I was glancing through my draft posts today and found this article by Neil Versel, now blogging at Meaningful Healthcare IT News, about State Medical Boards considering making EHR user a condition of medical licensor. That’s right. To renew your medical license using an EHR could be part of the clinical competence test.
On face value, it’s a kind of crazy idea to consider. Although, couple that with a post on EMR Thoughts that talks about a Doctor Quiting His Practice Over EHR Use. Makes you think for a second the value of EHR knowledge for a doctor practicing medicine.
Turns out that Massachusetts has already put this requirement in place starting in 2015. Here’s a quote about that doctor that closed his practice thanks to his inability to use the EHR.
Like all Massachusetts doctors, the physician also was required to comply with the state’s Section 305 law. It mandates that physicians demonstrate competency in EHR use by 2015 to maintain licensure.
I must admit that this is a hard pill to swallow for me. Do we really need to make this a requirement? Does making it a requirement add any value? In Massachusetts it says they’re using CME’s to show a person’s EHR proficiency. A really powerful measure of proficiency < end sarcasm font>. Therein lies the problem. How do you measure EHR proficiency?
Although, the doctor leaving the practice, which is an issue in itself, also illustrates why EHR proficiency shouldn’t be a requirement for a medical license. In the not so distant future, it will be hard to practice medicine without EHR proficiency whether the medical boards require EHR knowledge or not.
I don’t know whether I agree with this or disagree. On one hand, I’d like to say it should be a reuirement as a measure of keeping up with the times. On the other hand, it puts more power into the hands of government and takes away power from physicians to make a decision on their own. How important is it for them to be able to make that decision on their own?
>>> In the not so distant future, it will be hard to practice medicine without EHR proficiency whether the medical boards require EHR knowledge or not.
It’s not a matter of “EHR proficiency” but whether or not doctors wish to comply with laws that make them purchase expensive, unproven EHR systems and then be forced to upload data so some governmental pinhead can use the information to cut back further on care to our patients.
John, you know that I’m one of the most anti-EHR people out there, yet I actually programmed my own EMR/PMS using Visual Basic and the MS Access, MS Word, and MS Excel platforms. I use the $14 million Siemens system at one hospital and can use the $50 million GE system at another for patient care.
I just don’t think that the “enterprise” EHR vendors have made their case that their wares are better than paper or a cheap EMR. The HIMSS lobbying of our government even makes me angrier and makes the case that this EHR push is a farce only to pad the pockets of the greedy EHR vendors, or as I call them the modern day “Robber Barons.”
Al
Al,
I’m not sure I’d describe you as anti-EHR. I’d describe you as anti-poor functioning EHR. I think you’re a big fan of technology and its benefits when it’s implemented properly. You’re just against the Jabba the Hutt EHR companies out there that charge you an arm and a leg for a product that’s extremely lacking.
[…] many readers know, the state of Massachusetts will soon require doctors to prove that they’re at least minimally EMR-savvy. By the year 2015, doctors will need to be able to demonstrate that they’re competent in EMR […]
I’m so happy to NOT be practicing in Massachusetts. In Massachussetts, they have introduced legislation to have mid levels, including PAs, work independently to solve the primary care shortage. Docs are no longer necessary. We have created our own extinction.
http://www.boston.com/bostonglobe/editorial_opinion/letters/articles/2011/06/21/primary_care_shortage_calls_for_expanding_field_of_practitioners/
You’re not in primary care Al. Aren’t you an oncologist?
Either way, how do you suggest to solve the shortage?
Hi John:
I was an oncologist- nowadays I still do an occasional consult, but 2.5 years ago I dropped all chemotherapy. Medicare over the past 10 years has had several “Oncology Improvement Acts” that has decimated the specialty. Chemotherapy drugs are reimbursed at around cost, and frequently BELOW cost. Procedure costs have also been cut drastically. Example- a bone marrow biopsy used to be reimburse at $120 ($40 of which went to the cost of the tray). Now they are paying $80 ($40 still is the cost of the tray)… which means that when I stick a 4.5 inch needle into the hip of a patient I earn only a $40 profit. Not only was there a lot of skill involved, but the procedure took about 45-60 minutes to perform, including the post procedure note and the labeling of the slides. I can see 2 people with the sniffles for twice that, and with less lawsuit exposure.
When the recession hit in 2009, many of these patients, who lost their jobs after learning about their cancers, found it impossible to pay their 20% copay, which meant that I had to take massive losses when chemotherapy allowed amounts/margins were at or less than cost to begin with.
On top of this there is the fact that most patients with cancer are elderly and thus on Medicare which means that the MEANINGFUL USE penalties would hurt my bottom line even more drastically after 2015. The chemotherapy reimbursements would then be a total, massive loss. Screw CMS- I refuse to go bankrupt just because of some Democrat/Republican pinheads. They want to save Medicare on the backs of the very providers that are taking care of the elderly who are the sickest patients most in need of care. Shame on them!
I had a good 18 years of practice as an oncologist. I just wonder what the future holds for the specialty… and for those patients with cancer. As the years go by there will be fewer oncologists with open panels, that’s for sure. I’m delighted to be an Internist- I see my 15-20 patients a day and go home a happy man able to provide for my family. I’m also enjoying life more than ever, which is priceless.
How do we solve the shortage? Pay doctors their true value as set by free market choices. No Romeycare, no Obamacare, and make Medicare less oppressive. Get rid of unfunded or poorly funded, meaningless, unproven, costly mandates and bureaucratic nightmares like HITECH/Meaningful Use. At that point the healthcare market will fix itself nicely, all by itself.
Al
Al
I think I’d only heard parts of the full story. Thanks for sharing it all. How about insurance companies? They don’t seem much better than Medicare.
[…] I remembered the discussion of tying medical licenses to EHR adoption, but I’d forgotten that Massachusetts actually passed the EHR requirement law. The topic was again ignited by Hayward K Zwerling, MD in this Health Care Blog post. Here’s […]