Is Physician EHR Adoption Getting Past the Penguin Problem?

Remember the penguin problem described by economists?

No one moves unless everyone moves, so no one moves. 

Overcoming the penguin problem has a lot to do with creating expectations. A recent writing by Dr. James O’Connor in Physician Practice expresses a voice from the physician community that I’ve never heard before.  His essay is entitled “Meaningful Use — Doctors Have No Choice”.

Physicians Have No Choice Other Than to Adopt EHRs?

Dr. O’Connor argues that physicians are effectively being forced into adopting EHRs.  He cites facts and reaches a powerful conclusion:

1. CMS penalties begin in 2015.
2. What if you won’t or don’t accept Medicare/Medicaid patients (13 percent of practices in 2009, up from 6 percent in 2004? In August, four major insurers (Aetna, Highmark, United Health Group, and Wellpoint) announced that, at a minimum, they will link their pay-for-performance programs to federal meaningful use criteria. Other insurers are likely to follow.
3. Do you run one of the increasing number of “boutique” or VIP practices that work on a cash-only basis? The American Board of Medical Specialties (ABMS) released a statement in August saying that they intend to link meaningful use of health information technology into the ABMS Maintenance of Certification© program.
4. You don’t care about being board certified? (Sound of crickets chirping.) The Final Rule gives states the authority to impose additional requirements that promote compliance with meaningful use. As reported in Physicians Practice, the state of Massachusetts may take away your license to practice medicine in 2015 unless you demonstrate meaningful use of an EHR system. In Maryland, private insurers will be required to build incentives for acquisition of EHRs and penalties for not adopting them into their payment structure.

OK, so technically, we do have a choice. We could stop taking Medicare and Medicaid patients, accept cash only, give up our board certification (and thus usually hospital privileges), and move to a state (or country) that doesn’t impose EHR requirements. But is that really a choice? No

Revisiting the Penguin Problem of EHR Adoption. What’s Happening Here?

Consider Dr. O’Connor’s comments in the context of the penguin problem of EHR adoption:

…many physicians and hospitals have been reluctant to be first movers because they have doubted others will be following.  Much of the value of EHRs is dependent on achieving network effects —  the creation of a widely adopted network that allows for exchange of interoperable data and collaborative care management processes.

Should Dr. O’Connor’s writing be considered  a sentinel event — a possible early signal of massive changes ahead? Reread his conclusion and consider how the collective actions of the federal government, payers, and physicians associations are creating strong expectations of EHR adoption:

OK, so technically, we do have a choice. We could stop taking Medicare and Medicaid patients, accept cash only, give up our board certification (and thus usually hospital privileges), and move to a state (or country) that doesn’t impose EHR requirements. But is that really a choice? No.

I’ve never seen an article like Dr. O’Connor’s before — a writing by a physician effectively expressing that physicians are feeling tremendous pressure to get off the ice floe and jump into the waters of EHR adoption.

Is that pressure is perceived as a gentle nudge or a painful kick in the butt? Dr. O’s article suggests the latter, but let’s leave that issue for another discussion.

…and either way, you’re off the ice floe and swimming in the ocean of EHR adoption.

One article by one physician probably isn’t enough to get all the penguins into the water…but it’s definitely worth noting and continuing to watch…

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