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.

One-on-one with digiChart’s CEO Phil Suiter

Phil Suiter, CEO digiChart

To this point in the meaningful use experiment, Phil Suiter, CEO of digiChart, has had the privilege of sitting at the front of one of healthcare’s greatest movements. From his place, he’s watched the market act and react, and has seen colleagues seek solutions to corner their respective markets all in the name of providing the best service for the most people.

Suiter, however, may have a view of the current health IT landscape like no other. Leading a specialty only provider of electronic health records and practice management systems, digiChart serves only OBGYNs.

Long before healthcare reform and the thought of meaningful use, digiChart created and built solutions solely for this space, and, unaplogoetically, will continue to serve the space. Plans for expansion may one day include moving into the pediatrician market, which seems to be a safe bet given the connection between the two specialties, but according to Suiter, that’s not a plan actively being pursued.

What’s interesting about digiChart’s position, as Suiter tells it, is that even though meaningful use is vitally important to digiChart and the company has helped many physician achieve stage 1, OBGYNs have not voraciously jumped aboard the program.

What this means, he says, is that it’s a clear sign that the OBGYN market continues to live up to its reputation as a fiercely independent group of healthcare providers. Suiter said that only 20 percent of all digiChart’s clients have chosen to pursue meaningful use. Apparently, the other 80 percent have chosen to overlook the federal incentives and go at it alone.

From conversations he’s had with clients, they’re just are not seeing the benefit of meaningful use, especially for all of the work required with the only benefit is $44,000 over five years.

“At this particular point, they don’t realistically see a flip side in changing. In some practices, some have decided that they are better off without changing,” Suiter said. “Practices have determined that they can survive and be profitable if they are efficient and continue doing what they are doing, especially in the OBGYN space.”

Being profitable means they’ll ultimately forego Medicare patients to avoid the federal penalties levied against them for not meeting meaningful use. In many cases, they don’t see enough Medicare and Medicaid patients to make all the effort worth their while, Suiter said, so the work required simply is not worth the effort.

And, frankly, the question remains: Is the federal money going to still be available as stage 2 progresses? And, what happens in February 2013, should a new administration take office?

Despite the answers to these questions and whatever happens with the election in November, Suiter sees plenty of change ahead for the market. For example, EHR vendor contraction is coming after a period of great anticipation.

He predicts the market will dramatically shrink from more than 400 companies to less than 100, many fewer of them actually viable and sustainable long term.

At the same time, he believes hospital’s appetite for buying and owning private practices will disintegrate as soon as 12 months from now.

“I think we’ll see a disgorgement of practices by hospital systems within the next 12 to 18 months,” Suiter said, marking the end of a repeat performance last seen in the mid-1990s (1995, ’96 and ’97, he said specifically).

Hospitals have been voraciously trying to align themselves with private practice to capitalize on funds generated from meaningful use; however, they don’t seem capable of effectively managing private practices and their employees as they seem to be able to do with their internal systems and hospital employees, he said.

Private practices are too independent, for the most part, he said; especially, OBGYNs.

The fiercely independent group of physicians might have all the leverage they need to withstand outside pressure for adopting new technologies or changing the way they run there businesses at this point in their careers.

Why?

The average physician in the OBGYN space is 62 years old. At this point in their careers, they are not particularly interested in becoming hospital employees and if they are not interested pursuing meaningful use, which seems to be the case, they’ll either retire or go their own way.

Clearly, the technology used in healthcare will gain greater acceptance as new doctors enter the space. As colleges begin to implement the systems to train their residents (which they are not readily doing now), perhaps the appetite within the space will change. Clearly, there’s room for more adoption in the market Suiter serves.

But, digiChart is positioned well, serving a market it, and Suiter, understand, and know they’re place – as leaders – in it. There are very few vendors that can represent the specialty space well, especially in the land grad market of one-size-fits-all solutions penetrating the market. DigiChart and Suiter seem to understand that sometimes it’s better not to be the jack of all trades, but a master of one.