Chapter 2: A Spoonful of Sugar

Mary Poppins said, “A spoonful of sugar helps the medicine go down.” Whether this is clinically correct, Dr. Wigginton felt that the incentives Washington was offering to encourage doctors to implement Electronic Health Records (EHR) were effectively mandates. After hearing negative reports about EHRs from his colleagues, he was skeptical that the government incentives would make EHR implementation a net positive for him.

What’s more, he understood that penalties would eventually follow for failing to use an EHR system, and felt this to be somewhat of an indignity. To him, the penalties suggested that Uncle Sam cared less about his patients and more about creating cookie-cutter doctors in the image of The Stepford Wives. What happened to the days when people treated their physicians as individuals, not as cogs in an unwieldy machine called “the healthcare system”? The vague yet severe ARRA regulations seemed too much to digest all at once. Dr. Wigginton was convinced that any attempt to implement an EHR would decrease his efficiency and adversely affect his patients.

Luckily, his career was drawing toward its western horizon. With only eight years remaining until retirement, he understood that ARRA penalties would hit in full force in 2015, three years before he intended to hang up the stethoscope. If he avoided implementing an EHR altogether, Dr. Wigginton might feel the pinch of non-compliance, but the penalties would not put him out of business.

Nevertheless, government incentive programs applied to more than just EHRs. In 2008, Congress passed the Medicare Improvements for Patients and Providers Act, or MIPPA, which included incentives to encourage doctors to implement and use e-prescribing. Unlike ARRA, which enacted fines in 2015, MIPPA penalties begin in 2011. After running some calculations, Dr. Wigginton discovered that he would lose a net sum of $37,000 over eight years for failing to e-prescribe. These losses would be augmented by fines incurred for neglecting to use an EHR. The immediacy of e-prescribing penalties caused him to think more seriously about stand-alone e-prescribing than he had about implementing an EHR.

Furthermore, implementing e-prescribing promised to be much less invasive than installing an EHR. While e-prescribing required doctors to buy some software and possibly a handheld computing device, instituting a full-blown EHR entailed scanning thousands of pages from paper charts and completely rearranging staff roles. Why burst a capillary installing an EHR if e-prescribing could provide similar financial benefits without bogging down the practice?

Dr. Wigginton needed help formulating an approach to implementing e-prescribing. With so many vendors in the market, it was difficult for him to thoroughly explore the possibilities without sacrificing time with patients. Even though e-prescribing would be less cumbersome than trying an EHR, he also felt nervous to release patient prescription information over the internet. With these considerations in mind, Dr. Wigginton hired his 23-year old son, James, to research the best practices, software, and accessories needed for successful e-prescribing.

Dr. Wigginton and James were glad to be tackling the e-prescribing problem together. With luck, their joint efforts would get the new prescribing system up and running within the month. Despite their unease, they hoped that the research and implementation process would be just as supercalifragilisticexpialidocious as the folks in Washington promised it would be.

Chapter 3: A Trip Up the Amazon