I have often found doctors talking about the 2014 mandate for adoption of EHR software. In fact, this post was inspired by a bunch of people searching online for the term “2014 EHR Mandate.” I think that they found my site because I previously did this post about Obama’s goal of Full EHR adoption by 2014.

If I’m remembering right, this was actually just an extension of Bush’s goal of having 100% EHR adoption by 2014. Obama took Bush’s original EMR aspiration and kept it going.

Although, I do have a real problem with people who like to call it an EHR mandate. It’s really not a mandate. A mandate for me implies that you are required to do it or there’s some grave consequence to it. It’s not like you’re going to be thrown in jail for not using an EHR or not be able to practice medicine if you don’t use an EHR (although some have hinted at this idea). Certainly the HITECH act has provided some Medicare penalties that could be considered a grave consequence to not adopting an EHR. Although, when you consider this example of the Medicare penalties it doesn’t look all that grave of a concern to me.

What other penalties are there to not adopting an EHR by 2014?

There certainly are other potential issues with not adopting an EHR that are worth considering:
1. Ability to Sale Practice – I don’t think we know all the details of how this will play out, but be sure that many younger doctors are going to want to purchase a practice that has an EHR. The common thinking I’ve seen going around is that a practice will be more valuable if it is electronic.

2. Government Mandated Reporting – While the government can’t really mandate the use of an EHR, it seems reasonable that the government could require certain reporting be done. Of course, you could manually do this reporting, but at some point the manual way will be much harder than using an EMR where the reporting can be automated.

3. Reimbursement Requirements – At some point the insurance companies are going to require their data electronically. So, if you’re going to want to keep accepting insurance, then you’re going to need to be electronic. I think the insurance companies are still watching and waiting to see what happens with meaningful use before they decide how they’ll approach it. However, you can be sure that they want more data and electronic is the way to make that happen. Of course, you could always go back to cash pay if you don’t like it.

4. Patients – It hasn’t happened quite yet, but get ready for a new patient base that wants their doctor to be electronic. No, you won’t have a “Got EMR?” sign outside your office to market to patients like we once talked about on EMRUpdate. It will come in more subtle things like the ability to schedule an appointment online. The ability to request refill requests electronically. Not having to carry (and possibly lose) their prescription to the pharmacy and then wait for it to be filled. Not having to fill out the same paperwork over and over and over again. Once patients get a real taste for these features, they’re going to be more selective in the doctors they choose to use.

5. ROI for Your Practice – There are plenty of arguments for and against the use of an EMR from an ROI perspective. I personally side on the positive ROI side based on this list of potential EMR benefits. Certainly it takes a smart EMR selection process and a well done EMR implementation to achieve the ROI, but I know a lot of people who’ve saved a lot of money thanks to their EMR. Add in things to come like doctor liability insurance discounts and the ROI will get even better over time. I know one practice who was having tough times financially. Their implementation of an EHR helped to solve some of those financial issues.

I’m sure there are plenty of other reasons that could “force” you to move to using an EMR. Of course, this CDC study on EHR adoption says Physician EMR use is at 50%. Although, in that link I use their study to show that it’s probably closer to 25% EHR adoption. Either way, we still have a long way to go to achieve Obama’s dream of 100% EHR adoption by 2014.

In my previous post about the benefits of inter operable EMR software, Russ Reese left the following comment about the benefits of CPOE and whether CPOE will make it into the ARRA EMR stimulus requirements or not. Plus, he ends with an interesting thought about the EMR stimulus program. I thought it was interesting and more people should read it and comment.

Here is a link to a study that showed some positive results for EMR use – http://jamia.bmj.com/content/17/1/78.full

“Conclusions: A basic CPOE system in a community setting was associated with a significant reduction in medication errors of most types and severity levels.”

Note, this study is about CPOE which is not featured in all EMRs and I think that HIMMS has even been trying to get HHS to back off on making CPOE required for the stimulus $.

But here is real data that shows real benefits. This study is about error rates and not dollars – but if errors are reduced then lawsuits are reduced and hopefully malpractice insurance premiums follow.

IMO, we never needed the tax payer funded stimulus to begin with. Malpractice insurance companies should offer radically reduced rates to physicians that use CPOE and that would be all the “stimulus” that is needed to move doctors toward EHR.