From a purely spiritual perspective, one of my favorite musicians of all time was John Coltrane. There have been many musicians who have attempted to become one with their instrument in an attempt to achieve something beyond mere virtuosity who, while technically perfect, ended up being vacant in matters of the soul. Coltrane achieved the lofty goal of connecting the known and unknown world with the power of music to an extent not seen before or since.
Coltrane was known for taxing the patience and constitution of his many band mates. One incident involved a drummer who became so tired of trying to keep up with one of Coltrane’s saxophone marathons that in order to end the solo and earn a break, he felt he had no other option but to throw a cymbal at Coltrane. There is a legendary story about John Coltrane and Miles Davis having a conversation about the physical limits of music. John Coltrane was asking Miles Davis how he could control his innate need to continue to play until the musical resolution was discovered, if at all. Davis, in his legendary, gravelly whisper of a voice, looked at Coltrane and said “Take the horn outcha mouth!”.
I love this story for two reasons, one being that it continues to make me laugh after repeated telling, but more so because here we have a perfect illustration of finding a simple solution to a complex problem.
If only the solution to physician documentation and medical records were so easy. Sadly, as we get closer to the beginning of the incentive period for meaningful use of an electronic health record, it appears that the “solution” offered in the form of mandatory EMR is looking a lot like the beginnings of a Rube Goldberg device.
The Office of National Coordinator for Health Information Technology (ONC) projected this week that 50,000 additional IT workers will be needed by providers across the country in order to meet the meaningful use criteria. Without the gift of a calculator on my desk, I quickly compute in my head that with a maximum incentive of $44,000 over a five-year period (remembering that not every provider will qualify for this dollar amount), you would have to find one IT person at a salary of $8,800 a year to break even. If you’d like to place a wager on your odds of finding this unicorn of the IT world in today’s economy, give me a call.
Let’s look at a timeline for a moment to put this in perspective. In order to qualify for maximum incentives, registration of meaningful use of an EHR begins this coming January. At the time of this writing, that’s 126 days away! The Certification Commission for Health Information Technology (CCHIT) is still reviewing applications for companies that will test and certify EHR systems to determine whether they have the ability to meet the meaningful use criteria. Also in the equation is the plan for regional extension centers to assist providers during the transition. Currently, 5 states lack an extension center and 28 states, including California, have only one center currently open to offer assistance.
Seventy community colleges across the nation are also part of the plan, offering non-degree training courses for IT professionals to bring them up to speed. While the ONC’s website gives a time frame of “six months or less” for this training, the issue of whether 4 months of instruction prior to registration is sufficient will go unanswered up until the moment when the training is most needed.
We all crave simple solutions. The Great Migration currently underway towards the goal of electronic health records, given the rampant shortcomings of paper records, is a noble goal. Yet I may not be alone in rethinking whether the established timeline to qualify for maximum incentive payments is too short to be of value in the long run. Unfortunately, unlike the removal of a saxophone from one’s mouth, an easy fix does not appear to be readily available.