Q & A: ACR’s Peters on AMA’s EHR Call to Action

Doctors see the point of electronic health records, they just detest EHR systems as currently configured. The American Medical Association found as much last year, when its study with RAND Corp. confirmed widespread disgruntlement. Now AMA has issued a framework to fix the problems.

Released Sept. 16, the AMA framework is part of the group’s broader push to improve physicians’ job satisfaction and practice sustainability at a time when doctors are—effectively, albeit not actually—mandated by law to spend less time seeing patients and more time staring at screens. How relevant is the framework to the concerns of radiologists? Radiology Business asked Michael Peters, director of regulatory and legislative affairs for the American College of Radiology, to weigh in.

RadiologyBusiness.com: What are your impressions on how well the AMA framework reflects the interests of radiologists?

Michael Peters: AMA’s paper focuses on usability, which today is arguably the most readily apparent characteristic to end-users for distinguishing between EHR technology solutions. AMA explicitly calls out eight “usability priorities,” each of which can be broadly applied to the needs of various specialties, including radiology. 

While most of the eight points make sense, I was especially pleased to see the need for interoperability and prevention of data “lock-in” on AMA’s list. That issue continues to be a key, ACR Council-resolved policy priority for the College. For example, in 2013, ACR successfully engaged CMS and the HHS Office of Inspector General to significantly harden the interoperability regulatory requirements for hospitals and health systems who “donate” EHR technology to referring physicians in their region under the EHR exception/safe harbor from self-referral/anti-kickback rules—sometimes “trapping” referrals from the EHR donation recipients to themselves, and adversely impacting competition between imaging providers within the region. 

There is still more work to be done to discourage anti-competitive behaviors and promote data liquidity, so it is good to see AMA wave that flag publicly as well.

I should also note that ACR—and AMA too—have additional health IT policy interests beyond usability, as well as a host of additional issues of interest in the regulatory and health IT policy domain that are outside of the focus of this particular AMA paper.

RadiologyBusiness.com: What are the most recent figures on radiologists participating in Meaningful Use, and what do the numbers suggest about the specialty’s buy-in on electronic health records?

Michael Peters: CMS’ public data indicates that 4,576 diagnostic radiologists, 1,513 radiation oncologists, 210 interventional radiologists and 92 nuclear-medicine physicians successfully participated in at least one year of MU as of the end of February 2014. In a 2013 report discussing 2011-12 participation rates, the Government Accountability Office (GAO) appeared to use more than 23,000 as the denominator for the total number of program-eligible radiologists. That means almost 20% of eligible radiologists participated in MU at least once between 2011 and February 2013. I am guessing the GAO’s denominator from 2013 is probably lower than the actual total, so radiology’s real participation rate is probably a bit lower than 20%. 

Importantly, radiology’s MU uptake is not dissimilar from the other unique, non-primary care specialties. Several are above—particularly those with workflows and technology needs that are more similar to primary care—and several are below. A 2013 GAO report found that “general practice physicians” were one and a half times more likely to have participated successfully in MU than their specialist counterparts in 2011-12, despite specialists being the significantly larger piece of the pie.

More importantly, physician participation in MU across the board is much lower than the targeted 75%-by-2018 goal strongly hinted by Congress in the establishing legislation in 2009 (via the American Recovery and Reinvestment Act, aka the “economic stimulus package”).

And that’s really the ultimate point of AMA’s usability paper, ACR’s MU efforts and all of it. The concerns and input of physicians—particularly specialists—must be appropriately prioritized and implemented by government, and others, for this era of IT-informed medicine to be better for patients than it has been.

RadiologyBusiness.com: Do you see any blind spots or over-emphases, major or minor, in the AMA framework?

Michael Peters: AMA’s paper serves its purpose of bringing to light usability concerns and signaling to a wider audience that things like interoperability and exchange must be proactively facilitated by industry and government. 

Click here for AMA’s announcement of the framework and here for the group’s section on improving professional satisfaction and practice sustainability.