The Meaningful Use program is an electronic health record (EHR) incentive program initiated following the American Recovery and Reinvestment Act of 2009 that authorizes the Centers for Medicare and Medicaid Services (CMS) to award incentive payments to eligible professionals who demonstrate meaningful use of a certified EHR. The program has three stages, but incentives were only provided in Stage 1, which began in 2011. Stage 2 of Meaningful Use began this year and by 2015, eligible providers that have not adopted an EHR will face a financial penalty.

The AMA, headquartered in Chicago, is pressing for changes to the program after new analysis from CMS showed only 2 percent of physicians and less than 17 percent of hospitals have demonstrated Stage 2 Meaningful Use as of Sept. 30, the required reporting date for the 2014 fiscal year.

In response to the data, the AMA is urging policymakers to fix the program by adding more flexibility and shortening the reporting period to help physicians avoid penalties. Physicians representing the AMA also say that full interoperability is necessary to achieve the goals of EHRs — which are to facilitate coordination, increase efficiency and help improve the quality of care — but that is not widely available today.

"The AMA has been calling for policymakers to refocus the Meaningful Use program on interoperability for quite some time," said Dr. Steven J. Stack, AMA president-elect, in a statement. “The whole point of the Meaningful Use incentive program was to allow for the secure exchange of information across settings and providers and right now that type of sharing and coordination is not happening on a wide scale for reasons outside physicians’ control. Physicians want to improve the quality of care and usable, interoperable electronic health records are a pathway to achieving that goal.”

Although there are some systems on the market capable of interoperability, when data is transferred it is not always incorporated into the receiver’s EHR in a digestible way, making it difficult to act on and defeating the purpose of sharing, the AMA argues. Additionally, interoperability often comes at a price, which further hinders its use.

In addition to calling for EHRs to be more interoperable, physicians are also recommending that policymakers ease regulations to allow for EHRs to become more usable. To back its position, the AMA has been citing a 2013 report from AMA-RAND — a collaboration between the AMA and research firm RAND Corporation — that stated EHRs are a major source of dissatisfaction for physicians. The report found that physicians want to embrace technology, but they’re frustrated that regulatory requirements are forcing them to do clerical work and distracting them from paying close attention to their patients.

Physicians also raised concerns about interoperability in the study, saying that the inability of EHRs to "talk" to each other prevents the transmission of patient medical information when it is needed.

The AMA has provided the Office of the National Coordinator for Health IT (ONC) and CMS with a blueprint for improving the Meaningful Use program as well as a framework that outlines eight priorities for more usable EHRs.
 

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The AMA said physicians are not happy with EHRs because the technology requires too much time-consuming data entry, leaving less time for patients, according to a study that the association did with the RAND Corporation in October 2013. Physicians that were surveyed expressed concern that current electronic health record technology interferes with face-to-face discussions with patients, requires physicians to spend too much time performing clerical work and degrades the accuracy of medical records by encouraging template-generated notes.

“Physician experiences documented by the AMA and RAND demonstrate that most electronic health record systems fail to support efficient and effective clinical work,” said Dr. Steven J. Stack, AMA president-elect, in a statement. “This has resulted in physicians feeling increasingly demoralized by technology that interferes with their ability to provide first-rate medical care to their patients.”

The AMA said that numerous other studies support these findings, including a recent survey by International Data Corporation that found 58 percent of ambulatory physicians were not satisfied with their EHR technology. Most office-based providers find themselves at lower productivity levels than before the implementation of their EHR and workflow, usability, productivity and vendor quality issues continue to drive dissatisfaction.

In response to physician concerns, the AMA released a framework that outlines eight priorities for improving EHR usability. The association would like to see EHRs that do the following:

• Enhance physicians’ ability to provide high-quality patient care
• Support team-based care
• Promote care coordination
• Offer product modularity and configurability
• Reduce cognitive workload
• Promote data liquidity
• Facilitate digital and mobile patient engagement
• Expedite user input into product design and post-implementation feedback

The AMA said that these priorities were developed with an external advisory committee comprised of practicing physicians, experts, researchers and executives in the field of health information technology.

In 2012, the Affordable Care Act began requiring health plans to switch to electronic health records, which would reduce paperwork and administrative burdens, cut costs, reduce medical errors and improve the quality of care, the Obama administration said.

However, the incentives that were intended to drive widespread EHR adoption have exacerbated and, in some instances, directly caused usability issues, the AMA argued. The association urged the federal government to acknowledge the challenges that physicians face and to abandon the all-or-nothing approach. The AMA is also demanded that federal certification criteria for EHRs need to allow vendors to better focus on the clinical needs of their physician customers.

