Stage 3 of meaningful use should be delayed until Medicare value-based care programs are developed.
To move the Centers for Medicare & Medicaid Services toward that goal, the American Medical Association has created a new website – Break the Red Tape – where physicians can share their good and bad experiences with electronic health records (EHRs) in an effort to help policymakers understand the landscape.
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“We want to hear … both what is working so that we can help try to make that happen, but we also need to hear what is not working so that we can send a clear message through our stories, through our real-world experience, to those in policymaking so that they can help us to craft better policies and a better program that will make electronic health records and the policies that the federal government that seek to advance and support the adoption of those tools more effective,” Dr. Stephen Stack, AMA president said July 20 during a town hall event in Atlanta.
At the event, physicians shared how EHRs have affected their practices; many of the comments were negative, though a few bright spots, including electronic prescribing, were highlighted.
Dr. Stack summed up the majority of comments under two key points – usability and interoperability.
“We’ve got to fix the usability, and you all have clearly shown through your stories that information is not being exchanged and that’s not our fault because we didn’t write the code and we didn’t build the wires that connect it,” he said.
Dr. Steven Stack
Usability issues have translated to decreased productivity, even for those who are experienced in with EHRs. Dr. Melissa Rhodes, a pulmonary, critical care, and sleep physician at Respiratory Consultants of Georgia, said that even though she has been using EHRs since 2006, she still faces a loss of patient care time.
“Every time they have more regulations, more things that I have to answer, takes time away from the patient,” Dr. Rhodes said. She said that she currently sees two-thirds of the patients she could see, and added that she is now asking prospective employees if they know how to type, acknowledging that without that skill, her work flow would be even less productive.
Another comment on usability came from Dr. Albert Johary, a solo-practice internist in Dunwoody, Ga., who has participated in meaningful use for 4 years. He highlighted smoking cessation to illustrate how EHRs are making things more challenging. Prior to EHRs, he would chart that a patient was wanting help to quit smoking and note a prescription for varenicline.
With the EHR he is using now, which he did not identify, he said that he must account for a number of different steps.
“What I’ve started doing is I am doing this in front of the patients,” Dr. Johary said. “I am trying to work with it. I think meaningful use is not necessarily a bad thing,” but even giving notes to a patient is “a four- or five-step process.”
Interoperability “is a major issue” as well, he said, noting that he is part of the Emory Integrated Health Network and now is having to switch EHRs because of the lack of interoperability with the network.
Dr. Stack noted that the AMA supports the alignment of meaningful use with the coming value-based payment reforms. “We do believe that we should pause Stage 3 meaningful use so that it can align with these other new payment delivery models as we go forward,” he said. “We are now going to have the MIPS [Merit-based Incentive Payment System] program, which is going to have meaningful use as a substantial portion of it,” Dr. Stack continued. “We think that the rule making for these two should happen concurrently so that it makes sense when it comes out, not that we do them wrong the first time and have to redo them again to make it all make sense.”