Should older doctors be allowed to opt out of EMR?

A fair amount has been written on EMR for the individual physician facing retirement.

But I have come across a more complicated variation of the question.  What if a multi-physician group has one physician approaching retirement who is the “lone hold-out,” opposing EMR while the rest of the docs in the group are ready to take the plunge?

The older physician has a point.  The EMR implementation will likely require a large capital expenditure, reducing the value of the practice in the short term and adversely affecting the value of his retirement buy out.  The doc nearing retirement age may have difficulty with the IT skills necessary to master EMR and may not be practicing long enough into the future to see the long term return on the investment required to get those IT skills.

The older physician in this scenario may ask to opt out of the expenses of the EMR project when his income is calculated and to have his retirement buy out calculated without the EMR liability figured in.

That might sound like a good way to resolve a difficult dilemma … unless you understand the physician personality.  The problem is that we docs love our work too much.  That is partly why Medicare, Medicaid and private managed care providers have been able to sharply reduce our payments over the past 15-20 years, and we just keep showing up for work.  As a rule we don’t face retirement well.  Many of us never retire; we just die with our boots (or scrubs) on.

So the older doc who claims to be ready to retire may not retire as soon as he thinks.  So do you let him opt out of EMR or not?

I would be happy to let him opt out of EMRprovided he commits in writing to a retirement date and allows the practice to begin making plans to recruit a replacement physician.  The date would be fairly soon, no more than 18 months in the future.  If he fails to retire by that date he would begin incurring costs related to EMR, both in take-home pay and retirement buy out.

This approach avoids the nearly impossible task of trying to calculate the return on investment “break-even point” for an EMR purchase, as many authors try to do.

Mike Koriwchak is an otolaryngologist who blogs at the Wired EMR Practice.

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  • Kevin T. Keith

    I’m not clear if you’re referring to opting out of using EMR, or opting out of paying for a new EMR system.

    In the latter case, it makes perfect sense to let practice partners nearing retirement opt out of capital improvements on a pro-rated basis – not just EMR but any major long-term expenditure of the practice. You could even work out a sliding scale pro-rata contribution that would incrementally “vest” them in the costs of the improvement each year they stayed after it was implemented, rather than demanding a hard-and-fast retirement date. But that is simply a business accounting problem. It has little to do with medicine or EMR specifically.

    If you’re suggesting that some doctors should be allowed to refuse to use EMR simply because they’re near retirement, that seems to have less justification. EMR is intended to improve patient care (yes, there are questions whether it actually does, all things considered, but hopefully you have chosen an EMR system that actually is beneficial). Refusing to use a new system because you’re “too old” would be like refusing to learn appropriate dosages of a new drug because you just don’t want to – it’s simply a violation of your obligation to practice according to the highest current standards. And “I don’t know computers” is an even worse excuse (it’s basically offering “incompetence” as a reason not to use the latest methods, which is hardly a good reason).

    Business decisions about EMR implementation should be separated from issues of clinical efficacy and good patient care.

  • Debbie

    For those of you who have already adopted an EMR, can you give me an approximation as to your overall cost? I have a feeling our office is underestimating the expense. Thank you.

  • Vox Rusticus

    Like any other practice expense, there ought to be an understanding of how costs of capital equipment purchases are shared. Like new computers, new offices, phone systems or air conditioners, there are costs that have to be borne that don’t necessarily coincide with arrivals and departures of partners. Not wanting to share in the costs is just not reasonable, when one also expects to reap any benefits, near and far term. EMR is hardly the first substantial practice cost to be borne; hiring all the ancillary staff to deal with insurance claims and billing processes have cost much more over the years than does EMR, yet those costs aren’t the issue.

    If you are in the group, you share the good and the bad. And as the OP said, you never really know when someone will “retire.”

  • Steven Reznick MD

    Can you define ” older ” doctors?

    In my community many of my colleagues who have paid off their mortgages and fully funded their retirement funds and believe they are within 5-7 years of retiring full time simply will not put in an EMR system to their small one and two physician practices. They are willing to take the 1-2% re duction in the future because it is less onerous than the trauma of going from paper to paperless systems. Having said that and having put an EHR in my office six years ago, I am upgrading to a certified and qualified new system because it is just so much easier to be complete and thorough with a good EMR system than it was with paper. I agree with the participants who suggested a physician nearing retirement should be able to opt out of any capital improvement as per their contract with their group

  • soloFP

    I think it is trickery to assume that the EMR is going to help physicians. A local group of seven docs put in an EMR and had to hire two full time employees to scan in labs, studies, primary care letters, and other documents, as many docs still use dictation services. The EMR payment incentive look good now, but most EMR vendors will have annual updates and usage fees that will continue to increase. Most people buying EMRs now will get hit with major update fees when the ICD 10 comes out. Inpatients and outpatients complain that the nurses and docs spend more time typing on the computer than examining the patient. The EMRs also encourage upcoding. A final note is that many EMRs require new cmputer hardware and some EMR vendors will require you to turn over the software if you don’t pay annual licensing fees.

  • Margalit Gur-Arie

    Old is largely a state of mind. I don’t presume to know about financial arrangements in any given practice, but being “older” does not mean less able, or less willing to learn new things.
    Just watch this young-minded physician and what he does with his EMR.
    If you pay close attention, you will see that the he is not paperless (whatever that means), and he is still faxing stuff to pharmacies, but he found enough utility in the EMR to use it…..quite happily too (I love this video).

    • Mike Moore

      Great post Margalit, I think that the standardization and mobility of data is the next real advance in medicine/healthcare…and opting out of EMR/HIS is about as practical as opting out of using radiology or laboratory services.

      I think the subtext of EMR, that’s I’ve already encountered within the VA and DoD systems, is that EMR is about accountability and accuracy. It’s really hard to get away with not being through and accurate, and to not follow standard of care, in the EMR environment.

  • Magnus Ängslycke

    A quick note from a young MD in Sweden. I’m interested to see the debate over EMR going on in the US at the moment. At the same time I can’t believe that you haven’t introduced this already. Most smaller medical practices in Sweden started using EMR in the early 1990:s, mine in 1992. While I’m not up to date on the different problems you are facing, is EMR or no EMR really a question after all these years?

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