redesign. If not, the practice should use a consultant who can move the process along.
• Develop training sessions that are instructional and foster self-reliance. Physicians should conduct an inten- sive training session and then allow everyone to start working with the software on their own. The imple- menter should collect questions and after 10 days to two weeks, have a follow-up session with the trainer or the vendor. When the trainers leave, the staff will have to be self-reliant.
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• Create a plan for moving essential in- formation from paper records to the EHR. Initially, the practice will be living with an electronic system that combines data from electronic and paper records. Some historic infor- mation, such as medication and prob- lem lists, should be entered manually. Scanning portions of or the entire pa- per record into the computer offers an option for incorporation.
• Develop a uniform documentation format. One of the great advantages of EHRs is they can simplify docu- mentation through the use of tem- plates, which save physicians time by structuring patient encounters and reducing the need for narrative.
both to the successes and shortcomings of the meaningful use program,” Dr. Stack said.
“In the positive, meaningful use has
spurred rapid adoption of health IT. Without the incentives provided and col- laborations fostered by this program, it is unlikely our health system would be adopting these necessary tools as rapidly as it is now. There have also been unde- sired consequences. Attempting to transform the entire health system in such a rapid and pro- scriptive manner has compelled provid- ers to purchase tools not yet optimized to the enduser’s needs and that often impede, rather than enable, efficient clinical care. For these reasons, and as a general
observation, AMA is grateful Stage 3 rulemaking has been postponed to al- low health care providers and electronic health record (EHR) vendors much needed time to work together to address these shortcomings. Additionally, we be- lieve more flexibility is needed for pro- viders to meet Stage 2 meaningful use requirements to better accommodate the diversity of clinical settings and varia- tion in workflows.” Dr. Stack said AMA has these recom- mendations “to address EHR usability concerns raised by physicians and take prompt action to add usability criteria to the EHR certification process”:
“Undesired consequences”
Health information technology and health information exchange, when done well, “are essential to our ef- forts to advance the triple aim — bet- ter health, better care, and lower costs,” Steven Stack, MD, an emergency physi- cian in Lexington, Ky., and chair of the American Medical Association Board of Trustees, said during a “listening session” on May 3. The Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health Infor- mation Technology hosted the session in Washington, D.C. “That we are here today is testament
5/24/13 11:51 AM
• CMS should provide clear and direct guidance to physicians concerning the permissible use of EHR clinical documentation for the purposes of coding and billing. Given the exam- ples described above, the creation of this guidance clearly requires active dialogue with the physician commu- nity so as not to further hinder pa- tient care or further erode physician productivity.
• Stage 2 of the meaningful use pro- gram should be reconsidered to allow more flexibility to providers to meet these requirements while the EHRs are better adapted to accommodate the diversity of clinical settings
To read Dr. Stack’s full presentation, log on to the AMA website at
www.ama-
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