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Howard Zwerling, MD, a practicing doctor in Massachusetts and president of EHR vendor ComChart, took these concerns nationwide with a widely noticed post on The Health Care Blog earlier this week. In his "open letter to Massachusetts physicians," he said that the practice of medicine had already become more difficult because of external mandates. "And now, the politicians intend to tell physicians which software they must use in their office and which [EHR] options must be utilized during the office visit," he wrote.
Ronald W. Dunlap, MD, president of the Massachusetts Medical Society, told InformationWeek Healthcare that the society is hopeful that it can get the state Board of Registration in Medicine to adopt a more flexible interpretation of this provision so that physicians don't have to meet the government's MU standards on certified EHRs to keep their licenses.
[ Are government health regulation deadlines unrealistic? Read Meaningful Use Stage 2 Needs More Time, CHIME Says. ]
"If the rigid interpretation of this law is upheld, it's going to be a problem in 2015," he said. "If we were to implement that, half to two-thirds of the state's physicians would not be able to be licensed."
This high estimate is not based on any technological backwardness in Massachusetts. EHR adoption in the state is widespread compared to the rest of the country. But a large percentage of Massachusetts physicians are not even eligible to register for the Meaningful Use program, Dunlap noted. Either they are surgeons or other hospital-based specialists such as radiologists or pathologists, who are excluded from the program, or they're pediatricians who don't have enough Medicaid patients in their practices to qualify for government incentives.
Dunlap estimated that of the 28,000 licensed physicians in Massachusetts, just 4,500 are primary care physicians. Those doctors and up to 2,500 medical subspecialists are eligible professionals (EPs) as defined by the Centers for Medicare and Medicaid Services (CMS). Most of the other doctors are not, he said.
As a result, although many of the non-EPs are skilled at using EHRs, they would not pass the proficiency test that would allow them to keep their licenses if it required them to show Meaningful Use.
A small percentage of physicians continue to resist acquiring EHRs, Dunlap said. These are mostly solo practitioners who don't want to spend the money and older doctors who are close to retirement. But as hospitals and other large organizations employ more doctors, "the numbers of those people are decreasing daily," he said.
The original state law mandating that physicians use EHRs by 2015 was passed in 2008. Last summer, the amendment was added at the instigation of state Sen. Richard T. Moore, according to Dunlap. The medical society, which had been discussing with the board ways for doctors to show they were using EHRs "meaningfully," was caught off guard.
Now the society is trying to drum up support from hospitals and other stakeholders to put pressure on regulators so they will interpret the law favorably for physicians.
"We're hoping that we can get this interpreted so it's not a rigid, government-defined standard of Meaningful Use," Dunlap said. "Using computers meaningfully is different from that rigid standard. That's the position we're taking: we're hoping it's a broader demonstration of competence that applies to a lot of different specialties."
Zwerling, though, is taking a more defiant stand. His blog post called on all of his colleagues to write letters calling for the repeal of the law to Gov. Deval Patrick, the state secretary of health and human services, and their local representatives.