Some improvements in the "meaningful use" final rule sought by the AMA were accepted, but the Association says many practices still face barriers to adoption.

By Chris Silva, amednews staff. Posted Aug. 2, 2010.

Washington -- While the final rule determining what constitutes "meaningful use" of electronic medical records provides some needed leeway for physicians, barriers to EMR adoption and implementation remain for doctors, according to the American Medical Association.

The AMA said in a July 21 statement that it had helped effect some positive changes in the final rule, including a reduction in the total number of measures, from 25 to 20, that physicians have to meet in order to qualify for Medicare and Medicaid EMR bonuses in the first two years.

The minimum thresholds for meeting several measures also were reduced. For example, the requirement that a doctor use an EMR for computerized physician order entry of medication orders decreased. Instead of mandating that more than 80% of patients have at least one drug ordered through CPOE, the threshold will be more than 30% of patients. Thresholds also were reduced for transmitting electronic prescriptions and implementing clinical decision support tools.

EMR bonus program poses tight deadline for physicians

But the AMA says physicians still face several challenges in becoming compliant in time. There is no EMR system on the market now that offers the capabilities needed for physicians to become meaningful users. Federal officials expect such systems to become available this fall, which would give practices only a few months to install and test the technology before the Jan. 1, 2011, start date of the incentive program. Physicians who already have invested in EMRs now must upgrade their systems to meet certification criteria.

In addition, the total number of measures that physicians have to meet is still too high, the AMA says. The final rule divides the initial 25 meaningful use objectives into two categories: a core group of 15 objectives and a "menu set" of 10 objectives, from which they can choose any five to defer in 2011-12.

Also, some of the thresholds for meeting the objectives remain high, the AMA says. For example, one measure requires physicians to maintain an up-to-date problem list of current and active diagnoses for more than 80% of patients. In addition, there is no mechanism for physicians to appeal any decision made during the incentive program.

"The final requirements for the meaningful use of EHRs are an improvement over previous drafts, but challenges still remain that will make it difficult for physicians to meet the requirements -- especially physicians in solo and small practices," said AMA Board of Trustees member and Secretary Steven J. Stack, MD.

During a July 20 hearing, members of the House Ways and Means health subcommittee probed the administration's progress so far in shaping an EMR incentive program that is user-friendly for physicians and hospitals, yet that also yields a maximum benefit for taxpayers and patients.

Some lawmakers expressed concern that the administration may have gone too far in watering down the requirements in its final rule. But officials said the changes to the final rule were necessary to ensure that doctors and hospitals do not become overwhelmed.

"We wanted to make it possible for a small rural practice to become a meaningful user just as much as a large urban practice," said David Blumenthal, MD, the national health information technology coordinator. "It is not fair to hold accountable individual physicians who desperately want to become meaningful users."

Eugene Heslin, MD, a family physician in Saugerties, N.Y., testified that EMRs can be an effective and vital tool for small practices, despite some of the barriers they may face during adoption.

Dr. Heslin explained how paperless records may have saved the life of one of his elderly patients. The patient showed up at an emergency department with shortness of breath and had given paramedics a list of medications that Dr. Heslin determined from his home computer were incorrect -- it was actually a list for the patient's wife. If the patient's EMR had not been available to him at home, the outcome may have been a lot different, he said.

"Is meeting the criteria going to be easy for physicians and hospitals? Absolutely not," said Dr. Heslin, who is head physician at Bridge Street Medical Group, a six-physician practice. "But they will help me persuade my colleagues that there is critical mass, it is doable at the community level, and that they need to move now along the same pathway to benefit patients and their community."

The print version of this content appeared in the Aug. 9 issue of American Medical News.

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