The federal government is looking for ways to speed the uptake of electronic health record (EHR) technology among family physicians and other health care professionals and is asking for input from stakeholders, such as the AAFP, on ways CMS and the Office of the National Coordinator for Health Information Technology (ONC) could adjust existing policies and programs to accelerate electronic health information exchange (HIE).
AAFP Board Chair Glen Stream, M.D., M.B.I., of Spokane, Wash., responded to a list of questions posed by HHS in an April 18 letter(6 page PDF) to ONC National Coordinator Farzad Mostashari, M.D.
Stream prefaced his comments by pointing out that the AAFP is a strong supporter of both EHRs and HIE, but in response to a question about how changes in payment policy could affect the electronic sharing of information, he pointed out that any changes initiated by CMS "inevitably will require that ambulatory practices make significant investments of financial, intellectual and human capital."
Stream urged CMS to consider payment adjustments that would provide "substantial incentives in a multi-plan approach" to drive practice-level change. A multi-plan method -- as opposed to a plan involving only Medicare and Medicaid -- would affect more patients in a practice.
- CMS recently asked stakeholders, including the AAFP, for input on adjustments it could make to federal policy that would accelerate both the update of electronic health records (EHRs) and the electronic exchange of health information.
- AAFP Board Chair Glen Stream answered a variety of questions pertaining to issues such as payment policy, quality improvement and patient engagement.
- Stream pointed out that family physicians have been on the cutting edge of advancing EHR technology for many years.
Regarding the design and effectiveness of particular programs, Stream said that programs that have focused on structure, such as those requiring certification, accreditation or recognition, have not done much to move the needle on data-sharing.
In addition, he noted that incentive program payments for stage two of EHR meaningful use -- scheduled for rollout in 2014 -- would be significantly less than payments made to physicians in stage one. "The AAFP strongly urges ONC and CMS to ensure that the cost for technical compliance with meaningful use does not become progressively larger as the incentives become progressively smaller," said Stream.
He also addressed the challenges of achieving quality improvement across a variety of health care settings. Although the AAFP strongly supports continuous improvement in the provision of quality care, the Academy "is concerned that physicians could be held accountable for the actions or inactions of organizations and individuals beyond the physician's scope of control or even influence," said Stream.
Pressing the point of quality care, CMS asked stakeholders how requirements promoting quality that involve the exchange of health information could be phased in gradually. Stream responded, "Though HIE is an essential technology and technique that must be incentivized to improve quality and cost issues, CMS also must promote desired outcomes by allowing clinicians to adopt whatever tools they deem necessary to fulfill triple-aim expectations."
The AAFP defined the so-called triple aim as improving the patient experience and the health of populations while reducing the per capita cost of health care.
CMS also asked how it could use its EHR incentive program to advance the creation of "provider directories" that could, in turn, support the exchange of information between participating health care professionals. Stream noted that data-sharing between physicians should not be limited to those who have attested to meaningful use. And, he added that Medicare and Medicaid participation -- rather than meaningful use participation -- would offer a better inclusion criterion for provider directories.
Stream noted that the AAFP supports the development and use of a "single, identity-verified directory address or credential that could be used by federal, local and private programs to support provider directories and the secure and consented exchange of health information."
When CMS asked how it could best test, evaluate and scale innovative payment and service delivery models to accelerate the electronic exchange of health information among physicians, Stream's response reflected the can-do spirit of family physicians who simply want the best for their patients and their specialty.
"Family physicians have been key participants in EHR adoption and meaningful use in the United States for decades," said Stream. "A specialty-wide commitment to the patient-centered medical home positions family physicians to lead by example through data-sharing initiatives that directly improve clinical care."
CMS also was interested in the AAFP's recommendations regarding the maximization of patients' access to their health information and engagement in their own health care. Stream urged ONC and CMS to look at policy options that would provide a "standardized, practice-managed portal solution for patients and their families."