Ever since electronic medical records were introduced to the health care industry, professionals from front-line physicians to high-level administrators have worked to satisfy the requirements of meaningful use stage 2 requirements in order to qualify for incentive payments. The transition has not always been smooth, as physicians struggle to work out the right balance between data entry and patient interaction.
Some high-profile organizations, like the American Medical Association, have publicly declared their doubts about the incentive program's true effects on the ability of physicians to deliver the same quality of patient care, but governmental agencies have made it abundantly clear that EMRs will be a driving force of health care reform for years to come. While meaningful use incentives have driven physicians to participate in reform up until now, new legislation currently being considered in Massachusetts could change the thrust behind EMR adoption from incentives to threats of loss of licensure.
Choosing the carrot or the stick
Go Local Worcester reported on Chapter 224, a health care reform law passed in Massachusetts in 2012, which is currently undergoing language revisions by state lawmakers. These changes, if adopted and implemented, could cause a select group of physicians to lose their right to practice medicine if they cannot prove EMR certification and qualified use to state authorities.
While the rate of EMR adoption is much higher in Massachusetts than in the rest of the country, state officials urged that the true value of these systems comes not in their implementation by isolated practices, but in taking advantage of their interoperability – a facet which can only be taken advantage of if EMRs are used by a significant majority of practices across the state.
If passed, the revised bill would make physicians subject to license forfeiture beginning in 2015. Because most larger practices in the state have already received EMR certification, the only doctors likely to fall under the new punitive purview of the bill would be physicians working at academic centers who do not see patients regularly and therefore do not require EMRs, and providers who do not meet the current standards for patient demographics.
Some legislators have attempted to relax the requirements of Chapter 224, but their adjustments are being considered in committees as well.
Institutional acceptance grows, but personal skepticism remains
The Massachusetts health care industry has not had to chase the rest of country in EMR adoption rates since the initiative's inception. Medical Economics reported that, while the national average for EMR implementation rested at 48 percent of practices, Massachusetts was "significantly higher" than that mark. Massachusetts joined states such as Iowa, Minnesota, Oregon and North Dakota – with the highest rate at 83 percent – that all shared rates above the national average.
Despite the state's high implementation rate, some physicians are skeptical that the path toward EMRs is the right one from the focus of patient care.
"We're both very excited about electronic medical records and have the same cautions and concerns about their use, as with everything else that adds some complexity to medical care," Paula Griswold, executive director of the Massachusetts Coalition for the Prevention of Medical Errors, told Go Local Worcester. "They can be the solution that creates a new problem."
With these revisions to Chapter 224, Massachusetts is making it clear to physicians that, while EMRs may still have issues, health care reform will not move forward without widespread or possibly unanimous use of the technology. Rather than wait until later to figure out how best to solve these problems, practices large and small that have not yet adopted EMRs should move fast to correct that or face the loss of medical licenses in the coming years.