The latest challenge: adopting electronic medical records

A message to all physicians from AMA President Cecil B. Wilson, MD.

By Cecil B. Wilson, MDis an internist in private practice in Winter Park, Fla. He served as chair of the AMA Board of Trustees during 2006-07 and was AMA president during 2010-11. Posted April 4, 2011.

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For those of you who do not know me personally, I am an internist and have been in private practice in central Florida for more than 30 years. Like so many of you, I have had to make changes -- expensive changes -- over the years to keep my office up to date, my practice competitive, and to provide better service to my patients.

Right now, one of the biggest challenges small offices like mine are facing is the requirement to adopt health information technology -- health IT -- such as electronic medical records and electronic prescribing systems. Both are good ideas. Both ultimately will improve efficiency and should allow physicians to do more of what we are trained to do, and that is spend time with our patients.

Many physicians, however, are seeing a very rough passage between the here and now and full adoption of electronic medical records.

As a voice for America's physicians, the AMA is involved both in Washington and on the ground to ease the transition.

In December, the AMA was one of several dozen professional associations that co-signed a letter to Health and Human Services Secretary Kathleen Sebelius about the inconsistencies in requirements between the federal e-prescribing and EMR incentive programs. We petitioned for relief until those inconsistencies are rectified. The most troubling thing about the inconsistencies is a policy in the electronic prescribing program that will penalize physicians in 2012 if they do not e-prescribe in the first six months of 2011.

The AMA believes the penalty policy is unreasonable in that it will force physicians to purchase stand-alone e-prescribing software just to avoid penalties -- software most of them will end up discarding when they transition to a complete EMR system.

Under law, physicians cannot receive incentives from both programs simultaneously, yet they will face a penalty if they decide to participate in one over the other.

A subsequent report by the Government Accountability Office echoed the AMA's concerns about inconsistencies within the two federal health IT incentive programs.

As AMA Secretary Steven J. Stack, MD, has stated, "We continue to urge immediate action by CMS to harmonize the conflicting e-prescribing and [electronic health record] incentive programs in order to support effective health IT adoption."

Since the inception of requirements for the federal EMR incentive program, the AMA has strongly advocated for greater flexibility in adopting the meaningful use requirements for EMRs so more physicians can successfully participate.

We submitted comments to HHS during the creation of the first stage of meaningful use criteria and more recently responded to the proposed stage 2 criteria to help ensure physicians are not overly burdened with requirements that would prevent them from successful participation in the incentive program.

A survey by the Markle Foundation in February showed that nearly half of physicians indicate they are "not too" or "not at all" familiar with meaningful use requirements.

Not surprisingly, a recent Black Book Rankings user survey found that fewer than 10% of EMR purchasers are on track to meet meaningful use requirements.

More than 90% said they lack substantive support from EMR vendors, and 89% have delayed implementation because of the cost of additional support from EMR vendors and/or consultants. Significant numbers of others said they lacked trained staff (or available staff) to properly implement an EMR system or are unprepared and underfunded to rectify the difficult system interfaces.

It's a difficult situation all the way around for many physicians, made worse by the feeling by many practices that they must move quickly to adopt a complete health IT solution.

Make no mistake: The AMA is committed to widespread health IT adoption that can help streamline the clinical and business functions of a practice, but this takes time. We are working hard to help physicians understand the requirements of the federal incentive programs and how they can qualify for them. Even more important, we want to advise physicians to take the time to find the right solution for their practice.

While federal incentives for demonstrated meaningful use of electronic medical records begin this year, physicians don't have to rush into adopting a system today. If a practice reports on just the last 90 days of the year, that will qualify for meaningful use incentives, and practices even can wait to adopt a solution until 2012 and be eligible for full payment under the meaningful use program. Physicians should take the time to explore their practice needs, assess their practice's readiness to adopt health IT and select the right system for the practice -- and its patients.

Recognize that there are alternatives to implementing more complex systems, such as adopting a certified patient registry and certified e-prescribing application that also can qualify a doctor for stage 1 of meaningful use incentives and may be sufficient alone, or in conjunction with other modules, to qualify for subsequent stages as well. Such an approach can cost less, be easier to implement and be far less disruptive to work flow. But no matter the decision, it should be made with care and deliberation. In the Black Book Rankings survey, 82% of those who adopted health IT programs reported that a hurried selection of an EMR vendor produced negative consequences.

Dr. Thomas Fuller, a 17th-century British physician, noted, "All things are difficult before they are easy." That is certainly the case with EMRs.

In addition to advocating on behalf of physicians in Washington, the AMA is on the ground with support for physicians' offices that are moving forward in adopting health IT.

To this end, the AMA has many free resources available to help physicians with successful selection, purchase and implementation of health IT. We have information and tools to help physicians better understand the federal incentive program requirements and a wealth of additional health IT resources. You will find it all online (link).

Today and always, the AMA is committed to supporting the physician community as we try to find a way through these murky waters.

Cecil B. Wilson, MD is an internist in private practice in Winter Park, Fla. He served as chair of the AMA Board of Trustees during 2006-07 and was AMA president during 2010-11.

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