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DOCtalk by Dr. Gregg 6/29/11

June 29, 2011 News 3 Comments


Geez. You hear so many jokes about guilt-inducing religions, culturally-related guilt mongers, and mothers who guilt their children onto psychoanalytic couches, but when have you ever heard of legal, free money inducing guilt-laden angst?

And, yet, here I sit, a victim of “HITECH Guilt.” What is HITECH Guilt? The official DSM-5 axis isn’t available until 2013, but I can give you the Wiki version.

HITECH Guilt, also known as “DED-head Dread” (see below), is an extremely bizarre manifestation induced within a certain group of peoples known collectively as “EPs” who receive governmental financial support for trying to do the right thing. Certain EPs are granted these funds to help offset the costs of doing their jobs more efficiently and with greater chances for “interoperability.” (“Interoperability” is an antiquated term used in olden days to describe the abilities of electronic health record systems to work together, to collaborate, and to share information digitally. It has fallen into disuse primarily from lack of applicability.)

Most of the time, these poor EPs initially strove to achieve digital office information management in order to provide higher quality services – for their patients, for their staffs, and for their own geekoid good. Many invested staggering amounts of their already dwindling incomes to achieve this digitization without any promise of direct reimbursement … well, save those of overpromising sales folks and evangelistic health tech industry bloggers. (Gulp.)

Then, when the tipping point for HIT/EHR adoption seemed almost impossible to attain, along came HITECH. In order to help entice the reticent, governmental funds were found amidst all the red-inked ledgers to incentivize providers to digitize up. Not all providers, mind you. Just those deemed “preferred.”

The plan, in its most basic form, is essentially “carrot and stick.” The carrot is a little money. The stick is the withholding of money, a fair amount of money. The stick is definitely bigger than the carrot. Nevertheless, the carrot is not insignificant, especially for the EPs whose incomes are being assaulted on virtually every front.

For EPs who have yet to fire up the electrons in their patient recordkeeping work patterns, these incentive dollars definitely help lower one primary barrier to adoption by helping offset the costs of the transition. Even if the EHR adopted is one of the “free” systems, there are still significant expenses involved with training, implementing, workflow changing, and productivity “deficiting”, whether temporary or permanent.

For those EPs who were already DED-heads (Digitally Entered Data-heads), this HITECH incentive money was an unanticipated value add. I mean, who doesn’t like getting rewarded for doing something they thought was the right thing to do anyway?

However, with the funds came an unanticipated new form of mental pathology: HITECH Guilt. Despite feeling as if their hard work and attempts to move healthcare into the electronic age were worthy of reward, these mournful EPs now had to face the fact that they were contributing to the government’s staggering budget deficit and are, once all the trappings are cast aside, receiving welfare.

So, as I said, here I sit awash in HITECH Guilt. I got my check and, yes, I cashed it. If I had donated it to some worthwhile charity, I’d feel more “clean.” But, as I also don’t like the guilt associated with the harassing phone calls from creditors to whom I’ve had to delay payments, I chose to take the money. Times are hard in solo primary care. HITECH dough definitely helps keep the wolf (the ACO wolf?) from our practice door, at least for a little longer. Regardless, the guilty conscience lingers.

If you’re a provider who is outside of the EP clan, don’t think you’re missing out; there’s definitely a downside to “living on the dole.”

For my DED-head Dread suffering fellow EPers, there is one other little rationalization that helps:

Every time you see welfare patients come in who have better smart phones than you, notice how the angst melts a wee bit. When their kids have better portable video game players in hand than your kids own, you’ll feel better still. When you see them drive away in newer cars than yours, the guilt virtually disappears.

From the trenches…

“When we played softball, I’d steal second base, feel guilty, and go back.” – Woody Allen


Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, directs the Pediatric Office of the Future exhibit for the American Academy of Pediatrics, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

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