Incoming AMA President Robert Wah Defends EHRs

Kenneth J. Terry, MA

Disclosures

June 05, 2014

In This Article

Too Many Demands and Requirements

In general, he said, too many requirements and functions have been piled onto the EHR, which was not designed for some of these purposes. "The reason why most physicians started their records was to keep a record of what they saw and did and to be able to communicate that to other physicians. But now healthcare has put all these other demands on that same record: It's supposed to code, it's supposed to be a basis for reimbursement, it's supposed to be used for reporting quality. And what started out being very straightforward has become very complicated."

Making matters worse, he noted, CMS has created overlapping health IT programs with different timetables for incentives and penalties, including the e-prescribing program, the Meaningful Use program, and the Physician Quality Reporting System (PQRS).

"It's been challenging for physicians to figure out each of those different programs and their incentives and penalties," said Dr. Wah. "Ideally, you'd want physicians to be able to report a bolus of information, and then CMS could take that information and use it in whatever program it was needed for. In other words, report once and use many times."

CMS has moved in that direction by aligning the quality reporting requirements for Meaningful Use with those of PQRS.[2] But the AMA noted in a recent letter to the agency that much more needs to be done to alleviate the reporting burden on doctors.[3] Dr. Wah said he supported a proposal to fold Meaningful Use, PQRS, and the value-based modifier program into a single "merit-based incentive payment system." That proposal was part of the SGR replacement bill that Congress failed to pass earlier this year.[4]

EHR Usability Needs to Be Improved

The user interface is the biggest reason for physicians' unhappiness with EHRs, so that's where vendors should focus their improvement efforts, Dr. Wah said.

"There's a lot of work that needs to be done on the interface and the greater issue of [data] visibility. That gets into things like integration with workflow and making sure that the EHR helps physicians take better care of patients and doesn't provide another burden and another obstacle to patient care.

"Physicians will always embrace a technology that makes their work more effective and more efficient," he added. "They will always push back on any technology that gets in the way of providing better care for the patient."

Dr. Wah views the use of scribes[5] with EHRs as an "interim solution" to the human-machine interface problem. "The connection of man and machine can be an interface on the machine or can be a human go-between like a scribe. I'd hope that we'd come to a point where the human element of that interface -- in other words, the scribe -- would become less and less necessary."

Natural language processing, an analytic approach that extracts medical terms from dictation and places them in the correct EHR fields, could eventually improve the interface between computers and clinicians, Dr. Wah said. But he noted that although natural language processing has been "hoped for for quite some time, it hasn't arrived yet."

Whatever technological fix is ultimately devised, he pointed out, it's vitally important to get data into structured fields so it can be used for quality improvement. "We'll unlock a lot of power from digital systems when we have more machine-readable information," he said.

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