On Tuesday, the American Medical Association (AMA) released a blueprint for the future of the Meaningful Use program, including Stage 3, quality reporting, and EHR vendor certification requirements. In a 30 page letter submitted to the CMS Administrator Marilyn B. Tavenner and ONC National Coordinator Karen B. DeSalvo, MD, MPH,AMA CEO James L. Madara, MD states:
“Since the creation of the Electronic Health Record (EHR) Meaningful Use (MU) program in 2009, it is clear that physician use of EHRs has progressed considerably. Despite these achievements, the MU program has faced significant challenges. After three-and-a-half years of provider participation, we are at a critical crossroad where we believe it is important and necessary to pause and fully assess what is working and what needs improvement before moving ahead to Stage 3 of the program,”
AMA’s Future of Meaningful Use Recommendations
In the letter, the AMA outlined the following four recommendations to the MU program:
1. Adopt a more flexible approach for meeting MU by:
– Removing the existing all-or-nothing approach by adopting a 50 percent threshold for incurring a penalty and a 75 percent threshold for earning an incentive for MU Stages 1-2.
– Remove percentage/thresholds for measures and the concept of menu vs. core requirements for Stage 3
– Provide new health information technology (health IT) measures to expand the options for specialist participation for Stage 3
– Retain most of the measures the Health Information Technology Policy Committee (HITPC) recommended for removal to ensure provider participation
– Require physicians to meet no more than 10 measures under Stage 3
2. Expand hardship exemptions for all MU stages by:
– Providing an exemption for physicians who successfully participate in PQRS from the MU quality reporting requirements
– Expand the “unforeseen circumstances” hardship
– Provide an exception for hospitalists and continue exceptions for anesthesiologists, radiologists, and pathologists
3. Improve quality reporting that will:
– improve alignment with the PQRS program
– build a sufficient quality infrastructure
– Ensure public input for new electronic clinical quality measures (eCQMs)
– Continue to allow physicians to report on menu measures
– Develop a process to eliminate measures that no longer follow the latest clinical evidence and ensure registry participation and interoperability
4. Address physician EHR usability challenges
– Adopt the Health IT Certification/Adoption Workgroup recommendation to revamp the certification program to focus exclusively on: 1) interoperability; 2) quality measure reporting; and 3) privacy/security
– Remove the requirement that only licensed medical professionals and credentialed medical assistants are allowed to enter orders
– Adopt recommended approaches to address User-Centered Design (UCD) and incorporate well-developed data management principles
“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. 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,” said American Medical Association President Robert M. Wah, MD in a statement.
Last month, the AMA released their framework for EHR usability that offers eight challenges and solutions to enhance the potential of EHRs to improve interoperability and patient care.
The entire letter is available for review here.