A pivotal moment in the US health care system is taking shape. Physicians across the US are wondering what their role will be in this new healthcare landscape that is being shaped by legislation (from the Affordable Care Act and from Meaningful Use), by social media, and by technology advancements.
It’s an existential moment. Physicians are wondering if we are knaves, pawns, or knights in this chess game called the US health care system. Physicians are screaming to be heard on major news outlets about the perils of being a primary care physician in the face of increasing pressure from health care executives, insurance companies, unfunded government mandates, and so on. Right or wrong, physicians are in the middle of this changing and impactful landscape and we can choose to be leaders of this change or be succumbed by it.
But where do physician’s start? Speaking about it is a start and as such, it’s good to hear that some of the major news outlets are starting to speak about the inevitable horrors that the country will face when we realize that primary care (when measured in workforce numbers as well as moral support) has been neutered for decades in a fee-for-service model that inadvertently favors procedures over prevention and face-to-face time with a patient.
However, speaking about it alone will not change the way the game is played. Some have argued that those that have the current leverage (health care executives for instance), have the tools, money, and experience necessary to play the long game politically. For as long as the field has existed, physician training has been focused on medicine, pure and simple. But rarely has there been education and awareness about how our field could be pushed aside by others outside the field, perverting and distorting the health care delivery system that used to exist. As a result, we (physicians and patients together), have succumbed to the system. We have become divided by the system. And now we have essentially become pawns in the health care delivery game. As physicians, like to think of ourselves as knights, noble guardians of the profession, speaking about how we should reject the sliding slope of EMR technology as the tool that will bring our profession down. But in fact, the robbery has already happened. It reminded me of an amusing skit on the second season of the Muppet show (which I was watching with my kids recently) where Sam the Eagle speaks with dignified presence behind the podium about increasing crime. Sam speaks about how it is important to be vigilant about stopping crime whenever and wherever it lurks, while completely unaware that three robbers are stealing and taking away the props on the stage, eventually the podium, and then Sam the Eagle himself. Have we become, as a profession, Sam too?
So as we ponder our existential question and hope that we do not become permanent pawns in this health care system chess game, I strongly urge that we do not shy away from EMR technologies entirely, irregardless of your disgust, familiarity, and experience with EMR’s. Yes, we have been bamboozled and bullied into to buying EMR’s that don’t respect our clinical workflows with Meaningful Use and we have been insulted by the insane measures of how we ought to be using these EMR’s. Yes, most EMR’s really suck right now and no one is going to listen to us gripping and complaining, because we’re not (despite our belief that we ought to be) their ultimate customers. Most would unfortunately care less about how we think EMR’s are unsafe and unsatisfying to use. It’s not to say that these are not important issues (it should be!); it’s just that the game has been deliberately rigged where physicians are no longer heard anymore about this realm because we have become irrelevant (gasp!) in the realm of health care technologies. Shying away from these technologies and outright rejecting it does not make it go away, nor does it empower us. We must embrace the these technologies with our eyes wide open. Embracing the latest technologies and knowing their limitations and potential benefits is a sound strategy by any player in a game (such as our health care system chess game) as long as the tool is designed and optimized for the player.
As we speak, EMR’s aren’t really designed for us but it doesn’t mean that the door is shut. Embracing open source software technologies and projects which encourages participation and input from any or all physicians in the design and implementation of an EMR design, resulting in increased transparency and adaptability for the tools that we use, can be seen as a vital weapon against those that choose to sidestep our profession. As some disgruntled and primary care physicians who have stepped out of this health care system chess game and done it on their own terms (such as Direct Pay Practices…hooray for them!), physicians as a group must also set the standards and technologies (especially where it comes to usability and safety) for our EMR’s on OUR terms. By doing this, we stake our ground, and make others know that we’re not going to be stepped on anymore. Our dignity for the profession is not just merely reflected in our spoken words, but it is reflected in our actions.