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5/30/2013
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EHR Mandate Riles Massachusetts Doctors

Doctor's angry blog post calls attention to year-old law that would punish those who don't meet Meaningful Use EHR criteria with loss of their medical licenses.

9 Mobile EHRs Compete For Doctors' Attention
9 Mobile EHRs Compete For Doctors' Attention
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Massachusetts physicians are concerned about an amendment to a state law that would require them to show proficiency in the use of electronic health records (EHRs) sufficient to meet the federal Meaningful Use criteria -- or risk losing their medical licenses in 2015.

Howard Zwerling, MD, a practicing doctor in Massachusetts and president of EHR vendor ComChart, took these concerns nationwide with a widely noticed post on The Health Care Blog earlier this week. In his "open letter to Massachusetts physicians," he said that the practice of medicine had already become more difficult because of external mandates. "And now, the politicians intend to tell physicians which software they must use in their office and which [EHR] options must be utilized during the office visit," he wrote.

Ronald W. Dunlap, MD, president of the Massachusetts Medical Society, told InformationWeek Healthcare that the society is hopeful that it can get the state Board of Registration in Medicine to adopt a more flexible interpretation of this provision so that physicians don't have to meet the government's MU standards on certified EHRs to keep their licenses.

[ Are government health regulation deadlines unrealistic? Read Meaningful Use Stage 2 Needs More Time, CHIME Says. ]

"If the rigid interpretation of this law is upheld, it's going to be a problem in 2015," he said. "If we were to implement that, half to two-thirds of the state's physicians would not be able to be licensed."

This high estimate is not based on any technological backwardness in Massachusetts. EHR adoption in the state is widespread compared to the rest of the country. But a large percentage of Massachusetts physicians are not even eligible to register for the Meaningful Use program, Dunlap noted. Either they are surgeons or other hospital-based specialists such as radiologists or pathologists, who are excluded from the program, or they're pediatricians who don't have enough Medicaid patients in their practices to qualify for government incentives.

Dunlap estimated that of the 28,000 licensed physicians in Massachusetts, just 4,500 are primary care physicians. Those doctors and up to 2,500 medical subspecialists are eligible professionals (EPs) as defined by the Centers for Medicare and Medicaid Services (CMS). Most of the other doctors are not, he said.

As a result, although many of the non-EPs are skilled at using EHRs, they would not pass the proficiency test that would allow them to keep their licenses if it required them to show Meaningful Use.

A small percentage of physicians continue to resist acquiring EHRs, Dunlap said. These are mostly solo practitioners who don't want to spend the money and older doctors who are close to retirement. But as hospitals and other large organizations employ more doctors, "the numbers of those people are decreasing daily," he said.

The original state law mandating that physicians use EHRs by 2015 was passed in 2008. Last summer, the amendment was added at the instigation of state Sen. Richard T. Moore, according to Dunlap. The medical society, which had been discussing with the board ways for doctors to show they were using EHRs "meaningfully," was caught off guard.

Now the society is trying to drum up support from hospitals and other stakeholders to put pressure on regulators so they will interpret the law favorably for physicians.

"We're hoping that we can get this interpreted so it's not a rigid, government-defined standard of Meaningful Use," Dunlap said. "Using computers meaningfully is different from that rigid standard. That's the position we're taking: we're hoping it's a broader demonstration of competence that applies to a lot of different specialties."

Zwerling, though, is taking a more defiant stand. His blog post called on all of his colleagues to write letters calling for the repeal of the law to Gov. Deval Patrick, the state secretary of health and human services, and their local representatives.

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andyx
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andyx,
User Rank: Apprentice
6/11/2013 | 3:52:27 PM
re: EHR Mandate Riles Massachusetts Doctors
While there is justifiable need to raise strong awareness and physician response regarding implementing EHR, i neither agree with the legislative action nor the quoted strong response of the cited "letter to physicians". I believe strong and meaningful use of EHR is absolutely essential to achieving a viable public healthcare system in the United States. However, our physicians are not licensed to support our public healthcare system, they are licensed to practice medicine on individuals. This legislation crosses the line over what physician licensing means.
However, I believe that delays in modernization of the U.S. Healthcare Industry are detrimental to that industry and this relates to: Waste, Fraud, and Abuse; ICD-10 implementation; EHR and its meaningful use; accountable care; health information exchanges; and the general pay-as-you-go philosophy in medical care which leads to what T.R. Reid says places this country among the poorer performing National Healthcare programs in the world.
AustinIT
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AustinIT,
User Rank: Apprentice
6/5/2013 | 6:56:56 PM
re: EHR Mandate Riles Massachusetts Doctors
Agreed. The Amendment should be repealed and I am shocked it was ever passed in the first place.
jaysimmons
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jaysimmons,
User Rank: Apprentice
6/2/2013 | 6:10:52 PM
re: EHR Mandate Riles Massachusetts Doctors
I believe this law would certainly need to be reinterpreted to provide more flexibility for the physicians. As Dunlap says, there are a huge number of physicians that aren't even eligible for meaningful use because of the fields that they work in, yet they would be susceptible to losing their licenses if this law were to come into effect. I don't believe holding physicians' medical licenses hostage is a good way to get physicians to account for meaningful use. I think this plan would backfire and move physicians against health IT if anything.

Jay Simmons
Information Week Contributor
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