Not retiring at 65: Physician goes from anti-EHR to pro-ACO

Jeffrey Selwyn
TUCSON, AZ | May 14, 2012

Jeffrey Selwyn, an internist at New Pueblo Medicine in Tucson, Ariz., is 65, but he says he's nowhere near retiring. Unlike many docs his age who are throwing in the towel due to the increased pressures on physicians to use EHRs, Selwyn is excited. He wasn't always a fan, however.

As he looks back, Selwyn admits he was something of a spokesman for older physicians who didn’t want to learn the time-consuming new way of keeping patient records. He often said so in the local newspaper. The way he did things on paper was fine, he says. It was working. He was very organized. When his practice began adopting EHRs eight years ago, he was the last physician there to get on board.

[See also: Majority of ACOs in shared savings program are physician-led.]

“It was a tough transition; I was a tough dude to get moving,” he explains. “It was a big change from my routine and the way that I would do things.” Selwyn says at first he had to cut the number of his patient visits down to allow himself more time to complete each visit using EHRs.

“But after the many days that it took to ramp up, I learned more and I studied more from a remote site. I’ve always accepted a challenge like many physicians,” Selwyn says.

After even more practice, he learned the nuances of the EHR and began to see benefits. “It’s interesting at end of my career to see the difference in what EHRs can do for interoperability and patients – what they can do to streamline patient care. No one can see that at first,” Selway says. “It’s hard to look into the future and see what you can gain from doing something until you actually go through it – until until you are there. It was mind-expanding, and a patient-relevant experience, and it allowed me to see a big change.”

Selwyn wasn’t computer illiterate prior to EHR adoption. He used computers for personal use. He also was a huge proponent of the medical home model, something his practice has always strived to provide.

Now, Selwyn is president of the board of Arizona Connected Care, one of the first accountable care organizations (ACOs) to participate in the Medicare Shared Savings Program, a federal program to lower costs and improve care. Arizona Connected Care was one of the first 27 ACOs selected to participate in the program last month.

Selwyn is passionate about the program and was eager to sign on in a leadership role, he explains. He hopes to be an inspiration to other doctors, especially those who are resisting EHR adoption for fear it will load them with yet more work.

[See also: ACO program is asking too much, says expert.]

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Showing 7 Comments

Darrin Keller say: What about the quality or quantity of care?

May 15, 2012 | 10:01 AM GMT

There is one thing that Jeffrey did not comment on or that Diana Manos did not address and is at the heart of the issue.

What kinds of advances did he see as a result of implementing the EHR? Is he able to see more patients? Is he able to provide better care? If so, can this be quantified to some extent? Or was this simply an administrative change?

pjcasey75 say: Excellent Observation

May 22, 2012 | 18:40 PM GMT

darrinkeller, you hit the proverbial nail on the head when it comes to this ongoing debate. In the end, it's not really whether or not anyone, including providers, like this newfangled technology. It's whether or not using EHRs produce any kind of return on investment. It would be especially great if that return had something to do with better outcomes for patients. I'd even be encouraged if all we could prove were the same outcomes at a lower cost.

The latest report in the Annals of Family Medicine is sadly still pretty typical. It indicates that improved outcomes for diabetes patients were not observed when monitoring care given by providers using EHRs versus paper based records over a 3 year period. That's not what we've been promised, even back in 2004 which was the period covered by that study. Proponents of EHRs (admittedly, like me) will argue that the study addresses 8 year old technology and we've come a long way since then. Still, proponents should take this as yet another kick in the butt to recognize that the technology still isn't proven and still needs lots of improvement.

We need to keep pressing the issue that the goal here is not meaningful use, or health information exchange, or even restructuring the whole healthcare delivery system - it's doing what works to obtain better outcomes for more patients at lower costs.

Amanda Barker say: Young doctor, EMR is the only thing I know

May 14, 2012 | 17:56 PM GMT

As a young physician reading the above article, I can truly say that to me, there is nothing else except EMR. As I trained in medical school, residency and fellowship, I was subject to multiple types of EMR and was expected to not only use it but to catch on quickly!

