I have an electronic health record ... sort of. I designed my own in 2000, using some off-the-shelf Apple software, gradually modifying it with time and experience. It likely wouldn’t work for most doctors, but in a solo practice, it only has to work for one. I’m perfectly happy with it. It tells me what my schedule is, lets me review my notes and prescriptions, and shows me test results. I also can access it from anywhere.
Does it meet government "meaningful use" criteria? No.
As a result, I, like many other small, financially-limited practices, am scheduled to take a Medicare financial penalty starting in 2015, in spite of the fact that I work hard, provide quality patient care, and have a system that lets me practice on terms that work for me and my patients. It is a system that didn’t cost me a large sum of money that I didn’t have.
That’s why I was relieved to learn of the Electronic Health Records Improvement Act (H.R. 1331), recently introduced by Rep. Diane Black (R-Tenn.). This bill would create a hardship exemption for solo practitioners and those nearing retirement, realizing that those who can least afford to buy a "meaningful use" EHR are only going to be further devastated by cutting their income.
I don’t know if it will pass. It has a long way to go, but hopefully, it will appeal to common sense on both sides of the aisle. Putting small practices out of business only hurts people in general by making it harder for them to find care. This bill is a step in the right direction.
So far, 20 medical associations have stepped forward to support the bill (none thus far in neurology), and I hope that number (and congressional support) continues to grow. Small practices have formed the backbone of American medicine for more than 200 years and still have something to offer.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
This column, "Hitting a Nerve," appears regularly in Clinical Neurology News.