Pediatricians May Be the Only Group of Physicians Who Can Create Life-long Electronic Health Record Users and Advocates

Perhaps creating an opportunity is nothing more than observing the details and taking action once one has been identified.

Lack of opportunity, on the other hand, might be the opposite – keeping your head down and barreling through life without taking an adequate measure of the terrain in which you are navigating.

The feds missed an opportunity. During their planning and roll out of meaningful use, in their effort to collect the health data of this country’s population, specialists, in many cases, were not considered as recipients of their meaningful use incentives.

For many specialties, this might not apply. But pediatrics are different entirely. Not so much for the physicians’ sake, but for the patients they serve.

Given the direct marketing plan that the federal government has undertaken with its latest healthcare pet project, Blue Button, I’m surprised by its lack of foresight related to patient involvement to this group when it comes to meaningful use.

As the feds work desperately to change the perception of electronic data collection, and to move the most information into electronic records as possible, one might think the best way to ensure absolute adoption is by requiring the one group of physicians who might be able to affect the longest term change to participate in the incentive program.

Pediatricians, like it or not, have not been given special treatment as far as meaningful use is concerned. They, like another large group of physicians, OBGYNs, are left to fend for themselves. You can read more about OBs and their fierce independence in my recent interview with digiChart’s CEO Phil Suiter. The reason is well known and obvious: these groups of caregivers don’t necessarily rely on the government (Medicare/Medicaid) to keep their doors open.

The nature of pediatric practice is such that Medicare is not a significant part of their practice so meaningful use incentives don’t apply here. Therefore, the only avenue left for pediatrics is the Medicaid option – and it only works for practices that have more than 20 percent of their volume as Medicaid. In most cases, these groups of physicians don’t meet the minimum requirements of serving Medicare and Medicaid recipients to qualify, and, also in most cases, they don’t go out of their way to do so.

Therefore, given the logic that A+B=C, they are not lining up to get their share of the incentive checks.

But, one would think the feds would try to find some way to make an exception for pediatricians to participate in meaningful use without having to meet the minimum requirement that 20 percent of their population participate in Medicare. I’m not trying to re-open an issue that I know has been discussed countless times; I’m trying to make a different point.

That is, given the new push for patient engagement and the social media-like approach being taken through the Blue Button movement, I believe the importance of pediatricians has been overlooked.

Why? Well, it’s obvious to me that to engage a population, it’s best to change the population’s behavior. To do so, you have to catch them young; so young that they never knew a difference otherwise.

For example, children today will never know what life was prior to the web. They won’t be able to imagine life before mobile devices turned us into an always on society. There’s a lot they’ll never know.

Thus, if they are exposed to electronic health records in their doctor’s office as they grow up, by the time they reach adulthood, they’ll expect their doctors to use nothing but electronic health records. In fact, they won’t even know what to do with a paper record – how to read and understand it – and, therefore, won’t give their money to doctors without the systems.

It’s really the most direct route to changing a population’s behavior.

Indoctrination.

Sure, engaging the adult population through a service like Blue Button is important, and will certainly help fill the gap currently experience in healthcare’s ownership issue, but as we’ve seen in every other area of life, true change won’t come until those who know no other way become the majority and know no other way.

From Boom to Bust: Is Health IT Headed for the Same Fate as Housing

In speaking with a CEO of a major EHR/PM vendor recently, the conversation about the future of health IT kept coming back to money. Not necessarily the money saved by practices because of the implemented technology, but the money being flushed into the space by the government.

Though the money is flowing and the incentives are pouring into the economy and getting freely spent, there are obviously some still inside the vendor (and probably the practice) space that remain concerned about the viability of the government’s financial involvement in health IT in the long term.

The federal government’s money has created the structure of what we now know as health IT. Because of the push – the money, or the carrot and the stick, if you will – there’s now a deeper foundation set; there are studs and rafters in place, and even a few pieces of siding in some cases.

With roughly half (being generous) of the ambulatory market currently using some sort of an EHR, ground has obviously been gained in the market. It would have come eventually, the advancements, but the federal incentives no doubt hastened the proliferation of the technology. But, for the sake of argument, let’s say the federal money drives up or is re-appropriated. What happens then? Where does that leave the market, as my CEO colleague hypothesized?

I hadn’t exactly thought of it that way, especially now at this late stage in the program. But the man does pontificate an interesting point.

Given all of the money flowing into the health IT market, it’s one of the few booming economic segments, and given the number of parties staking claim to it hoping to make monumental returns on their investment, the scenario actually brings another very similar boom to mind.

From early 2004 though 2005, the profits were record breaking. Ad sales were way up, circulation was expanding into new markets and staffs were being bumped up to counter efforts made by the competition.

However, by late 2006, as a cautionary note, hiring slowed and expansion stopped. At the beginning of 2007, the layoffs began. Reporters, editors and production staff were cut. The newspaper chain I wrote for shuttered offices and cut more costs. Another round of employees was let go. Ad revenue hit the floor; newspapers stopped circulating, the market shrank and even more people were laid off. The business entered a tailspin that even now, five years later it hasn’t recovered from.

It never will.

The boom times went bust, and for newspapers, caught up in the seemingly never ending flow of cash from advertisers, who happened to be home builders and contractors, little planning for the future was done and any thoughts of a rainy day fund seemingly were little more than thoughts.

In Florida, at the time, you couldn’t spit or throw a stone without hitting a new housing development or condo conversion. There were housing starts everywhere. Houses, in all phases of development, were being erected. The building was constant. There was no end in sight. Contractors were hiring employees everyday, banks were lending, people were fighting, literally, over houses that were for sale.

When the boom was booming, everything even peripherally related to the market was booming. But when the housing market busted, well, I don’t need to tell you about how that affected each one of us.

So, my friend the CEO asks an interesting question. One that was probably asked thousands of times during the great housing bubble of the middle of the 21st century’s first decade: What happens if, God forbid, the money suddenly runs out of Health IT?

Come down to South Florida and see. I’m sure you could get yourself a pretty good deal on one of the thousands of properties sitting half built and empty.

Sure, they’ve got a good foundation, walls, rafters and, in some cases, a bit of siding, but they sure aren’t much to look at much less much better to live in.