APA, AMA Urge Adjustment of EHR ‘Meaningful Use’ Criteria

AMA/Ted Grudzinski

APA has joined the AMA, the College of Healthcare Information Management Executives, and 45 other physician and hospital organizations in calling on the federal government to add more time and flexibility in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program.

In a February 21 letter to Health and Human Services Secretary Kathleen Sebelius, the organizations noted that “additional time and new flexibility are vitally important to ensure that hospitals and physicians continue moving forward with technology to improve patient care. By making such changes, HHS would be demonstrating needed flexibility to maximize program success, without compromising momentum toward interoperability and care coordination supported by health information technology.”

Under the EHR Incentive Program (sometimes referred to as the “meaningful use” program), participating hospitals and health care professionals are required in coming months to adopt the 2014 Edition of Certified Electronic Health Record Technology (CEHRT) and meet criteria established to demonstrate “meaningful use” of EHRs.

APA, the AMA, and other medical groups have consistently expressed concern about the EHR criteria and urged the government to adjust them to ensure an orderly transition so EHRs can be widely adopted and safely implemented throughout the health care system. AMA President Ardis Dee Hoven, M.D., said in a statement that the AMA is increasingly alarmed that the meaningful-use program “continues to move full steam ahead” without regard to the challenges faced by physicians, hospitals, and EHR vendors.

“Continued difficulties experienced in the current program are a clear sign that federal requirements must be revised,” Hoven said. “Greater flexibility for physicians is needed to meet the meaningful-use requirements and avoid unfair penalties, and less proscriptive certification criteria will help vendors better focus on the clinical needs of their physician customers.

“Physicians need more training and education to learn how to best deploy and use the EHR systems they are purchasing,” Hoven said. “We have to recognize that if you require EHRs to be all things to all people—regulators, payers, auditors, lawyers—then it diminishes its ability to perform the most critical function—helping physicians support their patients.”

In the letter to Sebelius, the organizations stated that “with only a fraction of 2011 Edition products currently certified to 2014 Edition standards, it is clear the pace and scope of change have outstripped the ability of vendors to support providers. This inhibits the ability of providers to manage the transition to the 2014 Edition CEHRT and Stage 2 in a safe and orderly manner.”

The letter continues, “We are concerned this dynamic will cause providers to either abandon the possibility of meeting meaningful-use criteria in 2014 or be forced to implement a system much more rapidly than would otherwise be the case. The first choice limits the success of the program to achieve widespread adoption of EHRs, while the second is highly disruptive to health care operations and could jeopardize patient safety.”

Specifically, the organizations ask that the government extend the timelines providers have to implement 2014 Edition Certified EHR software and meet requirements (stages 1 and 2) through 2015 and add flexibility in meaningful-use requirements to permit as many providers as possible to achieve success in the program.

William Narrow, M.D., acting director of the APA Office of Quality Improvement and Psychiatric Services, said that electronic health records and medical information technologies will assume ever-greater prominence in the future of health care.

“The trick is to develop technologies that facilitate efficient, collaborative care while also being user friendly and preserving the human qualities of the physician-patient relationship,” he told Psychiatric News. “This letter points to the fact that much work remains to be done in designing optimal electronic systems. The meaningful-use criteria, while well intentioned, are overly rigid and will undoubtedly leave many physicians behind. A more flexible set of standards for meaningful use with a relaxed timeline for implementation will help ensure that more clinically useful technology will be developed, and many more physicians, including psychiatrists, will be able to make the transition to electronic records.” ■