Six years ago, on Feb. 17, 2009, the federal government passed the American Recovery and Reinvestment Act, a $787 billion economic stimulus package that, among other things, authorized CMS to implement the meaningful use program.
While a handful of providers are slowly trudging through the definitions and attestations, others are choosing to forgo implementing EHRs entirely.
Jeffrey Singer, MD, a general surgeon in the metropolitan Phoenix area, is one such physician unwilling to adopt and implement EHRs, and he will knowingly face Medicare reimbursement penalties over the next five years.
In an opinion piece published in the Wall Street Journal, Dr. Singer said his choice to not participate in meaningful use is due to EHRs harming patients more than helping patients.
Meaningful use, he wrote, was inspired by models used at large integrated health systems, such as Oakland, Calif.-based Kaiser Permanente and the Department of Veterans Affairs. HHS launched a five-year pilot program in 2008 to start using EHRs, and required EHRs nationwide just one year later. Dr. Singer argues the government moved forward with this national program without dedicating enough time to studying them. "By moving forward without sufficient evidence, lawmakers ignored the possibility that what worked for Kaiser or the VA might not work as well for Dr. Jones," he wrote.
Additionally, Dr. Singer wrote EHRs are lowering quality of care and raising healthcare costs.
"[EHRs] force me to physically turn my attention away from patients and toward a computer screen — a shift from individual care to IT compliance," Dr. Singer wrote. "This is more than a mere nuisance; it is an impediment to providing personal medical attention."
Dr. Singer points to studies to demonstrate a shared concern among physicians regarding EHRs. He refers to a 2014 survey by Medical Economics that indicated 67 percent of physicians are dissatisfied with EHR functionality, and Deloitte found 75 percent of physicians said EHRs do not save them time. "Doctors reported spending — or more accurately, wasting — an average of 48 minutes each day dealing with this system," Dr. Singer wrote.
Dr. Singer explained that as physicians spend more time on EHRs, they can't see as many patients as they used to, so they increase costs for the patients they do see. Additionally, the costs of implementing EHR systems (approximately $162,000 for the average five-physician primary care practice and an additional $85,000 the first year for maintenance, according to the Agency for Healthcare Research and Quality) are passed onto patients, he wrote.
In terms of lessened record errors and increased efficiency, Dr. Singer wrote his experiences suggest otherwise. He said EHRs assume patients are all average patients, prohibiting physicians from tailoring consultations to the individual.
He explained, "When I'm in the treatment room, I must fill out a template to demonstrate to the federal government that I made 'meaningful use' of the system. This rigidity inhibits my ability to tailor my questions and treatment to my patient's actual medical needs. It promotes tunnel vision in which physicians become so focused on complying with the EHR work sheet that they surrender a degree of critical thinking and medical investigation."
Regarding patient safety concerns, Dr. Singer simply refers to the first Ebola patient in the U.S., whose initial misdiagnosis is said to stem from an error in the EHR.
Dr. Singer concluded his piece by urging an end to the mandatory EHR requirements, suggesting such a proposal should be a key element in the Republican Party's healthcare agenda.
"Congress has devoted scant attention to this issue, instead focusing on the larger ObamaCare debate," Dr. Singer wrote. "For all the good intentions of the politicians who passed them, EHRs have harmed my practice and my patients."
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Deloitte launches consultation service to lower EHR cost