Physicians Don’t Want to Be Told What to Do

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It seems like a theme is cropping up around meaningful use. It has little to do with the regulations themselves. Instead it has to do with the fundamental concept of meaningful use essentially “Telling Physicians How They Should Practice.”

A comment on a previous post described it well when they said, “I am willing to bet that no matter what the final rule was, the majority of those involved in this industry would be upset with them.” It’s an enlightening point since I think it’s right on point.

It also illustrates that it’s not the meaningful use regulations that really bother people. Most physicians want to provide great care to their patients and many of the meaningful use requirements are no brainers. Physicians just don’t want to be told what someone else defines as great care. Physicians aren’t alone in this either. Just take a look at children’s reactions to their parents and you’ll see that for the most part humans don’t want to be told what to do and they kick against anything or anyone that tries to tell them what to do.

Anthony Guerra, founder and editor of Health System CIO, in an Information Week article highlights some similar points. He aptly points out that optimal performance is achieved not by issuing “prescriptive directives,” but by creating high level goals and let ownership of those goals take effect.

Anthony even suggests that the HITECH act money should have been spent to create a “set of best practices around EMR readiness assessment (think gap analysis), vendor selection, workflow redesign and system maintenance (think ASP/SaaS) for the providers that do care” While a certainly noble and worthy goal, I think there’s little evidence that this would have much impact. Why would doctors look to a government process to provide a best practice any better than they now look on meaningful use guidelines?

Meaningful use and the pile of EHR stimulus money reminds me a lot of a parent child relationship. The parents think they know what’s best and so they tell the child what they should do. The child kicks against those things regardless of whether it’s a good or a bad thing that the parent’s asking them to do. The parent then dangles the money in front of the child and says that if they want the money, then the child better do what the parent told them to do.

This is where we’re at with meaningful use. The parents (the government) have required something (meaningful use) of the children (the physicians) if they want the benefit (Stimulus Money). Now we’re waiting to see if the children will rebel or listen to their parents. I’m predicting physicians to be a little more rebellious than the average child. It’s not like the parents in this situation have a great history of past responsibility.