If you have to sell free money, something's *really* wrong

As those who read our briefs will see, some HIT vendors have decided that they're going on a whirlwind tour, intended to sell more physicians on the value of accepting the fat wad of cash being handed out under the stimulus package.

Putting aside, for a minute, the foolishness around "meaningful use"--after all, who's going to spend thousands or millions on an EMR and play "Pong" with it?--there's still something wrong here.

I may not have seen everything in life, but I've seldom seen anybody refuse to accept huge bundles of cash to do something they're probably going to have to do anyway. (Come on, doctors, admit it--whether you love EMRs or hate them, the momentum is just too strong. You are going to implement one at some point.)

What I'm wondering, at this point, is why the smart people in the Obama administration aren't stopping, scratching their heads a bit and saying "hey, maybe we're missing something here." It doesn't take a constitutional scholar like President Obama to figure out that if people don't want stimulus money, it's time to tinker with the incentives a teeny bit.

Of course, one way of looking at this is that change is always painful, and the bigger change it is, the harder it is to make. Scrolling indecipherable notes on paper is a tradition with a long and beloved history in medicine. Sure, it may be inefficient, but it's extremely familiar. Giving doctors money to change their ways may not be nearly enough to push people out of their familiar ruts.

On the other hand, maybe something deeper is going on here. I could speculate all day on technical and clinical issues involved, but just to name a few, maybe doctors are afraid they'll make serious mistakes that could harm patients when using new technology; maybe technical people are waiting for EMRs to become far more standardized and interoperable before they invest big bucks in a platform; maybe practices can't afford the indirect costs of installing an EMR (training costs, potentially costly practice changes, lower productivity from doctors) and so on.

The bottom line is that the situation is screaming out for further analysis. Please, President Obama and Secretary Sebelius, take a closer look at this situation. Nobody wants to see billions of dollars wasted on an EMR effort that won't work. - Anne