meaningful use

The President’s Podium: A Renewed Effort on HIT

Posted in Electronic health records, Electronic Medical Records, Health IT, meaningful use on May 20th, 2016 by MMS Communications – 1 Comment

by James S. Gessner, M.D., President, Massachusetts Medical Society

Physicians well know the rapid advance of information technology in medicine over the last Gessner Cropdecade.  Pushed by federal and state regulations and requirements, the adoption of electronic medical records has been swift. Today, some 90 percent of physicians in Massachusetts use some form of electronic medical records.

While health information technology (HIT) arrived with great promise and adoption has been quick, widespread acceptance has lagged, and EHRs remain a major concern among physicians of all specialties. Among the most contentious issues: interoperability, clinical workflow efficiency, and the myriad demands of reporting patient data as required by Meaningful Use and the Physician Quality Reporting System, among others.

Some physicians have embraced HIT; they see it as a way to reduce medical errors, streamline workloads, and offer a path to improved outcomes.  Others view it as an impediment to the physician-patient relationship, a huge expense, a tool that consumes too much time, and a source of immense frustration.  Some have even stopped practicing medicine because they found the rules and regulations and operations too onerous.

Health information technology has been a major focus of the Massachusetts Medical Society since the establishment of the MMS Committee on Information Technology (CIT) some 20 years ago. The Committee’s Guide to Health Information Technology has provided useful information and direction for physicians as we struggle through the obstacle courses of HIT and EHRs.

The last year has seen a renewed effort by physicians nationally and locally, to share our concerns about the impact of HIT on physician practices and how we deliver patient care.

In September, MMS hosted an AMA Break the Red Tape Town Hall, to voice concerns about Meaningful Use.  More than 100 physicians attended, and the collective message was clear: EHRs are cumbersome, time-consuming, and hurting productivity.

MMS officials have also met with CMS Acting Administrator Andrew Slavitt on multiple occasions, including a visit last fall, at our suggestion, to Massachusetts and the office of a local family physician.  The visit provided Mr. Slavitt with a first-hand, real-world look at the issues affecting physicians as they work with electronic health records and wrestle with interoperability.  The encounter influenced his thinking about Meaningful Use; Mr. Slavitt has made it clear that EHRs should be patient-centered, physician-focused, and simple.

Our most recent effort was the adoption of a new set of principles governing health information technology.  Proposed by the CIT, the principles were adopted unanimously by the House of Delegates at our May annual meeting.

The essence of the new policy is contained in seven statements. It states that information technology available to physicians should accomplish the following:

  • support the physician’s obligation to put the interests of the patient first;
  • support the patient’s autonomy by providing access to that individual’s data;
  • be safe, effective, and efficient;
  • have no institutional or administrative barriers between physicians and their patients’ health data;
  • promote the elimination of health care disparities;
  • support the integrity and autonomy of physicians; and
  • give physicians direct control over choice and management of the information technology used in their practices.

MMS members may read the complete report of the CIT on these new principles here.

Guided by these principles, MMS will continue to work on health information technology issues and how these tools can improve the practice of medicine – and that means first and foremost a focus on patient care.  HIT does indeed hold promise, but its priority should not be on data collection, but on how it can raise the level of patient care – a goal shared by each of us as physicians.

The President’s Podium appears periodically on the MMS Blog, offering commentary on a range of issues in health and medicine.

 

 

 

Physicians Speak Out: Stop Meaningful Use Stage 3

Posted in Electronic Medical Records, meaningful use on October 1st, 2015 by Erica Noonan – 1 Comment

By Erica Noonan, Vital Signs Editor

WALTHAM — Physicians are typically first in line when it comes to technology that can help them treat patients.

As early adopters of electronic health records and enthusiastic supporters of the earliest stages of Meaningful Use, typical physicians are eager to try new things and work with new tools.

“Doctors are digital omnivores,” AMA President Steve Stack, MD, an emergency department physician. “We adopt technology at a blistering pace when we work, and when it helps us take care of patients.”

That is why the physician-led movement to delay the implementation of Meaningful Use Stage 3 is so relevant, he said.  With only 12% percent of eligible physicians and 38% of eligible hospitals nationwide able to meet the requirements of MU Stage 2, the move to the next stage is untenable and the pressures are driving physicians out of practice.

