Physicians well know the rapid advance of information technology in medicine over the last decade. 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.
James Gessner, M.D. is the President of the Massachusetts Medical Society.
Cannot disagree with the principles, and wonder upon next steps toward execution how Dr. Gessner and the Society feel about the merits of a national patient identifier when it comes to the use of trusted data via health IT. And on the topic of health IT, the discussion needs to be broadened beyond EMRs. PHM technology is creating longitudinal charts and data aggregation across health systems for analysis, risk and reporting that impacts physician clicks and interoperability. Agree also with Dr. Gropper on the pros and cons of ONC and regulation. As we noted in our response to ONC’s RFI on MACRA interoperability, ONC needs to flex where it can:
“We would also within this realm of other data sources urge ONC to utilize your standards advisory as a measure of quality usage, by measuring the percentage of patient data exchanged that matches the standards advisory. We have long believed that ONC should take a stronger approach to compliance with the advisory to alleviate historical developer variations allowed within standard types. These variations lead to issues around interface pricing and a lack of uniformly readable data.”
We will be taking it up again at the ONC’s annual meeting next week in DC, where day three is devoted to the consumer-patient, and where the Society’s principles should air. On bullet seven of those principles, more and more CIOs and CMIOs, working with physician champions, are seeing the merits of health IT beyond the EMR, especially in an increasingly VBC payer world. MACRAopoly.
This resolution by a professional organization marks a turning point in our health reform discussion by introducing an outcome measure for health IT rather than the oppressive and wasteful process quotas of Meaningful Use. Control of the health IT standards by a small number of very large vendors and health systems has led to a clear example of regulatory capture https://en.wikipedia.org/wiki/Regulatory_capture where the ONC regulators cannot act beyond the limits set by the standards makers.
This MMS resolution bypasses the standards of how things are done and gets directly to tracking the outcome.
One example of an outcome measure is Independent Decision Support at the Point of Care for Patients and Physicians https://thehealthcareblog.com/blog/2016/05/13/independent-decision-support-at-the-point-of-care-for-both-patients-and-physicians/ This outcome measure directly addresses 6 of the 7 points in the resolution. (It’s hard to claim that it will impact disparities directly.) This outcome measure can be applied to any health care provider’s EHR system to yield a Yes or No. The result will be a vibrant market incentive in support of practice innovation as both patients and physicians gain direct access to _independent_ decision support during their encounter. By enabling this decision support at the point of care, we also support the physician’s role for safety and patient education.
Is there a better and clearer outcome measure we might apply to an EHR?
As an individual who has been involve in HIT for 3 decades, both as the creator of a (formerly) Certified EHR, a blogger on HIT, a member of the MMS’s Committee on Information Technology and a private practice clinician, I believe that adherence to these principles, by all players in the healthcare system, has the potential to improve the quality of healthcare of our patients, improve the efficiency of the healthcare system while simultaneously promoting innovation in the healthcare realm.
I would like to encourage individual physicians to ask their professional organizations, hospitals and medical communities to publicly adopt these Principles as part of the process of vetting potential HIT tools.
I would also like to encourage those who are in a position of responsibility within EHR companies, integrated healthcare systems, large hospitals, academicians and policy makers to publicly endorse these Principles as a means toward improving the utility of our HIT tools and thereby improving our healthcare system.
What a nice fantasy. If only it were possible …
It would be a very good step if more and more clinics starting implementing these tools and principles like http://theprecisionproducts.com/
I think the patient negotiating with the doctor should have a voice in how her data is collected and stored. It is her data created in collaboration with the physician and other providers. There must be such a thing as a vault where certain data can be secured from the world, such as the fact that a women had an abortion unknown to her spouse. No imagination needed here to go on…