Electronic Health Records


Physician series: Richard Armstrong, MD, FACS, Pt. II

By Kyle Murphy, PhD

- Last week, we introduced you to a vocal opponent of meaningful use, Richard Armstrong, MD, FACS. Dr. Armstrong is 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, 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 second half of our two-part Q&A, we asked Armstrong how government involvement has affected the work of physicians across the country and what providers really need from their health information technology. For more on this interview, check last’s week Physician Series.

Will the assessing of penalties spur providers to adopt an EHR?

A couple of points with regard to that. First, the penalties aren’t that severe, so what I would say to most physicians is, “Don’t be nervous about these things. Don’t worry about it. Just don’t install it because it’s just going to cost you more money to try to keep up than the penalty.” The second is the entire meaningful use thing — I will quote the head of IT who is a doctor from Henry Ford Health System that has 2,000 physicians. He wrote an article and said, “Meaningful use is not meaningful, so we’re not going to do this. And basically what he said is the truth.

What makes the healthcare industry so hard for the government to reform?

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What happens is a bunch of people in Washington who sit around a table decide we’ve got it all knocked. We’re going to figure this out for America and we’re going to tell everyone in the country how to do this. And it’s going to work because we’re experts. Well, it’s just nonsense. Medical care is so complicated. It’s not like the banking system. Banks have been free to go electronic and install all kinds of online banking systems, and it’s math and it works great. People love it. Healthcare is not banking. It’s much more complex than banking. Doctors make incredibly complicated decisions individualized to each patient every day. They can’t fit all these decisions into little template boxes. For anyone to actually believe that that could occur is just insane. And what’s happening now is nationally physicians are realizing this and pushing back and saying, “I can’t afford the time. I don’t get the support I need. I don’t need this to practice medicine. In fact, it makes it worse.”

Is the government the only one to blame?

The vendors that developed these things are in cahoots with the government financially. They sat down in all these offices across Congress and convinced these people that’s this is the best thing since slice bread: “Doctors are going to love this.” And not everybody hates it, but if you look at the people who have been successful developing EMRs for their practice, they’ve been heavily involved in designing their own systems to make their own practice run better. I know a bunch of endocrinologists who have done this, gastroenterologists, ophthalmologists. It’s usually a specialty practice that has a very narrow focus so that they could do the same kind of thing over and over again. So they can design a software system that speeds up their workflow. And that’s great. But they didn’t need the government to tell them. A lot of these guys did it on their own, starting seven to ten years ago, and they’ve been basically saying all this time, “I didn’t need the government to mandate that I do this. I was just interested in this so I did it for myself.”

If not through government mandates, how will innovation come about?

The experts are already out there. They’re the doctors who have developed systems all over the country that work. The Mayo Clinic was developed with no government guidance. It didn’t take the government to figure out a perfect way or very good way to practice medicine, same for the Cleveland Clinic and a whole bunch of other multispecialty practices. The government didn’t tell Kaiser in California how to build their system and run it. They build a system that was based on a pre-paid healthcare plan. People could sign up, and there are a lot of people who really love it. They sold it to businesses in California and it works for them. So who is government to tell Mayo or Kaiser, “No, you’ve got to do it our way.” That’s just completely ridiculous. I want to see the entire healthcare law go down, and I want to see the HITECH part of the stimulus bill go down. I think it was nonsense. I want to see America’s physicians be able to use their creativity and come up with solutions to help care for patients that actually work.

What do providers really need from their EHRs?

They really need a rapid way and a functional interface to document the visit that they have with a patient — something that doesn’t interfere with their actual communication and facetime with a patient. So many doctors (and patients are complaining about this to) go into the room and they’ve got a laptop, tablet, or whatever and they’re focused on the computer. The patient is saying, “I really want my doctor to pay attention to me, not the computer.” What happens with all these template systems, bullet points, and E/M coding is that it forces doctors to spend time trying to make that right — not for good medical care, just for documentation and the billing. But that’s not medicine; that’s just clerical work.

And how will they get it?

I think that we have to work to join forces as physicians and tell the government that this is working and to back up. There are so many people who have conflicts of interest here. One of the largest is the American Medical Association. The reason for that is they own the CPT codes. They make seventy to a hundred million dollars a year from their licensing of CPT codes. They signed a contract with CMS in 1983 to become the monopoly provider of CPT codes. So the AMA is in bed with the federal government and CMS. The AMA has every reason to say, “We support this,” when only ten percent of the doctors in the country are members of the AMA. And actually more and more are leaving the AMA and saying, “Don’t force me to do this. I hate this.” The problem is no one’s listening to reason because there’s so much money involved. All these people who are so supportive of these things see all of those dollars and just become seduced.



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