More than 100 physicians attended the AMA’s Break the Red Tape town hall meeting Sept. 29, hosted by MMS Vice President Henry Dorkin, MD, at MMS Headquarters in Waltham, to describe how misguided federal regulations had profoundly impacted their practices.

Most had stories of lost productivity, useful patient health initiatives put aside for lack of time and resources, and tens of thousands of dollars spent per practice annually on information technology fees in attempts to meet Meaningful Use requirements. Many questioned why physicians are held responsible and penalized when software programs from outside vendors fail to work properly.

“We treat the patient and save the lives. We shouldn’t have to write the software code for the EHR and be told we are a failure because the EHRs can’t talk to each other. The penalty programs are on us, not the vendors,” said Dr. Stack.

Matthew Gold, MD, a Massachusetts neurologist asked: “In what other system are the end users penalized? Quality measures need to be specialty specific and relate to patient care. Too much time is taken for things that are irrelevant and take away from patient care.”

Several participants mentioned colleagues who have stopped practicing medicine because of Meaningful Use rules, leaving thousands of Massachusetts patients — many senior or disabled in western Massachusetts — struggling to find a primary care provider.

Past MMS President Ronald Dunlap, MD, estimated imposed meaningful use requirements had slowed his staff  down by 30 percent. “Our productivity has been hammered by this,” he said.

MMS Secretary-Treasurer Alain Chaoui, MD, a family physician, described himself as an “early and enthusiastic” EHR adopter. “I thought Meaningful Use was in best interest of patients in 2011 and I did everything I could to comply with Meaningful Use stages 1 and 2,” said Dr. Chaoui.  “Even with my best intentions to take care of my patients, the pressures have landed only the medical profession. I don’t see pressures on the vendors to make them compliant and interoperable.”

Lloyd Fisher, MD, a pediatrician and director of infomatics for Reliant Medical Group, said Meaningful Use Stage 2 failed to take into account practice demographics, penalizing physicians with large numbers of Medicare and Medicaid patients. “We don’t need a disincentive to treat the neediest patients. They need to change the rules,” he said.

The AMA’s campaign pushes for delay for Stage 3 rules until at least 2017, and major improvements in EHR interoperability. “This is the wrong time for Meaningful Use Stage 3,” said Dr. Stack.  “We need to take time to learn from the stages we already have and do Stage 3 right.”

Interoperability is New Focus for Health IT

Posted in Electronic health records, Electronic Medical Records, meaningful use on February 13th, 2015 by Erica Noonan – Comments Off on Interoperability is New Focus for Health IT

By Leon Barzin

MMS Director of Health Information Technologykeyboard 1

Barriers to interoperability continue to be main challenges to moving the nation’s health care system beyond simply making electronic silos of information from paper ones, according to experts at the recent annual meeting of the eHealth Initiative.

The recent Meaningful Use Program started with three goals for the identified stages: Stage 1: data capture and sharing; Stage 2: advance clinical processes; and Stage 3: improve outcomes.

Stage 1 of Meaningful Use, as painful as it has been to some independent practices, is generally considered quite successful in fostering electronic data capture.  It has moved the use of electronic medical records from single digits in the pre-Meaningful Use period to an estimated 70 percent nationwide today.

Unfortunately, it appears that both Stages 1 and 2 have largely failed in the primary objective of “sharing,” moving health data security to the right place at the right time – especially among dissimilar systems.

In January 2015, the U.S. Department of Health and Human Services released the document, A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure.

If improved interoperability can be achieved via this federal roadmap, such a system would support more efficient and effective healthcare and lead to a continuously improving health system that empowers individuals, customizes treatment, and accelerates cure of disease.

On the heels of the release of the government’s document, the eHealth Initiative held its yearly meeting last week, bringing together physicians, administrators and other national experts to focus on how this plan could be implemented in real clinical environments.

Several consensus items among attendees were clear:

  • EHR vendors and providers can no longer ignore interoperability.
  • New secure interoperability software is on the near horizon and mobile devices will be the focus.
  • Patients will soon be included as active partners in their healthcare and possess some or all of their records on their smartphones.
  • Wearable sensor devices like Fitbit will become more clinically connected and able to provide useful clinical information.
  • Early pilots in telemedicine are moving toward standard operation, especially chronic disease management, benefiting from advances in sharing technology.

