Meaningful use is a barrier. The criteria are meaningful only to scorekeepers and administrators – in other words, bureaucrats. However well-meaning the crafters of the MU criteria were, at the end of the day they defined EHR to be a tool of little use to small practices. The role of the practice is to collect the data and pass it on to the bureaucrats.
In a message posted on docEHRtalk.org <a href="http://www.docehrtalk.org/messageboard/2010/08/20/many-older-physicians-may-just-say-no-emr">Dr. John Concannon </a>expresses well the push-back I've heard from nearly all of the docs I've talked to over the past several months, ranging from solo practices to individual members of large practices and hospitals. In the message he notes that physicians will readily adopt new technology when it helps them fulfill their mission, and he uses the gamma knife as an example.
The reason that a physician will readily adopt a gamma knife but not an EMR is simple. The former successfully addresses <ul>
a job the physician needs to get done </ul>
(i.e., safely remove a cancerous tumor) faster, more conveniently and more affordably than the other available alternatives. The latter does not. Therefore, the physician gladly takes up the gamma knife and resists the EMR.
To get to wide adoption of EMR, there apparently needs to be a much deeper understanding of the jobs that the physician and his/her practice need to get done. Based on the testimony of the intended users, EMRs in their present incarnation fail to satisfy. Most physicians view EMRs as tools to collect data to feed bureaucrats – work that distracts from the physicians’ mission to deliver health care. For EMRs to be widely adopted, I think EMRs must get much more directly involved in the actual delivery of care – at least if we expect physicians to be end-users of EMRs.
This reminds me of a situation I encountered a number of years ago in the field of public safety. The Providence police – the guys out in the patrol cars – were very antagonistic towards the mobile data terminals installed in their cars. Why? Because the terminals were only used to collect data, and entering the data created no benefit for the cop who had to do the job. The data was only used to compile reports to the bureaucracy (i.e., the Brass, the State Police, the FBI, the Justice Department, …). The system gave the individual cop nothing of value in return.
A few years later the situation had changed dramatically. The system still required cops to collect data, but it also provided useful information to the cop such as flash reports of stolen cars and missing persons, video feeds of areas under surveillance, and mug shots of suspects. The system had become something the cops said they couldn’t do without.
As long as “meaningful use” is defined as collecting data for bureaucrats to consume, adoption of EMR is going to go very slowly. Although the MU criteria are meaningful to the scorekeepers and administrators, it looks to me that none of the criteria is especially meaningful to the practices that are expected to provide the data.