Now, I work for the largest HMO in CA and we are proud of the EMR system that we have in place. Not only does it make care succinct and efficient but it provides me the ability to be tied to my colleagues every step of the way. This connection also provides the patients the comfort of knowing that their medical care is done in a team-type atmosphere. We limit unnecessary testing, imaging and repeat lab draws; we are safeguarded to prescribing medications that do not interact with their medication list and we can discuss care plans with other specialists on-the-spot. In addition, I exchange quick emails with patient's all day long which has improved patient communication and satisfaction.

I give Dr. Selwyn a lot of credit for moving with the times. It's a lot easier to transform into a dinosaur rather than dynamically exploring how we can be smarter, better, quicker and more present physicians.
As I begin my career, I hope I am one day as motivated as Dr. Selwyn to be the best- kudos to you!

Dmanos say: Happy to see both sides commenting

May 14, 2012 | 17:21 PM GMT

As a journalist, I'm very happy to see a story elicit reactions from both sides of the fence. ACOs and EHRs are definitely hot buttons these days. I would love to hear from anyone who has a yearning to vent on this subject. Email me at diana.manos@medtechmedia.com

pjcasey75 say: Interesting Anecdote

May 14, 2012 | 16:22 PM GMT

I find one aspect of this story particularly interesting. I've been a documentation consultant for hundreds of practices over the years on both paper and EHR systems. During that time I've worked with a good number of doctors in Dr. Selwyn's age range. Among those who, like Dr. Selwyn, have eventually warmed up to their EHR, his transformation from opponent to proponent rings true. Only when the doctor personally sees a benefit can they get on board. Which is not too surprising, after all.

What's tricky is that it seems almost impossible to predict what feature/benefit will be the turn-on for any given user. It's like trying to explain Google to someone in 1960. "Why would I want to go to all that trouble to "google" something when I already have an Encyclopedia Britannica on my shelf?" In that context, it's almost impossible to "sell" the idea. You just have to let them use it.

As with Dr. Selwyn, you don't know why a provider will like it (if they even do) until they actually use it. Will it be the drug formulary checking? Will it be quicker access to prior visits, update medication lists, or easy exchange of data with other providers? And will all that offset the pain of change, additional input requirements, etc. etc. etc.? And then, of course, it still depends on whether or not you have an EHR that is any good in the first place, fits the user reasonably well, and a whole lot upon the user's own attitude towards change.

I enjoyed Dr. Selwyn's particular story.

jconcannon say: EHR only makes your older years in practice more frustrating

May 14, 2012 | 13:36 PM GMT

I agree with the previous comment completely. EHRs are not likely to truly improve patient care; what they do well is to count beans for the Feds and inscos. Savvy physicians have developed diagnostic substitution work-arounds to pigeon-hole their data so that they can obtain that all-glorious meaningful use cash. EHRs are disorienting at first and increase the malpractice risk for new users. The cost of EHR, both as start-up and ongoing support costs and time are enormous and are driving the concept of small, independent medical practices into extinction. Having been all-in on EHR for 4 years, and with considerable computer experience beforehand, I can state that I believe that this has all been a big mistake for the future of the practice of medicine.

DonJarrell say: Your mileage may vary ...

May 14, 2012 | 12:45 PM GMT

In reading this headline and the article, I started thinking of the infomercials on late-night TV (yes, I'm insomniac) in which someone is explaining how much fun it is, and how much money can be made, with some system of buying foreclosed homes, selling nutraceuticals, or placing ads in thousands of newspapers. In all of those, there is the subtle message that YOU TOO can have that fun and make that money. The FTC has cracked down on many such programs and advertisers and forced them to add the fine print "These results are not typical". But, Dr. Selwyn, good for you.

I think that admonition is probably applicable here as so many doctors and hospital executives are vocalizing that EHR systems, and several other grand schemes emanating from CMS, are FAR more about feeding long-range, national research than they are about improving patient care and HCO/provider operating efficiency. Research is certainly great, but when someone can ignore the questions of prime objective value and ROI, and *mandate* something born in a specific context to the entire industry - including those who simply cannot afford it - there is a real problem.