the cutting edge, not only in the medical aspect of how we take care of patients, but also in the delivery models and business aspects of health care. We decided in 2003, long before there were federal regulations to the contrary, to pursue our own vision with electronic medical records, and we made that commitment.
We went live with the system in 2005, five years before the government got officially involved. Without regulations weighing us down, we were free to pursue our own vision of what we and our patients wanted. We solved problems nobody knew existed related to implementing EHR into practices without causing chaos.
Hamilton: In 2011, CMS began implementing the Meaningful Use program under the American Recovery and Reinvestment Act of 2009. How did this affect EHR innovation?
Koriwchak: All that innovation and free thinking came to a grinding halt the day the government got involved. The feds created this body of regulations not only to incentivize the use of EMR, but to direct exactly how every physician in the country uses EMR, with a burdensome, one-size-fits-all program. I call it the day innovation died. All of a sudden, all we could do was tread water and be compliant with regulations. We couldn’t really serve our patients anymore with the technology. It’s been very detrimental.
The Meaningful Use guidelines force you to do so many things that don’t help with patient care. They force you to report so much data that no one is going to read that, as a result, we’re forced to practice medicine distracted.
Hamilton: How does distracting physicians from patient care affect patient experiences?
Koriwchak: Everyone agrees that if you’re trying to use your phone and drive at the same time, you have a significantly higher risk of hitting another car or a pedestrian. A lot of “God forbid” events happen when you’re distracted.
It turns out we’re fighting much the same problem in medicine. Many patients can tell you how frustrating it is when they’re trying to talk to their doctor and the doctor appears to be preferring the computer to them. Let me assure you: Nothing can be further from the truth. We would much rather look into our patients’ eyes, talk with them, examine them, and understand not only what’s wrong and where it hurts but also what their hopes and dreams and fears and expectations are.
Unfortunately, the way federal regulations are structured, if we don’t stare at the computer screen, we will take a financial hit that could knock us right out of practice.
Hamilton: Many doctors rejoiced when CMS Acting Administrator Andy Slavitt hinted in January the Meaningful Use regulations might become less restrictive. Did you share their reaction?
Koriwchak: That was a shocker, to be sure. If you’re not familiar with the intricacies of current regulation that’s about to go into effect, called the Medicare and CHIP Reauthorization Act, that sounds like manna from heaven. If you do understand what’s happening, you know it’s all preprogrammed. The law basically rolls up Meaningful Use requirements with a bunch of other things and just calls them something different.
Hamilton: Do you think CMS will be responsive to doctors as it sets policy going forward?
Koriwchak: Comments Slavitt made the next day were even more interesting. He said he thought CMS had lost the “hearts and minds” of physicians and needed to get them back. That was truly revolutionary, so I posted on my blog an open letter to him saying we physicians are shocked he even understands we exist beyond just being a cog in the machine. Either Slavitt meant what he said, or this was nothing more than political subterfuge.
I tweeted a link to my letter, and he answered me on Twitter within two hours. We were emailing by the end of the day, and I had a face-to-face meeting with his team in March. The results we’ve gotten so far are window dressing: mission statements, vision statements, and the new name for Meaningful Use, which is now called Advancing Clinical Information. If that’s all we get, then we’ve really not accomplished anything, but that’s about as much as you can ask for at this point.
I do give them credit for wanting to communicate, and my personal experience so far has been encouraging. I’m cautiously optimistic.
Michael Hamilton ([email protected]) is The Heartland Institute’s research fellow for health care policy and managing editor of Health Care News.
Michael Hamilton, “Policy Diagnosis: Doctors and Patients vs. Medicare and Medicaid,” Health Care News, The Heartland Institute, June 2016: http://news.heartland.org/newspaper-article/2016/05/07/policy-diagnosis-doctors-and-patients-vs-medicare-and-medicaid