AMA's town hall calls for MU pause, interoperability fix

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The American Medical Association (AMA) held another town hall meeting to discuss the challenges of the Meaningful Use (MU) program as part of its Break the Red Tape campaign.

The event gave numerous clinicians the opportunity to share their experiences—good and bad—with health IT.

MU has been successful by measure of adoption, said AMA President Steven Stack, MD. But, “less successful in spurring the innovation and the efficiency we want it and need it to have.” Health IT should help physicians be more efficient, help patients get better coordinated care rather than more fragmented, eliminate data silos and establish one large ecosystem all for the betterment of patient care. “We’re not there yet.”

MU is preventing some organizations from working on the development of “tools that are really responsive and innovative for physicians and patient needs,” said Jesse M. Ehrenfeld, MD, MPH, associate professor of anesthesiology, surgery, biomedical informatics, and health policy at Vanderbilt University School of Medicine and member of the AMA Board of Trustees. Such tools, he said, are helpful in his work every day but they had to stop development to comply with the regulations of Stages 1 and 2. Vanderbilt had a well thought out six-month plan for the electronic prescribing of controlled substances. That program would have been more useful to the institution, he said, asking the audience whether anyone else had work stalled because of the requirements of MU.

Among the comments made during the meeting were a request from a medical student for an appropriate traning environment and a call for quality measurements to be specialty specific and relevant to patient outcomes.

One pediatrician noted the positive benefits of her practice’s EHR: she can create school and camp reports in one click, track immunizations well and electronic prescribing is excellent.

E-patient Dave deBronkart said the question is “for whose benefit does the data exist? When I advocate for open data sharing and patient inspection of the data, I hear about many cases where care was impeded by an inability to pass data to the next provider.” Patient ownership of the data will benefit clinicians and interoperability, he said.

One family practitioner said it costs $103,000 a year just to run the EMR. “That’s not the cost of the EMR or the computers; it’s just the annual cost of the IT infrastructure and does not include the original purchase.” She also noted that three doctors have left her practice in the past year specifically because of MU. “They need to know this. They’re chasing out the doctors who are the bread and butter. We’re the ones who keep costs down by keeping people out of the ER.”

MU regulations are “disincentivizing the things they want us to achieve,” said Stack. “We must fix interoperability. We must make these technologies communicate with each other in an efficient, effective way that allows clinicians to have access to data without having to learn all sorts of bizarre technology to make it happen.”

The AMA is not calling for an end to MU, Stack said. “We are saying take the time to learn from the stage we are currently doing and then do Stage 3 right. Stage 3 is currently more of the same and we’ve heard a lot of compelling reasons why that is problematic.”