AMA Wire

Wednesday, May 15, 2013

This Week's News

AMA board chair: HHS should address EHR usability issues immediately

AMA board chair: HHS should address EHR usability issues immediately

The government needs to act quickly to remedy the impaired usability of electronic health records (EHR) if the technology's touted benefits are to be realized, AMA Board of Trustees Chair Steven J. Stack, MD (left), told officials during a federal hearing last week.

"The AMA and most physicians believe that, done well, EHRs have the potential to improve patient care," Dr. Stack, an emergency physician in Lexington, Ky., said during his 30-minute testimony. "At present, however, these EHRs present substantial challenges to the physicians and other clinicians now required to use them."

He emphasized that many of today's EHR systems require significant changes before they can deliver the promised outcomes. Referring to Medicare's meaningful use program, he pointed to undesired consequences of pushing EHR systems on physicians before the technology was completely ready for prime time.

"Attempting to transform the entire health system in such a rapid and proscriptive manner has compelled providers to purchase tools not yet optimized to the end-user's needs and that often impeded, rather than enable, efficient clinical care," he said.

He noted that physicians are "prolific technology adopters" but that adoption of EHR systems has required federal incentives because the technology still is "at an immature stage of development."

"EHRs have been and largely remain clunky, confusing and complex," he said.

According to a recent survey by AmericanEHR Partners, physician dissatisfaction with EHR systems has increased. Nearly one-third of those surveyed in 2012 said they were "very dissatisfied" with their system, and 39 percent said they would not recommend their EHR system to a colleague—up from 24 percent in 2010.

Dr. Stack spoke at a "listening session" hosted by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), a division of the U.S. Department of Health and Human Services (HHS). The agencies coordinated the session to examine how a marked increase in code levels billed for some Medicare services might be tied to the increased use of EHRs.

Dr. Stack noted that some Medicare carriers have begun denying payment for charts that are too similar to other records.

"In this instance, even when clinicians are appropriately using the EHR, a tool with which they are frustrated and the use of which the federal government has mandated under threat of financial penalty, they are now being accused of inappropriate behavior, being economically penalized, and being instructed ‘de facto' to re‐engineer non‐value‐added variation into their clinical notes," he said. "This is an appalling Catch‐22 for physicians."

Dr. Stack advised officials that three key actions are necessary to rectify these issues with EHR systems:

  • The ONC promptly should address EHR usability concerns raised by physicians and add usability criteria to the EHR certification process.
  • CMS should provide clear and direct guidance to physicians concerning use of EHRs for documentation, coding and billing.
  • Stage 2 of the meaningful use program should allow more flexibility for physicians to meet requirements as EHR systems are improved.

The AMA will continue to work with federal agencies to improve EHR systems and the Medicare meaningful use program.