Time Capsule: Buying Doctors Systems They Don’t Want: Why Even Detroit’s Bailout is More Progressive than the HIMSS EMR Welfare Program

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in January 2009.

Buying Doctors Systems They Don’t Want: Why Even Detroit’s Bailout is More Progressive than the HIMSS EMR Welfare Program
By Mr. HIStalk 

I must be getting old. I can actually remember when the most-feared words you could hear were, "I’m from the federal government and I’m here to help."

That has recently changed to, "We’re such terrible businesspeople that we desperately need Uncle Sam as a business partner to survive."

HIMSS is right there in the bread line, begging for $25 billion of taxpayer dollars to help loosen up prospects that haven’t shown much interest in buying the EMRs that its vendor members sell. That’s not too surprising; as a trade association (its words), the #1 job of HIMSS is to help its big-paying vendor members make money, of which Uncle Sam’s is as good as anyone else’s (which isn’t saying much these days since the overheated currency printing presses will probably deflate the dollar’s value as quickly as they’re printed.)

That’s what "advocacy" is all about (don’t you DARE call it "special interest lobbying" because that doesn’t sound as noble, just like the annual conference is an "educational event" rather than drawing in captive provider prospects for the vendor members to woo.) Obama’s got lollipops for everybody, even justifiably failed dinosaurs like venture capital owned Chrysler, proud purveyor of bad cars that even rental car companies avoid. So, why not a nice, round $25 billion to move a few EMRs?

(Prospects don’t have the money for these desperately needed systems, HIMSS intones, yet it rails against free EMRs, whether open source or government created. So, HIMSS is apparently pro- EMR only when its vendor members profit.)

At least Detroit is keeping a straight face when it says it will make much-needed product and efficiency changes with our money. The HIMSS program doesn’t say that the EMR vendors who get the money will change anything at all. To them, the dust-gathering EMR products aren’t the problem, it’s those darned chintzy doctors who won’t buy them. And unlike Detroit, nobody’s offering taxpayers any equity or oversight in the companies that will rake in all the freshly printed money. It’s the EMR version of George Bush’s "everybody go shopping" stimulus package all over again, which did — well, nothing at all except run up the federal debt.

What’s also lacking is any kind of context in the recommendation. With all of healthcare’s problems, is $25 billion for the same old systems really the best investment? If healthcare needs dramatic reform (of which there are few doubters except those who profit from it today), then is this the right time to automate? Are EMR trailblazers having such great success and positive ROI that massive rollout is sure to be worth it?

That last item is the biggest bugaboo in the HIMSS EMR welfare program. Without provider skin in the game, there’s no assurance that we’ll see anywhere near $25 billion worth of patient benefit. "Having" is a long way from "using optimally," especially when one vital fact is brought back by cynics like me: these are systems that most doctors have already assessed as not being worth it. And, in Cynicism Round II: free isn’t cheap enough for systems that take more doctor time to use without giving them any benefit. How about a show of hands of all of you willing to stick around at work for a couple of extra hours each day to use a new computer system that doesn’t benefit you or your employer?

HIMSS has got politicians moistened up at the concept of interoperability as the big payoff for all of this acquisitive action. Sounds great, right? That’s what all those failing RHIOs said, too. "Interoperable" is a theoretical systems capability, quite a long way from overcoming the governance, privacy, and cost problems that stand in the way of actually interoperating. Instead of pushing "interoperable" systems, why not use the $25 billion jackpot to reward providers who actually exchange predefined data instead of just funding their technical capabilities and hoping it will somehow just happen?

That’s my pitch for Uncle Sam. Don’t use my money to fund stale tactics and failed market participants. Use it (if you must) to set the goals of what we really need (improved quality, outcomes, and efficiency), create rewards for meeting them, and let the market decide which tools are best suited for getting the job done. If your EMR can do that, it will fly off the shelf under its own power without requiring HIMSS to fling it at doctors like Cupid’s arrows.

Let’s hope the Detroit equivalent of HIMSS has less self-serving ideas than to simply hand out taxpayer dollars so people can buy Chrysler Sebrings.