On October 14, 2014, the American Medical Association (AMA) outlined its vision for the Electronic Health Record (EHR) Meaningful Use (MU) Program in a letter to the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology.  Despite the MU program’s achievements since its creation in 2009, the AMA believes “it is important and necessary to pause and fully assess what is working and what needs improvement before moving ahead to Stage 3 of the program.” 

At the outset of the letter, the AMA highlighted some of the program’s current challenges:

  • MU requirements often decrease the efficiency of patient visits
  • according to estimates by the National Center for Health Statistics, only 18 percent of physicians will be eligible for MU incentives
  • “[a]t best, the evidence to support that MU improves patient care is mixed, and there has been no comprehensive evaluation of the MU program”
  • for many physicians the cost of the MU program “far exceeds” the maximum incentives offered under MU and the cost estimated by CMS to purchase and maintain an EHR

The AMA then set out its recommendations, which include:

  • adopting a more flexible approach for meeting MU, which “would allow physicians to work toward meeting the MU requirements but not face penalties for missing a single measure”;
  • expanding hardship criteria to include, for example, an exemption for physicians from having to meet MU quality requirements if they have successfully participated in the Physician Quality Reporting System (PQRS) and an exemption for physicians who are or will be eligible for Social Security benefits by the end of 2015;
  • improving quality reporting by, for example, improving alignment between MU quality reporting and PQRS quality reporting and developing a process to eliminate quality measures in the MU program that no longer follow the latest clinical evidence; and
  • addressing physician usability challenges by, for example, removing the requirement that only licensed medical professionals and credentialed medical assistants are allowed to enter orders and adopting the Health IT Certification/Adoption Workgroup recommendation to focus the certification program exclusively on interoperability, quality measure reporting, and privacy/security