EHRs Tied to Physicians’ Licenses: A Bad Idea

 
~ by Linda M. Girgis, MD, FAAFP

Starting in January 2015, all physicians in Massachusetts must use an electronic health record system or face disciplinary action that could result in the loss of their license to practice medicine. Doctors fear these laws will spread to the rest of the country.  While law makers are devising regulations and laws enforcing EHR use and metrics recording, doctors are saying enough. According to a survey on SERMO 97% of doctors polled felt that medical licenses should not be tied to compliance with meaningful use requirements.

EHR technology has great potential, but most doctors don’t feel the technology is meaningful or an effective as a tool in patient care. This fact alone makes tying our medical licenses to compliance with the requirements absurd. One internist wrote “ I have had the opportunity to use multiple EMRs through my residency and fellowship training. My feelings are:

1. they always slowed me down
2. took my attention away from patients and their issues/questions
3. often confused me on what medications the patient was on when multiple people could input medications
4. found the diagnoses were often confusing for the same reason as #3. EMRs should not be mandatory for physicians who provide efficient and quality care for their patients.”

According to one urologist: “Physician productivity and contact with patients is compromised. Physicians turn into coders and data entry clerks. The physicians I know who have worked with a certain EHR system are especially unhappy and frustrated.“

An ER doc went so far as to say, “EHR is a triumph of politics and cronyism over common sense. It is lining the pockets of those who are part of the new medical computer industry. It is antithetical to the art of medicine and will do nothing to improve the quality of medicine we practice.”

Not only do physicians find the EHR time-consuming and confusing, some have simply quit medicine because of it. One ER doctor said “The whole system is cumbersome, slow, and stupid to the point or surreality. I quit in October. Three other hospital staff members have also quit.”

EHR costs prohibitive

Cost is another big factor in EHR adoption. While it may not be difficult for hospitals and large healthcare systems to purchase pricey systems, it is wrecking havoc on small practices and private doctors. One ophthalmologist said, “We figured out the cost of EHR – extra staff to scan things, IT support and an amortization of the license. I would have had to increase my medicare volume by 30x to come out even.”

Overhead costs are soaring while our incomes are shrinking or at least remaining stagnant. It is difficult for already financially strained practices to meet this added expense.

While doctors object to purchasing and using inadequate EHR technology, they are more opposed to the meaningful use requirements recently imposed. Initially, it was set into place as a bonus program. Over a few years, the government is now rolling out penalties in reimbursement to doctors who fail to meet requirements. Politicians now tell us how to use EHRs to improve patient care with little physician input. Surely, doctors know more of what goes on in an exam room than our elected officials who are far more likely to be lawyers than doctors. As a result of reporting all these metrics, doctors are spending more time looking at their computer screens than with eye-to-eye contact with patients.

One orthopedist wrote, “EMR can’t replace the back-and-forth of an exam. Checking boxes is not the same as a hand-written notation such as the patient likes to crochet and likes the color blue (for whatever reason).” We are losing this personal knowledge of our patients by computerizing them. A Clinical Medicine lab specialist goes on to say, “Patient care is not just a science…it’s an ART. For the Art part, it has to be an up-close and personal event; you just can’t fill in a form, follow an SOP and hope for the best.”

The criteria put forth does not reflect quality patient care in many doctors opinions. “An ophthalmologist stated, “MU requirements get tougher, and the work to keep up with them is extremely time-consuming. I doubt we will make it through this year’s Stage 2, Year 1. I made it through the others, but this one seems to be beyond me. Is there any evidence to support that EHRs improve patient care? They certainly don’t improve patient flow or satisfaction”.

Physician compensation is sometimes pinned to the absurd. According to an endocrinologist, “ You know what “meaningful use” means to me? Every visit with an infant, or child with diabetes, or hypothyroidism, or short stature begins with the phrase, “the government requires me to ask you if Johnny started smoking since your last visit.” And if I don’t ask, I am not in compliance and my ‘quality’ metric goes down.”

Some of these measures are not even in the control of the doctors required to report them. A urologist informed us, “the criteria are not necessarily based on patient care, especially as one current parameter is a certain percentage of patients have to contact you electronically. No one can control whether or not your patient:

1. has internet access
2. has an email address
3. knows how to use a portal system

It makes absolutely no sense to tie licensure to whether or not a physician follows all the MU use rules, especially since the rules keep changing.”

With all this, imagine how enraged doctors are to have their licenses tied to proper implementation and usage. An occupational medicine doctor writes, “State boards are usually tasked with assuring public safety. I in no way see this as a public safety issue and therefore it should not be within the scope of a state medical board.”

“Licensure is and should be linked to education, competence, and a commitment to maintaining one’s knowledge. I cannot agree with even the suggestion that issues related to record-keeping, no matter what it is used for, have any place in consideration of a professional license of any kind,” wrote one general surgeon.

While patients are feeling they are not getting enough time with their doctors, these mandates are prying us further from the human contact they need and want. EHRs are a time drain, far from improving patient care, they are making it more difficult.

Doctors Do Not Stand Alone

Doctors are not alone in their stance against medical licenses being tied to EHR use and compliance with the accompanying regulations. According to Ken Congdon, Editor in Chief of Health IT Outcomes, “Although I am a supporter of the MU program and what it is trying to accomplish, requiring a physician to adhere to MU (or HER use) or lose their license is ridiculous. While there are several benefits to using the technology effectively, many physicians will never be comfortable using the tool. Does this mean they should be forced out of practice? Absolutely not. However, over time, patients may demand the benefits EHR technology facilitates (e.g. health record access, care continuity, patient portal, etc.). However, a provider’s patient base should drive this adoption. The state or other government body should not enforce licenses this way. Just because a physician doesn’t use an EHR doesn’t mean they’re not a good physician or valued caregiver.”

While the potential of EHRs is tremendous, the technology as it currently stands is failing us. This intrusion is unwanted and is decreasing the value of healthcare. We should test mandates efficacy before we tie physicians’ licenses to them. They should meet quality tests and minimum levels of clinical usefulness. We do not feel EHRs improve patient care, but rather they erode the doctor/patient relationship.

To mandate their use at this stage is ludicrous. To tie it to our medical licenses is insulting. There is no way a doctor’s competency could or should be determined by their ability to use an EHR or to compliantly check metric boxes.

Does anyone truly want a doctor whose quality is determined by their data entry skills? Patients deserve caring, astute doctors in exam rooms, delivering the best treatment options. Let’s focus on giving them the best of our knowledge and experience, not our secretarial skills.

Bio

Dr. Linda Girgis MD, FAAFP is a family physician in South River, New Jersey. She has been in private practice since 2001. She holds board certification from the American Board of Family Medicine and is affiliated with St. Peter’s University Hospital and Raritan Bay Hospital. She teaches medical students and residents from Drexel University, UMDNJ, and other institutions.  Dr. Girgis earned her medical degree from St. George’s University School of Medicine. She completed her internship and residency at Sacred Heart Hospital, through Temple University.  She has appeared in US News and on NBC Nightly News.