This column was originally published in AMA eVoice on May 15, 2008. Dr. Davis is president of the American Medical Association.
The AMA had quite a presence in Washington, D.C., late last week. During testimony to the U.S. House of Representatives Small Business Committee on May 8, AMA Trustee Cecil B. Wilson, MD, urged Congress to take immediate action to avert looming Medicare physician payment cuts, including a cut of 10.6 percent scheduled to take effect on July 1, that will harm seniors' access to care.
Also that day, during testimony to the U.S. House Energy and Commerce Committee Subcommittee on Oversight and Investigations, AMA President-elect Nancy H. Nielsen, MD, PhD, shared the AMA's concerns about some prescription drug advertisements directed at consumers.
And during a May 9 meeting at the Brookings Institution, AMA Trustee Steven Stack, MD, highlighted the AMA's support for electronic prescribing and pointed out a number of key steps that would lead to broader adoption among physicians of health information technology (HIT). The AMA has strong policies regarding HIT, but this marked the first time the AMA has shared an outline of what physicians would accept as part of e-prescribing legislation.
E-prescribing software allows for prescriptions to be transmitted electronically to a pharmacy's computer system. Through e-prescribing, physicians can manage patients' prescriptions electronically, view potential drug interactions and side effects, view prescription drug coverage and insurance information, receive electronic notification about the need to authorize refills or approve generic substitutions, and share simultaneous access to prescription histories and allergies with pharmacies. E-prescribing may be part of an electronic medical records (EMR) application or a stand-alone software system.
I believe e-prescribing can play an important role in transforming health care by improving patient safety, enhancing care coordination among health care providers, and reducing administrative burdens that take physicians away from patients. A number of physicians nationwide already are using e-prescribing or are in the process of implementing this technology.
To help more physicians take advantage of e-prescribing, financial incentives are needed to offset the costs of implementation. Grants, low-interest loans, increased reimbursement for the use of e-prescribing, and tax credits are economic incentives that would help physicians who find it difficult to afford implementing this software.
We also need a national framework that includes a uniform set of e-prescribing standards and a transitional period for physicians to adopt technology. Any e-prescribing requirement that triggers potential penalties should be deferred until two years after final standards are in place. This will allow physicians to acquire and implement e-prescribing tools and train their staff. In addition, any proposal should include exceptions for small practices and physicians in rural areas as well as emergency situations in which doctors may have to prescribe medications outside their normal offices.
I urge Congress to direct the Centers for Medicare and Medicaid Services (CMS) to release final e-prescribing standards by the end of 2009. CMS issued three standards last month and plans three more, and their completion would help create uniformity around functionality, which would help ensure connectivity. These standards also would help make sure that this technology does not become obsolete.
One of the main concerns about e-prescribing is that the privacy and confidentiality of patient information could be put at risk. Earlier this week, the Coalition for Patient Privacy and 25 of its member organizations asked Congress not to pass an e-prescribing mandate unless it includes privacy provisions. Last year, as part of a statement to a U.S House subcommittee, the AMA encouraged Congress to make privacy and confidentiality a top priority when developing an HIT infrastructure.
Congress must also remove a barrier in place under the Drug Enforcement Administration's prohibition on e-prescribing controlled substances, which account for about 20 percent of all prescriptions.
E-prescribing is just one aspect of the huge range of products and systems that make up HIT, which encompasses all software, hardware, and infrastructure used to support the collection, storage, and exchange of patient data throughout the clinical practice of medicine.
The AMA has done significant work to address barriers that keep physicians from implementing HIT into their practices, and has developed a number of resources to help physicians make the best technology decisions for themselves and their practices.
The newest of these resources is the AMA's Physician Spotlight, an online feature that provides an inside look at physicians around the country who are transitioning their practices from a paper-based system to one with electronic health records (EHR). The latest Physician Spotlight highlights the experiences of Paul Buehrens, MD, medical director of Lakeshore Clinic in Kirkland, Wash.
A recent trend is for hospitals, health systems, and health plans to donate HIT to physician practices. Given this, it's important for physicians and practice managers to understand the details associated with HIT donation agreements and Stark law and anti-kickback statute requirements.
The AMA has developed a flier (PDF, 71KB) and a separate, more in-depth guide (PDF, 464KB) that point out federal regulations for HIT donations and summarize the conditions surrounding them. Both documents provide valuable insight for those interested in accepting an HIT donation, including recommendations to aid in the decision-making process.
For physicians, residents, and medical students looking to learn the basics about HIT, the AMA offers an overview, a glossary of terms, and links to numerous articles and reports on the subject. The AMA also outlines the different HIT applications, such as practice management systems, electronic medical records and EHRs, picture archiving and communications software, and personal health records.
It's important that physicians understand the benefits, risks, challenges, and costs of HIT before pursuing it for their practice. The AMA spells out the risks and benefits involved with implementing HIT and helps physicians assess the needs and status of their practice. The AMA also helps with vendor assessment and can inform physicians about the costs—both direct and indirect—of adopting HIT. Tips for physicians who have decided to implement HIT into their practices are available as well.
The AMA also offers links to self-assessment resources developed by the Texas Medical Association and the Doctor's Office Quality–Information Technology (a quality initiative sponsored by CMS) to help physicians determine if they and their practices are ready to pursue e-prescribing and HIT.
Please send comments, questions, and replies to amaprez@ama-assn.org.
Content provided by: Ronald M. Davis, MD