Although there seems to be little impetus for additional “checkbox” Meaningful Use requirements, it appears efforts will shift throughout the industry, within provider communities, and at CMS to push forward with interoperability improvements.

The President’s Podium: Common Sense on EHRs

Posted in Board of Medicine, Electronic health records, Electronic Medical Records, Health IT, meaningful use on September 26th, 2014 by MMS Communications – 1 Comment

By Richard Pieters, M.D., President, Massachusetts Medical Society

In its landmark 2001 report,  Crossing the Quality Chasm: A New Health System for the 21st Century, the Institute of Medicine recognized the “enormous potential” of technology to improve health care.  Indeed, of all the changes sweeping throughout healthcare in recent years, perhaps the most revolutionary has been health information technology (HIT).

One area of explosive growth within HIT has been electronic health records (EHRs). The U.S. Department of Health and Human Services noted in May of 2013 that the use of EHRs by doctors and hospitals more than doubled from the previous year, with Massachusetts one of the heaviest adopters.  Statistics from the Office of the National Coordinator for Health IT show that 71 percent of physicians and 80 percent of hospitals in the Commonwealth have adopted EHRs.

Yet, 14 years after the IOM’s report, after billions of dollars spent in federal incentives, and despite skyrocketing adoption, physician acceptance of EHRs appears at best, a mixed bag, at worst, a struggle. Recent efforts are instructive.

In its 2014 Survey of America’s Physicians released this month, The Physicians Foundation found that nearly half of respondents (45.8%) felt that EHRs “detracted from efficiency” and slightly more (47.1%) thought it “detracted from patient interaction.”  More than half (50.5%) believe EHRs “pose a risk to patient privacy.”

Separately, on September 16, the American Medical Association called for an overhaul of EHR systems. “Today’s current EHR products,” said AMA President-Elect Steven J. Sack, M.D., “are immature, costly, and are not well designed to improve clinical care…. The usability of EHRs is a significant driver of physician professional dissatisfaction and a challenge to practice sustainability.” AMA then outlined eight priorities for improving EHR usability to benefit caregivers and patients.

Frustration and dissatisfaction with electronic health records among physicians had surfaced well before the AMA pronouncement, and complaints about EHRs have been increasing as well. The inability of different systems to communicate easily with one another – the “interoperability” issue – remains a drawback.  Perhaps most unsettling, however, is the reality that hazards and risks remain, as the promise of widespread and reproducible gains in patient safety has yet to be fulfilled.

Here in Massachusetts, electronic health records have captured physicians’ attention for quite another reason.  Chapter 224, a law passed in August 2012 that outlined phase two of health care reform for the Commonwealth, included a provision that required physicians to demonstrate “meaningful use” proficiency (which only applies to Medicare and Medicaid) with EHRs as a condition of licensure.  That mandate is to become effective on January 1 of next year.  Without proper interpretation, the law as written could have had severe unintended consequences by disenfranchising over half of the state’s licensed physicians.

Now here’s the good news: The Board of Registration in Medicine has proposed regulations that include a broad set of exemptions for certain license categories.  The Board’s proposal also establishes multiple ways in which physicians could comply with the requirement.

The Board has posted its draft regulations and is accepting comments on them through Friday, October 3 at 5 p.m. MMS offered testimony in strong support of the proposals at the public hearing on Monday, September 29, and I encourage members to add their comments as well. Comments may be submitted via email to Eileen.Prebensen@state.ma.us All comments become public records and will be posted to the state’s website.

MMS has advocated on this issue since the law was passed two years ago, raising the specter of severe disruptions in physician practice and patient access to care.  We are now near a resolution that is advantageous to both physicians and patients.

The Board’s proposal, which addresses all of our major concerns, represents a reasonable, prudent approach to complying with the law, easing physician concerns, and maintaining access to care for patients.

While physician frustration with EHRs is high, it is important to distinguish between problems of technology and problems of policy.  Technological issues are likely to be worked out over time, if only by continued physician persistence and outcry for solutions, as demonstrated by the AMA.

