Chapter 1: Of Horses, Buggies, and Automobiles

Meet Dr. Scott Wigginton. In many ways he is much like you. He studied feverishly in medical school at UC San Diego, and he suffered grueling 36 hour shifts during his residency in internal medicine in Dallas, Texas. Upon finishing his residency, Dr. Wigginton joined a group practice at St. Luke’s Medical Center in Sacramento. He started a family in those early years, and now he has a wife, three children, and a dog.

Although he began in a group and later worked for an HMO, Dr. Wigginton prefers his present situation as a solo practitioner. While the business side of medicine is stressful, Dr. Wigginton enjoys the freedom that solo practice offers.

In February 2009, President Obama signed the American Recovery and Reinvestment Act (ARRA), a stimulus package designed to jumpstart the American economy.  ARRA included nearly $20 billion in financial incentives for doctors to adopt Electronic Health Records (EHR), and penalties down the road if they didn’t. 

When he heard the news, Dr. Wigginton realized that he would need to reassess his small-business model. Having practiced medicine for 27 years without using an EHR, Dr. Wigginton felt that implementing an EHR would be a herculean task. “I feel like a country doctor driving a horse and buggy,” Dr. Wigginton lamented. “For 27 years, my horse-and-buggy paper charts, dictaphone, and fax machine have worked just fine in running my practice. Now that the new-age EHR automobile has arrived on the scene, the government thinks that my trusty horse will no longer be enough.”

The size and breadth of the EHR incentives caught many off guard.  While information was available about the specific financial incentives, it did not detail how EHR implementation would affect doctors’ practices. Consequently, Dr. Wigginton had to rely on reports from his colleagues to obtain a sense of what ARRA means for physicians like him. At his 30year UCSD Medical School reunion, Dr. Wigginton heard from his Kaiser classmates that they often work until 11 pm to update patients’ electronic charts. Such news did not bode well for Dr. Wigginton, who already worked 12-hour days in order to keep his private practice fiscally viable.

Dr. Wigginton, like many other veteran physicians, wondered what he should do. The experts were saying that EHRs would ultimately improve the efficiency and quality of medical practices, but Dr. Wigginton worried that an EHR could compromise efficiency and cost thousands of dollars in staff time and product and service purchases. Conversely, if he didn’t implement an EHR, he would become subject to government penalties in 2015, notwithstanding the superb quality of care he provided his patients. Could Dr. Wigginton survive as a horse-and-buggy physician in Henry Ford’s brave new world?

The remaining articles in this CMA serial briefly recount Dr. Wigginton’s story. Join us each week as we recount the successes, failures, and surprises that Dr. Wigginton encounters in his journey towards creating an electronic medical practice.

Chapter 2: A Spoonful of Sugar