Federal agencies should align to Medicare pay so it supports interoperability seamlessly within paperless systems, the American Medical Association (AMA) plus other medicine groups have urged.

If the USA is serious about achieving goals of an efficient and high quality health care system, it will need to improve health information exchanges and interoperability, AMA along with organized medicine groups told federal health officials.

As the American health care system moves away from paper records and spurs the use of electronic health records (EHRs), the AMA warns that serious gaps in the adoption of health information technology remain.

Under the Obama administration, billions of dollars have been spend on EHR adoptions programs to physicians and hospitals since 2011, with not much progress, critics say.

The Department of Health and Human Services Office of the National Coordinator for Health Information Technology had recently invited comments on how interoperability could be advanced, as well as overcoming the challenges to health information exchanges. The AMA as well as more than 200 organized medicine groups and other key stakeholders responded with new ideas on how the current EHR environment could improve.

The AMA urged the Centers for Medicare & Medicaid Services (CMS), as well as the Office of the National Coordinator for Health Information Technology (ONC) to concentrate on providing doctors with incentives that promote greater care coordination across the health care system.

For example, Medicare does not pay for email consultations, support for patient self-management or consults with other doctors. The AMA believes it should consider paying for this because care coordination depends on good communication.

The AMA letter stated:

“Providing Medicare payments for these services would provide an enormous incentive for physicians to devote more time and resources to care coordination, and to redesigning the delivery of care to support better coordination.”

At the moment, CMS’ and ONC’s functions are as follows:

  • CMS sets targets and thresholds for HER users to demonstrate meaningful use of paperless systems
  • ONC coordinates doctors’ and hospitals’ efforts to use new health technologies

A growing number of doctors feel that meaningful use effort should be more flexible, because current requirements to earn bonuses and prevent future penalties sometimes do not fit a doctor’s practice.

For example, meeting measures for meaningful use regarding a typical office visit is not really that relevant for radiologists, pathologists and other specialists. These specialists have difficulty meeting such measures.

While anesthesiologists may treat Medicare patients, they are not involved in any follow-up care, while other health care professionals who treat beneficiaries in their homes may not have the same communication technologies that are available in practices and hospitals, and are thus unable to achieve certain thresholds.

Current requirements are set to become tougher for doctors as soon as early adopters move on to stage 2 of the program next year.

The AMA describes the exchange of electronic health data with professionals throughout the US health system as “challenging”. They Association points out that there are serious gaps – long-term care and home health professionals are not included in the meaningful use program; these HCPs (health care professionals) continue to use paper records.

As most EHR systems were originally designed as stand-alone systems, many of them are not able to communicate with others, according to an April 17th letter sent by the American Academy of Dermatology.

The AMA says that doctors have to bear the cost of building electronic interfaces to share data with other HCPs whose EHR systems are different. This is a difficult task, doctors say, because they are responsible for protecting patient information and are ultimately responsible if there were data breaches.

The AMA letter said:

“While new technology is coming out every day, the current incentive and certification programs, however, heavily favor the older technology, which further impedes EHR adoption. urge CMS/ONC to move ahead thoughtfully to maximize utility of newer, more innovative technology and minimize redesign and retrofitting of myriad middleware layers between disparate systems.”

In an April 18th letter, the American Academy of Family Physicians (AAFP) said that EHR certification requirements for stage 2 of meaningful use should improve functionally. “New standards will allow family physicians to share clinically relevant data sets.”

40% of physicians used EHRs to write clinical notes in 2012, compared to 17% in 2008

The AAFP letter stated “Achieving quality improvement across a variety of care settings is a difficult but worthwhile task. Physicians must be held accountable for care provided to their patients and thus should be expected to continuously improve the delivery of care. However, the AAFP is concerned that physicians could be held accountable for the actions or inactions of organizations and individuals beyond the physician’s scope of control or even influence.”

Republican senators, led by Sen. John Thune (R, S.D.), criticized the Obama administration’s role in overseeing the EHR program in an April 16th white paper. The program, they say, will eventually pay out an estimated $35 billion in grants and bonuses. They wrote “We have significant concerns with the implementation of the [Health Information Technology for Economic and Clinical Health] Act to date, including the lack of data to support the administration’s assertions that this taxpayer investment is being appropriately spent and actually achieving the goal of interoperable health IT.”

President Obama signed legislation authorizing the EHR program in 2009. ONC spokesman, Peter Ashkenaz claims the program has achieved notable successes and is working to improve further adption of EHRs and to encourage the sharing of data electronically.

Seventy-three percent of doctors and health professionals (388,000) of those eligible for the program have registered for incentives from Medicaid or Medicare, of whom over 230,000 have received incentive payments as of March 1st.

Ashkenaz said that the interoperability will get better when Stage 2 of meaningful use is underway. “Stage 2 will place a greater emphasis on exchanging information with other physicians and communicating with patients electronically.”

Doctors say that many electronic medical tests are going unnoticed, researchers from the Veterans Affairs Medical Center in Houston reported in JAMA (March 2013 issue).

The authors have likened electronic medical tests to emails, i.e. notification overload.

They carried out a survey of 2,590 primary care physicians (general practitioners) and found that over 30% of them admitted to missing alerts regarding test results from an electronic health record notification system – ironically, the system was set up specifically to inform them promptly of any unusual test results.

The surveyed doctors said they were receiving about 63 alerts each day. Eighty-seven percent of them said there were far too many of them. Nearly 70% said they were unable to keep up.

Written by Christian Nordqvist