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AMA wants limits on insurers' use of EMR, claims data
■ Delegates said payers now have too much power over the process of evaluating physician quality and efficiency.
By Kevin B. O’Reilly — Posted Dec. 4, 2006
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Las Vegas -- The AMA House of Delegates adopted principles it said should govern the collection, use and warehousing of electronic medical records and claims data to protect physicians from economic profiling, and patients from privacy violations.
With insurers increasingly using claims data to evaluate physician quality and efficiency as part of pay-for-performance programs, doctors have become concerned because payers "control the entire process," according to the American Medical Association Council on Medical Service report the house adopted at its November Interim Meeting.
Principles the AMA says payers, vendors and other entities should follow include:
- Gathering only the minimum necessary electronic medical records and claims data to accomplish the intended purpose.
- Complying with the Health Information Portability and Accountability Act.
- Informing physicians on a case-by-case basis of any analysis undertaken, the criteria for the analysis, what data is being studied and how the results will be used.
- Reimbursing physicians for any additional compliance burden.
- Allowing doctors to appeal any adverse decisions based on data analysis.
- Limiting clinical data searchability to access only for payment and health care operations.
- Transferring electronic medical records and claims data upon request to another vendor and deleting the data once transfer is complete.
The AMA also will monitor the economic implications of resale of aggregate data and make available model contract language on its Web site to help physicians stake an ownership right to their claims data.
