Will meaningful use drive small practices under?
It is significant that Kibbe is asking the question. He supported meaningful use, in contrast to certification based on feature sets. He has mostly written with approval about National Coordinator for Health IT David Blumenthal and his team.
But, as he writes at The Health Care Blog (copied from his personal blog) small practices are already drowning in paperwork -- most if it insurance-driven -- and since health reform left the insurance system intact, the burdens of automating go on top of that.
Two-thirds of doctors are spending more than half their time on documentation, rather than patient care, and they don't have the bandwidth for anything more, he writes.
Maybe this will kill the small practice segment of medicine, and some won't miss it, but they're the "canary in the coal mine" -- a warning that the environment is toxic.
What is more remarkable than Kibbe's post may be the attaboys it generated. Margalit Gur-Alie of OnHealthTech (new to our blogroll) was especially eloquent on this point.
"EHR is going to reflect the same exact BS that the paper system does, only this time on a shiny screen. If you want to fix the perception of EHRs, you need to fix the financial and regulatory system that drives the design of the tool," Gur-Alie wrote.
A survey from the Medical Group Management Association agrees. Implementing all 25 of the meaningful use criteria will decrease productivity, two thirds of those surveyed said. MGMA, like Kibbe, supported meaningful use.
The most onorous requirements are those which are most patient-friendly, giving patients copies of their health records in a timely manner, because doctors haven't had to be patient-friendly before.
An analogy can be made to the economy. The burdens of insurance paperwork might be compared to the deficit this Administration inherited, and the meaningful use criteria the additional debt being used to re-start the economy.
The risk in both cases is the same. The system collapses. The diagnosis was accurate, the surgery was successful, but the patient died. The fact that the patient was going to die anyway -- the system was collapsing already -- becomes irrelevant to the family.
They're going to blame the doctor.