The Carrot and Stick: Enemies of Progress

Dec. 5, 2014
In the wake of HITECH, a recent data brief reveals that most doctors have adopted an EHR to earn incentive money or avoid penalties. Is this one reason why interoperability is still a dream and most systems are unusable?

I live in the real world.

I just wanted to get that out of the way before I write this blog because people will read this and assume that I don’t. They’ll assume that I’m young (true), naïve (possibly true), and maybe even a little ignorant (hopefully not true). They’ll assume my head is in the clouds—and maybe it is.

But I’m slightly irked, and that’s why this blog exists. So I’ll write anyway.

This week, the Office of the National Coordinator for Health IT (ONC) released a data brief that detailed why physicians have decided to adopt an electronic health record, both post- and pre-HITECH. The top reason to adopt an EHR before HITECH was the ability to electronically exchange of data.  Post-HITECH?

To quote P-Diddy: “It’s all about the Benjamins, baby.” For those who don’t know late ‘90s rap that means money.

I shouldn’t be surprised. Like I said, I live in the real world. You put a carrot in front of ANY rabbit, they’ll go after it. You put a stick in front of them? They’ll move too. Money makes the world go ‘round and it also talks. You know all the clichés.

Still, when I think of all the problems plaguing adoption of EHRs and health IT in general, I think of incentives and penalties. I think of people taking grant money and doing nothing with it. I think of poor usability and data in silos.

This is a broad generalization, of course. There are plenty who have done well with grant money and plenty who have meaningfully used EHRs, financial incentives/penalties be damned.  And sure, there are plenty who could use that money and plenty more who could avoid being penalized for not adopting an EHR. I also appreciate the honesty that comes from doctors.  

But when do we acknowledge that adopting an EHR or any health IT system mainly to earn incentive money or avoid penalties, is the wrong attitude to take?

Providers and vendors alike seem to have become so zeroed in on checking boxes to get those Benjamins, we’re losing sight of the larger picture. It’s the oldest lesson in dealing with money. When parents give their kids an allowance, what do they usually say? “Don’t spend it all at once.  Think long-term.”

This could be said for the adoption of health IT systems. The point shouldn’t be to earn money in the short-term. It’s to save money in the long run while improving care. The potential of health IT isn’t to earn or save you a few bucks. It’s to improve our health system for all parties. Eventually, this includes lowering costs. Eventually.

Wouldn’t it be nice if we could adopt usable EHRs without any kind of penalty or incentive money?

“Grow up! This is the real world,” you might be saying right now. I live in the real world, remember? I understand the investments in some of these systems are amazingly high (key word is some). But like I said, there are organizations that have done this. There are solo doctors who have done this. They have adopted EHRs that have improved care and lowered costs. They adopted them for the right reasons. They started before HITECH was a thing.

Why is it hard to imagine that it can be done in a post-HITECH world?  I’m not sure. Then again, maybe my head is just in the clouds.

Please feel free to respond in the comment section below or on Twitter by following me at @GabrielSPerna

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