Take the Medicaid Sustainable Growth Rate fix, or the “doc fix.” Since 2003, Congress has passed patches and temporary fixes to stall Medicare reimbursement cuts to physicians. President Obama has proposed repealing SGR fixes, which different reports indicate could cost anywhere from $115 billion to $175 billion over the next 10 years. What started as a 4.8 percent reduction in payment has climbed to a 24 percent cut in payment, with the large political question of how to pay for that.
Could this have been avoided if Congress had forgone the easy fix and made the difficult decisions to proceed with cuts 15 years ago? There’s no way to know for sure, but I’ll take my chances and say yes.
There is also the adoption of EHRs and the progression of meaningful use, which will not be easy transitions. But again, the point isn’t to make it easier. The point is to make it better.
In his article, Mr. Millar discusses the idea of designing things to make it easier to do something badly.
For instance, many clinicians use the copy-and-paste function to place information into EMRs to save time. A 2013 study found notes entered by 82 percent of residents and 74 percent of attending physicians contained at least 20 percent copied text.
This feature, seen by many as “user friendly,” also makes it easier to do just that — makes it easier to do something badly. Copy-pasting is linked to a variety of errors, including outdated information, redundancies, the spreading of false information and an inability to identify when the documentation was first created.
Sure, paper records are no longer ideal, but such carelessness wasn’t an option on hard copies of records. Typing individual entries into individual fields isn’t a design flaw — it’s a feature that demands a clinician’s attention, effort and helps ensure the patient’s record is as accurate as it can possibly be.
To be clear, I don’t want to suggest we make things harder on ourselves. We already deal with enough hardships and difficulties on a day-to-day basis. Instead, I’m suggesting we let go of the idea that there is always an easier or simpler alternative, especially as we move forward with the redesign of the healthcare industry. So often what we make easier for the lawmaker, physician or executive ends up being harder for the patient or consumer.
“We should be wary of only designing for ease of use,” writes Mr. Millar. What’s easy may not be best. The industry needs to undergo a lot of change, but it’s never going to improve if we don’t embrace the difficulties along the way.
Facing, and then surmounting difficulties, equals growth. It translates into progress. If this redesign were easy, it wouldn’t be worth it, and we wouldn’t give a damn.
(Photo courtsey of The Ohio State University Libraries: http://library.osu.edu/projects/woody-hayes)
