"One Cannot Measure What One Does Not Manage": HIT--"Doc, I'm here to help ya." (Part XIII-p)

July 8, 2009
Jeffrey Kaplan, MD

Health information technology has become a national priority and there are incentives for using an EHR.

The adoption and implementation of health information technology (HIT) nationally is "For the Future of Health and Care," and thus, the American Recovery and Reinvestment Act, or Recovery Act, for short was born. It is providing $19 Billion and has incentives. For example, a physician can receive up to $44,000 for purchasing and using the computer in their office in a "meaningful" way but what does that really mean and is this campaign a Trojan Horse?

In an article, "EHR Financial Incentives Tied to 'Meaningful Use'" [Pediatric News. June 2009;43(6):34], "Dr. John Halamka defined it as “processes and workflows that facilitate improved quality and increased efficiency.” The same article refers to the Markle Foundation's “simple” definition of patient-centered "meaningful use," which is: “The provider makes use of, and the patient has access to, clinically relevant electronic information about the patient to improve patient outcomes and health status, improve the delivery of care, and control the growth of costs.”

It's worth reviewing their Consensus Document; it has been, endorsed by AARP, the American Academy of Family Physicians, the Joint Commission, Surescripts, America's Health Insurance Plans, and the National Committee for Quality Assurance.

However, notwithstanding the efficiencies gained with computerization, and mindful of HIPPA "protections," the EHR may be an entry to governmental oversight. I have no problem with unobtrusive feedback into my practice (and I know the value of an "episode of care" kind of analysis, measurement and management), but 'been there; done that' when it comes to HMOs looking over my shoulder and being judgemental—"Doc, I'm here to help ya."

Oh, Dr. Pedipod: We see you've not immunized X patients. (Could it be that I'm not their PCP?)

Dr. D. Mellitus: Your Hgb A1c levels? (Could it be that patients are losing coverage or are noncompliant?)

Dr. C.A.P.: Too many of your patients are being admitted to the hospital. (Could it be that many of them continue to pollute their lungs?) Also, are you asking me to practice 'cookbook' medicine? (My patients are different.)

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