Policy issues, as shown by the Board of Registration in Medicine’s common sense approach to fulfilling the requirements of Chapter 224, are more readily capable of resolution.

MMS, like the IOM, believes that electronic health records do indeed have “enormous potential” for patient care. Our extensive policy on EHRs declares support for them and a desire to work toward improving them, to capture “an opportunity for dramatic benefits to patients in clinical care, research, and the delivery of health care.”

Reaching that potential, however, will require the strong voice of physicians. Whether the issue is one of technology or policy, our local experience has shown how important it is that physicians participate in the conversation.  I urge you once again to review the draft regulations and send in your comments.

The President’s Podium appears periodically on the MMS Blog, offering Dr. Pieters’ commentary on a range of issues in health and medicine. 

Recapping a Busy Year: MMS Health Care Advocacy in 2014

Posted in Annual Meeting 2014, Electronic health records, Health Reform, meaningful use, Medical Marijuana, Medicare, Payment Reform on May 15th, 2014 by MMS – Comments Off on Recapping a Busy Year: MMS Health Care Advocacy in 2014

Ronald W. Dunlap, MD, president of the Massachusetts Medical Society, kicked off the Society’s 2014 Annual Meeting with a review of five significant advocacy issues from the 2013-14 year:

  • Medicare payment
  • ICD-10 deadlines
  • Regulatory overreach
  • State regulations on EHRs
  • Medical Marijuana

 

Data Tracking and Analytics: No Longer Avoidable in Physician Practices

Posted in Accountable Care Organizations, Electronic health records, Health IT, meaningful use on March 29th, 2012 by MMS – Comments Off on Data Tracking and Analytics: No Longer Avoidable in Physician Practices

In an age where the federal government has settled on a total of 33 quality metrics in its final rule for accountable care organizations, figuring out how to track data and meet quality and performance benchmarks is becoming a critical part of a physician’s role in providing quality care to patients.

More practices in Massachusetts are focusing on data and analytics, because where risk-based contracts and accountable care delivery models are becoming increasingly prevalent. Understanding practice level and physician level data is a key to success, starting at the point of payer contract negotiation.

Many practices are challenged by where to start, which is not surprising given the alphabet soup that exists in terms of recognized metrics, HEDIS, NQF, NCQA, PQRI, PCPI to name only a few.

The good news is that while many are just beginning on this path, several practices have been operating in the data and analytics space for many years, and they are happy to share their lessons learned as well as the upside and downside of their experiences.

One such practice, South East Texas Medical Associates (SETMA), under the leadership of Dr. Larry Holly,  has worked to hone its data analytic capabilities to successfully manage their patient population, and has demonstrated success in improving metrics in areas such as diabetes management.

Of course, this is the result of years of evolution and a level of comfort with the metrics that are being tracked. That being said, SETMA has demonstrated success in working with the plans in risk based contracts as a result of their efforts.

Again, it took years for SETMA to perfect its strategy. One should not fear data tracking and analysis but embrace the initiative by starting with a few metrics that are important to the practice.  There is plenty of opportunity to tweak, improve and revise your processes over time.

As experienced practices such as SETMA will tell you, it’s about starting somewhere and perfecting your process over time.  On that note, why not start now?

If you’d like to learn more about how to approach data and how organizations like SETMA were able to successfully use data, join us at MMS on March 30th for the program titled “The Importance of Data in Physician Practice”.  Visit http://www.massmed.org/DataAnalytics2012
— Kerry Ann Hayon

State Steps Up EHR Support Services for Physicians

Posted in Electronic health records, Electronic Medical Records, Health IT, meaningful use on September 9th, 2010 by MMS – Comments Off on State Steps Up EHR Support Services for Physicians

The state agency charged with helping physicians and hospitals implement electronic health records has released its list of 18 certified “implementation organizations” to act as consultants to practices during the implementation process.

They range from hospitals and health care systems, to private consulting firms, to even a few EHR vendors themselves.

The state also unveiled a list of 10 certified vendors of EHR software, and said that it’s made arrangements through Webster Bank to provide loans to physicians to help them purchase and install the software.

In addition, Dr. JudyAnn Bigby (pictured), secretary of the state Executive Office of Health and Human Services, issued an open letter today to all physicians inviting them to take advantage of the state’s support services. (.pdf)

She wrote, “As a physician, I understand that making the transition to electronic health records is challenging, but the Patrick Administration and the team of professionals at the Regional Extension Center will help you every step of the way.”