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The study, commissioned by the National Partnership for Women & Families — a Washington, D.C.-based nonprofit, non-partisan advocacy group aimed at promoting fairness in the workplace and equal access to quality health care — set out to examine consumer views on health information technology, with research directed by Alan Westin, Ph.D., professor emeritus at Columbia University.

The study, conducted by New York-based research firm Harris Interactive, comes at a time of transition to electronic health records, which health care providers can receive incentive funds for under provisions of the American Recovery and Reinvestment Act.

Conducted from Aug. 3 to Aug. 22 with 1,961 adults in the respondent pool, the survey was funded by the Commonwealth Fund, Merck & Co., Inc., WellPoint, Inc. and the California HealthCare Foundation.

"We fielded this survey now, in the early stages of the transformation to EHRs, to assess consumer views and to measure whether the ways doctors and hospitals are using them is what patients want and need," said Christine Bechtel, vice president at the National Partnership and patient and family representative on the federal Health Information Technology Policy Committee. "For health IT to deliver on its promise, consumers must support it.”

Bechtel said that while the findings were encouraging, consumer support is necessary to navigate through “potential landmines,” including political pressure to repeal the incentives.

"This survey draws attention to a critical, but sometimes overlooked, facet of health information technology — patients and their families need to be at the center of efforts to modernize health care’s information infrastructure," said Dr. Farzad Mostashari, national coordinator for health information technology with the U.S. Department of Health and Human Services.

Titled “Making IT Meaningful: How Consumers Value and Trust Health IT,” surveyed respondents who had an ongoing relationship with a care provider and knew whether the provider uses an electronic or paper record system.

The study found that regardless of the form of health records, patients saw the value in EHRs, with 88 to 97 percent of those whose doctors use EHRS responding that EHRs are or would be useful for elements of health care like timely access to information and communication. In patients whose doctors use paper medical records, 80 to 97 percent said EHRs would be useful.

Just six percent of respondents whose doctors use EHRs reported dissatisfaction, according to the study, while three in four respondents whose doctors use paper records said it would be valuable if their doctors adopted EHRs.

One in four respondents who had online access to their medical records were more supportive of health information technology than those who did not, and reported being more trusting of doctors to protect their privacy.

The survey sampled Hispanic adults and found that while those whose doctors use EHRs were significantly more likely than others to see them as valuable in helping them personally in maintaining a healthy lifestyle, understanding their health conditions and keeping up with their medications, they were also more likely to report having experienced a data breach and to worry that more widespread adoption of EHRs will lead to even more such breaches.

Mostashari said that while the survey showed patients saw value in the power of electronic health records in improving care, respondents also said the success of advanced health care information technology requires vigilant protection.

"At a time when America’s taxpayers have made such a large investment in the implementation of health IT, we have an obligation to use their dollars wisely and get this right," the National Partnership’s Bechtel said. "Amplifying the voices of consumers is key to success."

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The number represents more than one-third of all primary care providers nationwide who will work with their Regional Extension Center to participate in the Medicare and Medicaid Electronic Health Record Incentive Programs as a way to transition from paper records to certified EHRS, a major step toward “broader and more meaningful use of health IT,” according to the U.S. Department of Health and Human Services.

Designed to jump start EHR adoption, the Health Information Technology Economic and Clinical Health Act of 2009 created a nationwide network of regional extension centers comprised of local nonprofits to provide guidance and resources to help eligible professionals make the transition.

The 2009 legislation falls under the Recovery Act and offers incentive payments to eligible providers that meet meaningful use of certified EHR criteria.

The 62 extension centers focus on assisting primary care providers and providers serving traditionally medically underserved populations taking part in the Medicare and Medicaid HER incentive programs use electronic records in ways that can reduce health care costs, increase patient safety and improve the overall quality of patient care.

Providers face challenges in adopting the process, including tight budgets, overstretched health information technology staff and limited broadband access, according to the Department of Health and Human Services.

“The RECs are playing an integral role in helping providers on the path to EHR adoption,” said Farzad Mostashari, M.D. and ScM at the Office of National Coordinator for Health Information Technology. “This compelling milestone demonstrates strong interest in adoption and meaningful use among community health centers, small practices, and rural providers that can lead to improvements in health and healthcare.”

Half of the providers committed to making the transition to certified EHRs are in small group practices or consortia of small group practices. The remaining providers focus on the underserved, with 18 percent in community health centers; 11 percent in public hospitals; and 21 percent in other underserved settings, such as critical access hospitals, rural health clinics, and practices in medically underserved areas, according to the department.

The centers serve the majority of primary care providers in small practices in rural areas.

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