"Because I said so."
If you have ever been a parent of a teenager, you've likely uttered (screamed) those four words on more than one occasion. While it's developmentally appropriate for kids to test boundaries and express their own opinions, it can be futile to logically explain your viewpoint to kids of a certain "maturity."
When your 15-year-old continually asks, "Why?" to your insistence that he/she cannot stay out until 2 a.m./get an iPhone 6/have a boy-girl sleepover, at some point you have to look your beloved offspring in the eye and say: "Because I said so!"
Of course, no one likes to settle for such an unsatisfactory answer -- whether you're 15 or 55. We want logical explanations and dialogue. We want our viewpoint considered and to count for something. It's one thing to unquestioningly follow orders in the midst of a battlefield. It's another thing when you are trying to accomplish your job in a manner you believe is most efficient and effective.
Case in point: Several years ago I was working for a company and traveling regularly. The company mandated that all employees fly on a particular airline, unless the price was drastically different. If the price was similar, we had to fly the preferred airline – even if it meant flying from Dallas to Los Angeles to get to Chicago.
Of course, many of us were angry that management had created this ridiculous policy, and failed to seek advanced input from those most impacted by the it – the road warriors who traveled every week. Although we argued that the value of our time made up for any possible fare discount, we were typically told something along the lines of, "Just take the 6 a.m. flight and you'll get there in time for your 3 p.m. meeting."
In other words: "You'll take this flight because I said so."
Recently it occurred to me that when the meaningful use program was first introduced, many physicians must have felt a similar sort of anger and exasperation. Most providers probably had a preferred method for keeping patient records. Many had invested thousands or millions on EMRs that were meeting their needs, and weren't pleased to learn they would have to spend more money in order to qualify for incentives. Many were likely convinced that their record-keeping method was superior in terms of efficiency and effectiveness.
[See also: Ending EHR absurdities]
Furthermore, the changes were prescribed with minimal advanced input from those most impacted by the policy: the doctors. I realize that CMS and ONC did their best to get provider input, but getting feedback from several hundred thousand eligible providers is a near-impossible task. In the end, providers were required to turn their documentation routines upside down and chart in very specific ways, or suffer the financial consequences.
Now the new Stage 3 proposed rules have dropped, we will soon be telling providers to make further changes to their workflows. Policymakers will argue that the changes will improve the quality of care and outcomes, while many providers will argue that meaningful use interferes with the patient-provider relationship, requires too much physician data entry, and creates bloated notes with pages of extraneous data. In the end, providers wishing to earn incentives and avoid financial penalties must comply and do what the rules say.
Frustrations with meaningful use go beyond the seemingly "because I said so" nature of the program. Ultimately, what every one of us wants is better outcomes and increased efficiencies. Now that payment models are shifting from volume to performance-based models, perhaps it's time to reconsider whether better outcomes really do require providers to use only certified technologies and to capture particular data elements for a certain percentage of patients and to produce records in a specific format.
If certain processes do, in fact, improve care and efficiencies, won't the new payment models motivate providers to embrace best practices – with or without meaningful use?
When in battle, soldiers must unquestionably do as they are told, or risk their lives and the lives of others. But does winning the healthcare quality battle really require that we turn our doctors into compliant soldiers?
