Pressure is on for meaningful use rebuild
"Without changes to the MU program and a new emphasis for interoperable EHRs/EMRs systems and HIT infrastructure, we believe that the opportunity to leverage these technologies will not be realized," the organizations wrote.
The letter is signed by the American Academy of Family Physicians, American Medical Association, Medical Group Management Association, National Rural Health Association, Memorial Healthcare System, Mountain States Health Alliance, Premier healthcare alliance and Summa Health System.
The AMA also wrote a separate letter to CMS and ONC, pushing a similar agenda and offering a detailed "blueprint."
The coalition letter to Burwell references the recent final rule that provided some flexibility in cases where certified EHRs were not available.
"Unfortunately, the recently released final rule that provided relief for unavailable technology did not address or improve the challenges of interoperability and usability," the letter stated. "It also only limited its impact to 2014, despite the growing concern with future stages of the MU program. Our organizations remain concerned that without changes the forward trajectory of the MU program will be in jeopardy."
The coalition recommended the following:
• Streamline and focus the ONC certification requirements on interoperability, quality measure reporting and privacy/security. Removing a heavy handed set of certification mandates and allowing instead for a flexible and scalable standard based on open system architectural features like application program interfaces will promote the delivery of more innovative and usable solutions. This in turn will allow data to move more freely across the healthcare system, reducing data lock-in and promoting more usable systems;
• Foster collaboration among stakeholders to promote the development of new HIT that is focused on meeting clinical care needs;
• Remove restrictive MU policies that stifle HIT innovation;
• Recognize vendors and providers need adequate time to develop, implement and use newly deployed technology and systems before continuing on with subsequent stages of the MU program. Testing and achievement of specific performance benchmarks should occur before providers are held accountable for any new MU requirements.
Among the AMA recommendations in the letter it sent CMS and ONC were:
Adopting a more flexible approach for meeting meaningful use to allow more physicians to successfully participate;
•Better aligning quality measure requirements including reducing the reporting burden on physicians and helping relieve them from overlapping penalties;
• Ensuring quality measures and clinical decision support within the program are current to improve care for patients and ensure physicians are following the latest evidence; and
• Restructuring EHR certification to focus on key areas like interoperability.
"Physicians will always embrace technology that can help them provide better care for their patients and foster innovation, but improvements must be made to the meaningful use program in order for those goals to be achieved," said AMA President Robert M. Wah, MD, in a news release. "We can no longer just delay the program from taking full effect. We must make the necessary changes to ensure that the meaningful use program requirements are in fact meaningful and deliver – not hinder – the intended improvements in patient care and practice efficiencies."
The blueprint outlines several ways CMS and ONC could improve meaningful use immediately and in the future.
As part of its recommendations to improve the program, the AMA is asking the administration to make optional the objectives physicians are finding most challenging. These objectives include view, download and transmit, transitions of care and secure messaging.
In addition, the AMA recommends that CMS and ONC take the opportunity with Stage 3 to make the meaningful use program less primary care centric by expanding options within the health IT objectives to meet the needs of specialists and requiring physicians to meet no more than 10 requirements.
The letter also reiterates AMA concerns with Stages 1 and 2 of the program, and offers recommendations for addressing the programs.
"The whole point of the EHR incentive program was to build an interoperable health information technology infrastructure that would allow for the routine exchange of important medical information across settings and providers and put medical decision-making tools in the hands of physicians and patients, yet that vision is not being realized and the lack of interoperability is stifling quality improvement," said Wah. "While more than 78 percent of physicians are using an EHR, thousands have not participated in the meaningful use program or attested to Stage 2, in large part because of the program's all-or-nothing approach. Physicians should not be required to meet measures that are not improving patient care or use systems that are decreasing practice efficiencies. Levying penalties unnecessarily will hinder physicians' ability to purchase and use new technologies and will hurt their ability to participate in innovative payment and delivery models that could improve the quality of care."
The coalition seems to be in agreement. In its letter to Burwell, it wrote:
"In addition to HIT interoperability challenges, existing systems also lack usability, complicating physician and provider workflows, and diverting resources away from patient care. For instance, many of the physicians have vocalized concerns that these challenges and greater administrative burdens are creating significant dissatisfaction with EHR/EMR usability; yet, their vendors are limited from addressing these concerns as they focus on meeting increasingly complex certification requirements."