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Physician series: Richard Armstrong, MD, FACS

By Kyle Murphy, PhD

- Meaningful use refers to the benefits derived from a doctor’s use of an electronic health record. According to the Office of the National Coordinator for Health Information Technology, the benefits of using an EHR in a meaningful way are better-coordinated care, evidence-based decision support, and lower costs. The most popular anecdotal evidence for meaningful use comes from providers and patients who have avoided key medical mishaps, which fortunately for them were caught by the electronic systems. The recent announcement of 89 more accountable care organizations (ACOs) shows growing support for integrated care models that will rely on communication between providers to deliver efficient and efficacious care.

Despite the publicity surrounding the billions of incentives paid out by the Centers for Medicare & Medicaid Services (CMS) through the EHR Incentive Programs, little evidence shows that EHRs used in a meaningful way deliver on the promises made by legislators and decision-makers. While most research agrees on the premise that EHR can prove beneficial to managing a patient’s care more effectively, its results fall short on showing that the benefits of using an EHR outweigh the traditional paper-based methods. And what’s entirely missing is proof of the proposed cost savings made possible by going digital. These early results (or lack thereof) have many wondering if there weren’t other factors motivating the enactment of the Health Information Technology for Economic and Clinical Health Act (HITECH) and the creation of the EHR Incentive Programs.

One such opponent of HITECH and meaningful use is Richard Armstrong, MD, FACS, a practicing general surgeon at Helen Newberry Hospital, a critical access hospital (CAH) in the upper peninsula of Michigan. On top of his medical duties, Dr. Armstrong is active professionally as a member of the Medical Advisory Board for Sermo, the online community for physicians, and Chief Operating Office of Docs4PatientCare, in which capacity he has rather vocally argued against HITECH and the Affordable Care Act.

In this two-part Q&A, we asked Armstrong about his experience using an EHR system as well as his thoughts on what’s truly motivating meaningful use. Check back next week for the second half of our interview.

Are you currently using an EHR system where you practice?

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We have a hybrid from a company called Healthland. It’s a Midwestern company that’s been around for a while that has its headquarters in two cities, Minneapolis and Louisville. We had the initial core system several years ago based on Windows XP. We installed that first-generation system on the hospital side of our operation and in the laboratory, and then we went on to put in their office software in our medical practice.

I work in a critical access hospital. We have a connected multi-practice group that I help manage. The system that they had for office EMR was a disaster. It just let everyone down; it didn’t do the things that they promised. We actually threatened to sue them, and they pulled it out and gave us our money back.

And what makes it hybrid?

When I meant hybrid, I actually meant that for real. We’ve got this clunky system in the hospital, which frankly I rarely use, and it’s partially paper and partially electronic. We have in the office a PACS system for x-rays —  I’ve got two monitors on my desk and I can see all the x-rays I need to see. We have our laboratory system that allows me to look at all the patients’ labs. We don’t really have a true EMR system installed.

Without an EHR, how do you record your encounters?

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I dictate my notes, which I believe is the most accurate and best way, after seeing patients. We have a professional transcriptionist, so I download those notes into my computer and they go directly to her. She types them, it comes back to me as a Word file on my computer, and I can edit them before they become a permanent part of the record, which is electronic though not in the sense that a true EMR is. And then we have professional coding staff that does the coding and billing in the old-fashioned way although it’s submitted electronically. So we’re not coding directly from an EMR system. We don’t use e-prescribe which has been variously successful across the country. We don’t, of course, use a template system. Some of the offices in primary care are actually using the old T Sheet paper, which is then scanned in and available. And our emergency room is still using that.

Given all this work, why have you chosen to go this route?

It gets to the core of the problem really. And that is, the entire EMR infrastructure is built upon the business of coding and billing, based upon AMA’s licensed CPT Coding System. Everybody who works in this industry should know that.

What work have you done to inform decision-makers about your experience?

I’m the Chief Operating Officer for Docs4Patient Care, so we’ve been very active politically. I’ve probably been to Washington thirteen times in the last two years and have had significant conversations with many of the politicians on the Hill who had absolutely no idea what they were doing when they voted for HITECH. And what I’ve explained to them is that if they want a vision of what this whole mess is, it’s like a medical Katrina.

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The vendors talked the politicians into voting for this thing based upon no knowledge of it at all and making tremendous promises — this is going to reduce medical errors, it’s going to reduce the time it takes for doctors to see patients, it’s going to increase efficiency— and it does none of that. It doesn’t prevent errors; it actually makes things worse. It’s never been tested really in the real world. And there are a whole lot of reasons for that, but what happens is that vendors convinced the politicians to vote over $30 billion of federal money to help support this thing. The people who are installing this nationwide are discovering the reality of it. That is, all these claims that were made aren’t true.

And why aren’t they true?

They’re not true because if you had allowed the market system and people to design something that actually worked and we weren’t locked into this box that’s defined by this CPT Coding System and this infrastructure that’s been built, then something would occur that doctors would purchase just like people buy iPads and iPhones. If there was something that actually worked, doctors would line up at the Apple store to buy it. And why aren’t they doing that? It’s simple, it’s because it doesn’t work. It causes tremendous headaches.

And what’s the root cause of these headaches and growing pains?

Generally, the people who are making the decisions to buy these multi-million dollar systems aren’t doctors. They are administrators either of big clinics or hospitals. Down at Cedars-Sinai in Los Angeles several years ago spent $34 million and he didn’t talk to the doctors. The doctors came in and tried to use it and couldn’t — it didn’t work. It confounded their entire day. It screwed up everything because they were asking doctors to suddenly be not doctors but secretaries. The doctors said, “No, we’re not going to do this.” And they had to throw it out. They wasted $34 million.

Check back next week for the second half of our interview with Dr. Armstrong.

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