She invited physicians to become members of the state’s Regional Extension Center, which will provide direct support services to practices worth $4,500, upon payment of a registration fee up $600 to $800. The application form is available here. (.pdf)

General information about EHRs from the Massachusetts eHealth Institute is available to anyone, regardless of whether they’ve joined the Regional Extension Center.

MMS on Meaningful Use Criteria: “Too Much, Too Soon”

Posted in Health IT, meaningful use, Medicare on March 15th, 2010 by MMS – Comments Off on MMS on Meaningful Use Criteria: “Too Much, Too Soon”

119779298_9325985cc0_oThe MMS told the Centers for Medicare and Medicaid Services today that its proposed rules for a national electronic health record incentive program are too aggressive, and would deter  many physicians from participating in the program.

The MMS said the program “asks for too much, too soon” from many physicians, especially those in small practices. Read the MMS letter here. (.pdf, 6 pages)

The comments were a response to the federal government’s proposed  definition of “meaningful use,” the criteria that would determine whether physicians can recoup more than $40,000 of Medicare or Medicaid subsidies per person for installing an EHR. Today was the deadline to submit comments on the widely anticipated rulemaking.

Among the proposal’s shortcomings, according to the MMS:

  • Not enough representation from small practices on its advisory committee
  • Pediatricians are disadvantaged because few would meet the minimum 20% Medicaid patient panel to qualify
  • Specialists are disadvantaged because the criteria are focused on primary care physicians
  • The high administrative burden on small practices, who must redesign their workflow to implement an EHR
  • Hospital based physicians who also practice in outpatient clinics are unfairly excluded from the program

The MMS recommendations include:

  • Lengthen the schedule for adoption and compliance
  • Reduce the number of required criteria
  • Provide partial reimbursement for partial completion of the criteria
  • Create a separate track for those who do not yet have full health IT capabilities

The American Medical Association’s comments today were similar. In a document co-signed by 94 state and specialty medical societies (including the MMS), the AMA said it worries that physicians who install an EHR will find the requirements “overly complex and unattainable.”

The American Hospital Association called for a “rational timeline,” and criticized the lack of clarity in several sections of the proposed rules.

Feds Release Draft EHR Rules – Critics Attack

Posted in Electronic health records, Electronic Medical Records, meaningful use on January 4th, 2010 by MMS – 2 Comments

The federal government last week finally unveiled its proposed definition for the “meaningful use” of electronic health records. Almost immediately, there were critics.

Physicians and hospital systems have been waiting for these definitions for many months. Last winter, as part of the sweeping federal stimulus bill, Congress set aside $20 billion to subsidize physicians, hospitals and others who install electronic health records and demonstrate their “meaningful use.” For physicians, that subsidy could be more than $44,000 per person over a four-year period.

So the definitions released on Dec. 30 had been eager anticipated. But almost immediately after they were released, several key stakeholders protested.

The American Hospital Association said the eligibility requirements for physicians and hospitals are too restrictive, and would penalize many hospitals that have already implemented clinical IT systems.

The Medical Group Management Association said the proposal is “overly complex,” and would discourage EHR adoption.

The American Medical Association hasn’t announced its position yet, but in initial comments it echoed earlier worries  that the time frames for implementation might be too strict.

A privacy advocacy group, Patient Privacy Rights, attacked the rules on the grounds that they don’t give patients control over their personal health information.

The 692-page proposal unveiled last week came in two parts:

The rules are the first of three phases. Phase 1 takes effect in 2011. Phases 2 and 3 – not released last week – take effect in 2013 and 2015 respectively.

David Blumenthal, MD, who leads the federal government’s health IT strategy in Washington, warned that the next two phases will introduce even more stringent criteria, because that’s what Congress wanted.

The rules issued last week are not final. A 60-day comment period begins when the rules are officially published in mid January.

Blumenthal, writing in the New England Journal of Medicine, said the insights from physicians, hospitals and others “can improve this rule.”

Like the AMA, the MMS is studying the proposals and will send in our suggestions to improve the rules’ ability to promote the adoption of electronic health records.