Physicians, we hear you: EHR meaningful use isn't meaningful

Steven J. Stack, MD
Immediate Past President
American Medical Association
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The message from physicians is loud and clear: Electronic health record (EHR) systems have so much potential, but frustrating government regulations have made them almost unusable.

Atlanta-area physicians told me this firsthand Monday in the AMA’s first-ever town hall meeting on EHRs and the meaningful use program. Rep. Tom Price, MD, from Georgia’s sixth district, joined me to listen to physicians’ everyday challenges with EHRs and burdensome government regulations that detract from patient care. About 500 other people registered to watch the event via live-streaming.

As an emergency physician, I experience my own struggles with my hospital’s EHR system. But I wanted to hear from physicians in all specialties in a live venue that would enable policymakers to hear their concerns firsthand and unfiltered. Not surprisingly, it turns out that we’re all struggling.

For example, Melissa Rhodes, MD, a Georgia physician in pulmonary critical care and sleep medicine, is fed up. She was an early adopter of the technology, implementing her first EHR in 2006, more than three years before the meaningful use program was created in legislation. She wanted the system to live up to its promise—but that didn’t happen.

“I don’t think we’re going to do meaningful use Stage 2,” she said at the town hall. “And we’ll take the penalty.”

Dr. Rhodes tallied up how much her three-physician practice has spent on her EHR and related IT costs—over the past year, that number hit $84,000.

But more important than the costs, Dr. Rhodes’ EHR has limitations that affect her patients. The system won’t allow her to titrate orders for patients in the intensive care unit. And she has to personally enter orders, no matter what time of day or night, without being permitted to benefit from the help of nursing colleagues at the hospital.

“There are so many orders you can’t put in,” she said. “It only leads to harm for patient care, and more medical errors—not less.”

Dr. Rhodes’ story sounds like so many others we heard at the town hall: Physicians are trying to use EHRs to improve patient care, investing a lot of time and money into making them work, but they are being thwarted.

The goal of the meaningful use program was to encourage physician adoption of EHRs. This has been accomplished. Today, more than 80 percent of physicians have implemented some form of EHR system. But we’re not getting what we expected from this technology.

As physicians, we had hoped that these tools would help facilitate patient engagement, reduce administrative burdens and promote the exchange of data. Those three things have definitely not happened. Instead, we’re dealing with systems that won’t talk to one another, cost too much to maintain and require us to spend an inordinate amount of time entering data instead of helping patients.

The consensus Monday night was that EHRs do not give accurate information in usable forms. Without this, they cannot and will not improve the quality of care.

A top priority for the AMA, just as it is for Dr. Rhodes, is ensuring that our patients’ clinical needs and those of the clinicians providing their care are given greater importance than meeting federal regulations. Based on our study with the RAND Corporation, we know EHRs are a major driver of physicians’ dissatisfaction with their practice environments. As a result, we worked with doctors and other experts to create eight priorities for making EHRs usable. These priorities continue to serve as a guide for our activities with vendors, policymakers and health care systems.

That’s why I need you to share your story with us. Please help us take this viral with a groundswell of physician input to inform D.C. policymakers. Please tell us your EHR experiences and stories—how EHRs and current meaningful use regulations have impacted your practice and the care you provide your patients. Then, email your members of Congress and ask them to halt Stage 3 of meaningful use until the program is fixed.

We need policymakers to hear our stories and take action, which is why I’m so pleased Rep. Price was able to listen firsthand. Despite plans to realign several government reporting programs, including meaningful use, the government seems poised to do so without addressing these issues first. We need regulators to hit pause, fix the problems and make the meaningful use program actually meaningful.

Please visit to watch the town hall meeting, share your stories about EHRs and meaningful use, and contact your members of Congress. Help us get the government to listen.

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I have always said that Physicians (included) are Idiot Savants. We may be excellent at medicine but we are absolute idiots at government, insurance and legal issues. ANYONE who would think that the Government is making you do something that is good for you is without question an Idiot Savant. EHR just like HIPAA were constructed by the government for a very specific purpose and if you do not understand that purpose you qualify for Idiot Savant+++++.
The AMA is doing a nice job of documenting what we already know – about how bad the current EHR situation is for doctors. It is time for efforts that go beyond that, i.e., look for solutions, other than begging for MU 3 delay and hoping vendors will somehow make a product that meets our needs.<br/> <br/> Foe instance, how about a publicly available health information technology (EHR) system at no or nominal charge, that is governed by a consortium "comprised of individuals with technical, clinical, and legal expertise [in] open source health information technology," to which any user, or even patient, could make and share improvements with the consortium for distribution to all when appropriate? Such an environment would have stimulated needed innovation. <br/> <br/> Such a provision was proposed in 2008 (HR6898), but due to EHR industry lobbying, was sidelined and replaced by HITECH, which gave us "meaningful use," which was not really meaningful use in the plain meaning of the term, but a whole host of government-imposed data gathering requirements, most of which are not relevant to care of the patient, at the expense of physicians and others who use the EHR. What, if any, input was there by the AMA at the time?<br/> <br/> In 2009, the AMA adopted policy (H-478.992) that might have revived the plan proposed in 2008, but it did nothing, and in 2013 rescinded the policy, stating incorrectly that it had been accomplished.<br/> <br/> The AMA ought to be holding town hall meetings to solicit solutions, and not just complaints. As Einstein noted, "We cannot solve our problems with the same thinking that created them."
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