EHR 'proficiency' requirement may have unintended consequences

I must admit, I was surprised when I read that Massachusetts's healthcare law, passed last summer, includes a provision that requires physicians to demonstrate a "proficiency" in the use of EHRs, electronic prescribing, computerized physician order entry and other forms of health IT as a condition of licensure. The law defines "proficiency" as, at a minimum, sufficient skills to comply with the Meaningful Use requirements. 

I'm surprised not only at the existence of the provision, but also that it's received such scant attention. The law is slated to go into effect in 2015; I was alerted to it via a blog post published earlier this week by a Massachusetts physician who suggests that the requirement be rescinded. The provider, Hayward Zwerling, M.D., said that the government has a "misguided obsession" with dictating what kind of software and functionalities physicians should be using to treat patients. 

This law goes far beyond the federal HITECH Act and Meaningful Use program. HITECH will impose financial penalties on physicians who don't meaningfully use electronic health records by 2015. In Massachusetts, physicians who don't meaningfully use their EHRs by then will lose their licenses to practice their livelihood. 

That's a big difference.

Clearly there must be a back story here--a rationale. Is the state just bootstrapping on the federal law and using it to increase health IT adoption on the grounds that most physicians already will be participating in the Meaningful Use program? Is it using the federal law, since it's already established and well known? Or is it overstepping boundaries by micro managing the operations of a physician practice? 

A quick search of the websites of the Massachusetts' Medical Society, the Massachusetts Legislature and the Massachusetts Board of Registration of Medicine did not provide much illumination. The provision is just a tiny part of a much more sweeping law that addresses escalating healthcare costs and the need for increased transparency. Perhaps at the time the bill was being debated, this provision was lost amid the bigger issues. 

It's also not yet known what the board will require to demonstrate "proficiency." Will physicians have to demonstrate successful compliance with the Meaningful Use program? Or simply that they know how to use a computer? 

What I'm concerned about are the unintended consequences of such a Draconian requirement. It will be, as Zwerling points out, increasingly harder to meet the Meaningful Use requirements. That means it will be increasingly harder for Massachusetts physicians to maintain their licenses to practice medicine. 

Moreover, many physicians have not yet--and may not ever--comply with the Meaningful Use requirements. For some, the amount of the penalty is not large enough to warrant the financial and operational investment in an EHR. There also are many physicians who use EHRs but don't participate and comply with the Meaningful Use program. 

Sometimes a requirement that looks good on paper creates unintended consequences that raises new problems. The healthcare industry is rife with such examples, including those involving EHRs and licensure. 

But no physician is going to want to potentially jeopardize his or her license to practice medicine. Will doctors suck it up, seeing it as just one more burden, or will this be a tipping point causing physicians to exodus the state--via retirement or relocation--to avoid this provision? Other states have suffered similar fates for lesser reasons

Massachusetts may want to consider the unintended consequences here. - Marla (@MarlaHirsch)

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