Your Say

Editor's Note: This letter is in response to Cheryl Clark's Feb. 3 online article, "Many Small Practice Physicians Putting off Meaningful Use Guidelines."

A Model for EMR Adoption
Many of the responses within the article, and indeed the national discussion about EMRs and meaningful use, are missing the fundamental reality of where the future of healthcare lies. We should not be focusing on preserving the traditional model of small-practice medicine, with physicians "circuit riding" to multiple hospitals with therefore necessarily disjointed communications and follow-up. The national effort should be focused on a more achievable goal, that of forming medical communities where physicians aggregate around a principal hospital—a surrogate for the community—and that institution assumes responsibility for hosting and sharing the community's EMR functionality, bridging all patients (inpatient and outpatient) and hospital-owned practices and voluntarily participating community physician practices.

Successfully navigating the multiple divergent priorities and goals of hundreds of small businesses (private practices) is a recipe for frustration and greatly delayed reward. The pain involved in the EMR transition needs to be followed, within a reasonable horizon, by significant reward, and not just for the payers or quality gurus, for this effort to succeed. I know, we've done it, and made the transition, involving inpatient, outpatient, owned and private practices, but it is still an uphill climb to change mentality from physician-focused information management to patient-focused information management, community based.

Arnold Wagner, Jr., MD
Medical Director, Informatics
NorthShore University HealthSystem, Evanston, IL

Editor's Note: This is in response to Philip Betbeze's Jan. 22 online column, "Healthcare Reform's Not Over by a Long Shot."

Reform: What Happened, What's Next
The vote in Massachusetts for Senator Scott Brown was not against the idea of healthcare reform, but a complete rejection of the process. It took way too long; advocates didn't sustain the narrative on why it was important; and most important, it was being held back in a very public way by several Democratic senators. This gave wavering moderate Republicans a reason to say no to a bill they were ready to support. The deal struck with Sen. Nelson of Nebraska was enormous and, I think, really frustrated the electorate. I know it did me.

That said, I am optimistic that very soon, when the dust settles, a meaningful bill can come through. In the meantime, leading providers aren't waiting; they are preparing for and creating a post-reform healthcare delivery environment—one that is safer, more technologically advanced, integrated, and more efficient. That will be good for all of us.

CJ Bolster
Vice President and National Healthcare Sector Practice Leader
Hay Group, Atlanta