About 20 percent of eligible professionals—mostly physicians—have dropped out of the Centers for Medicare & Medicaid Services’ (CMS) meaningful use electronic health record (EHR) incentive program, according to an AMA analysis of data from the agency. The trend reflects physicians’ challenges with the program’s rigid and complex criteria and the widespread frustration with EHR systems.
The AMA continues to provide input to federal policymakers on ways to improve meaningful use by making the program requirements more reasonable and achievable for physicians.
In particular, the AMA over time has asked CMS and the Office of the National Coordinator for Health Information Technology to make the following changes:
- Remove the “all or nothing” approach, in which missing a single requirement results in failure for the entire program year and puts physicians at risk for financial penalties
- Make program requirements more flexible to accommodate different practice patterns and specialties
- Decrease the number of requirements EHR vendors must meet, which would give them more time to focus on improving their software for physicians
- Extend each stage of meaningful use to at least three years
- Use experience gained since the program’s inception to inform Stage 3
The AMA also has raised concerns about the cost of complying with the program, such as the lack of customized interfaces between EHRs and labs, which don’t exist on a widespread basis yet. Currently, customized interfaces are difficult and costly for physician practices to implement, test and maintain—but without them, physicians face the burdensome task of manually keying lab information into their EHRs to meet meaningful use requirements.
AMA advocacy has resulted in the Stage 2 deadline being extended another year and has called more attention to the meaningful use program in general, convincing members of Congress that the timeline was too aggressive.
Most recently, the AMA and a group of nearly 50 of the nation’s largest physician and hospital organizations asked the U.S. Department of Health and Human Services to give physicians more time to implement the 2014 Edition of Certified EHR Technology. As a result of AMA advocacy, CMS created an additional “hardship exemption” that permits physicians who have not received their Version 2014 EHR software from avoiding a financial penalty.
EHRs and the meaningful use program are a primary culprit behind slowed physician workflows and eroding professional satisfaction, according to an AMA-sponsored study of 30 physician practices in six states. Many physicians find the systems inefficient and are frustrated that EHRs can’t share health information electronically.
At the same time, four out of five physicians would rather stick with digital technology than go back to paper records, according to the study. Physicians see the value and potential of EHR technology, but its capabilities need further development based on input from the medical community and their clinical and documentation needs.
To address these physician satisfaction issues surrounding EHRs and meaningful use, the AMA is taking a variety of steps, including working with other groups and engaging regulators about the meaningful use program’s overly aggressive pace. The AMA continues to communicate to ONC that the certification process for EHRs needs to be overhauled so vendors can be freed to focus more attention on making products work better for physicians rather than having to meet overly prescriptive federal requirements.
“The AMA will continue to work with EHR system developers to ensure that the perspectives of practicing physicians are adequately incorporated, that standardization and integration of clinical performance measures are developed by physicians for physicians, and [that] a seamless integration of the EHR into the day-to-day practice of medicine [can take place],” the AMA Council on Medical Service stated in a report issued at the AMA Interim Meeting in November.
The report provides an update of the AMA’s advocacy work around the meaningful use program and stated the AMA’s intent to work not only with EHR developers but also with other medical organizations to advocate for patient safety and usability issues.
The AMA also is developing practice-level solutions to enhance physicians’ practice of medicine as part of its Physician Satisfaction and Practice Sustainability initiative.
Additional information about the AMA’s advocacy related to the meaningful use program is available on the AMA’s meaningful use Web page.
