NOSH ChartingSystem

A new open source health charting system for doctors.

Crying over spilled milk (personal)

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Lots of important and exciting changes are coming to NOSH soon.  But before I present more posts about this, I’d like to take a moment to vent based on the recent developments in the ONC/Meaningful Use/MACRA/Primary Care/ACA world.  In my view, these negative developments started to take shape in 2009, which was the beginning of the end of my solo family practice, which was finally laid to rest in 2012.  And now in 2017, I can’t help but feel disgusted.

The big news in the Health IT world last year was the doing away of the Meaningful Use program (even before it was supposed to be finished).  This is what I had anticipated way back when and I reasoned that it was going to be an expensive, meaningless endeavor that was going to lead to 2 things: 1) consolidation of the EHR market so that the big market leaders are going to grab everything and leave nothing left for innovation and 2) consolidation of primary care physicians and the death of the independent medical practice for those who are still seeing Medicare patients.  I was secretly hoping none of the 2 things were going to happen but I’m sad to say that after nearly 7 years, both have come to fruition.

And the architects of this legislation are now crying over spilled milk.

They talk about unintended consequences, but I think that is a very poor excuse.  I was just a low-paid primary care physician with a little solo practice, and I was not a full time policy wonk.  But somehow I predicted this was going to happen because I could see it through the lens of my micropractice.

Instead, I think they know exactly what was going to happen and turned a blind eye towards the consequences.

They can’t turn back time and say to the primary care folks, “Oops we made a mistake, please let us continue this torture because we can’t turn back because if we stop, it would be, yeh – crazy.” or “Oops, please forgive us, but we need you back somehow but please let us torture you some more”.

It’s too late to cry over spilled milk.

And one wonders why we still don’t have interoperability between EHR’s when in fact standards were developed and the largest EHR vendor decides to break them?  Shouldn’t there be certifications or legislation for playing by the rules?

And one wonders why EHR certification is a solution looking for a problem and why the wrong kind of certification like this one is onerous to innovation?

And one wonders why physicians are outraged because we’ve been treated condescendingly by this legislation and being forced to use broken tools and are told, “give us better care!”

And one wonders why physicians are told to buy these expensive, broken, and useless tools and are told, “give us better care for less cost!” and if we can’t give them whatever it is they want, we get paid less anyways.

And one wonders why physicians are told to buy these expensive, broken, and useless tools with the intention to recoup these costs and then snatching the program away and build a new one, never recouping the cost anyways.

Do they think this is funny?!  Do they think these unintended consequences are academic?

These are real lives, real people, real physicians, and real livelihoods.  The toil and trouble for primary care physicians is not academic.  It’s been going on for decades and with this legislation, the house of primary care has been turned to ashes.

I know sometimes I should not even think about it and walk away.  But the curiosity inside me and me being trained as a trauma-informed medical provider requires that part of my healing process is to know what happened, a post-mortem if you will, even though I’m going to re-experience the pain.  I felt that a great opportunity was lost and the damage that has been permanently done in the name of crony capitalism, monopolization at the cost of cooperation, innovation, and evidence-based approaches are now coming home to roost.

But like the great Elton John once sang…”I’m still standing”.

As a physician.

As a healer.

As a hacker.

As a coder.

As a husband and father.

And from the ashes, a phoenix will rise.  Stay tuned…

Author: shihjay

I am a family physician and previous medical director for a child abuse assessment center. I am now promoting my new electronic health record system (NOSH ChartingSystem) that I have developed and used for myself in my private practice since 2010 and now I want to share it to the rest of the doctoring world.

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