• Put the Baseball Bat Down: What the AAFP is Doing to Address EHR Issues

    There are few terms in the English language that solicit vitriol among physicians quite like “electronic health record.” Listening to physicians discuss their EHRs conjures up visions of the infamous scene in Office Space where a printer meets its doom at the hands of three employees who have endured its incompetence. Although it may not be practical for a physician to take a Louisville Slugger to his or her EHR, it does not stop them from fantasizing about it.

    How we got to this point is complicated. I am old enough to remember the massive file cabinets in a physician's office containing thousands of paper medical records. I also am old enough to remember writing paper checks to pay my bills. These two industries -- medicine and banking -- have had completely different levels of success with implementing information technology and data sharing during the past 20 years. The banking industry moved to accelerate the use of information technology and data sharing technologies, rendering paper checks (and many a bank teller) obsolete. Transactions can be made electronically in real time. As a result, many of us have not written a check in years.  

    In comparison, the health care industry was caught flat-footed and resisted the technology wave of the 1990s and early 2000s until practices and health care systems were forced by law and regulation to change. Many practices still use paper-based charts or non-interoperable electronic health records that are, in reality, an electronic equivalent of paper charts.

    Recognizing the emerging role of information technology in health care and the potential benefits to patient care, the AAFP established the Center for Health Information Technology (CHIT) in 2003. CHIT was a commitment by the AAFP and family medicine to the transformation of our health care system to one that was better aligned to deliver high quality and continuous care. CHIT provided a platform to achieve true care coordination and population health management in the average family physician office and not just in the large integrated systems. The Academy was easily the first physician organization to establish a team of individuals charged with EHR policy and advocacy, and our leadership role continues to this day.

    In 2004, President George W. Bush created the Office of the National Coordinator of Health Information Technology and called for the “widespread adoption of electronic health records in 10 years.” Despite investing more than $100 million in federal funds in demonstration projects, little progress was made. In 2009, Congress intervened and forced health care into the technology era when it enacted the Health Information Technology for Economic and Clinical Health (HITECH) Act. This six-year, three-phase program set aside $19 billion in federal money to facilitate the adoption and implementation of EHR systems in hospitals and physician offices by 2017 through the so-called meaningful use program.  

    To date, federal and state governments collectively have paid more than $24 billion in incentive payments to hospitals, physicians and other health care providers.  

    We are now at the 10-year mark established by President Bush, so what is the current state of play? Sadly, the state of EHRs and HIT in general is, well, not positive. Some would call it an epic failure (pun intended). How we move forward is critical to the success of our health care system, the quality of care delivered to patients, and the AAFP remains at the forefront of these efforts.  

    Today, more than 68 percent of family physicians use an EHR -- a participation percentage that dwarfs other physician specialties. However, as previously stated, most physicians have a hate-hate relationship with their EHR and view the systems as a burden on their practice of medicine. The AAFP, like most of you, is concerned about the lack of intuition and interoperability in the current EHR systems. We also are concerned that EHRs have become a financial drain on practices, the root-cause of frustration for physicians, and a contributor to decreasing productivity in practices of all sizes. We are especially frustrated that EHR vendors, insurers and governments have not addressed these concerns in a meaningful way, so we are ramping up our advocacy efforts to create change.

    The following is a few of the many resources and advocacy activities the AAFP has pursued to assist our members:

    • We have a webpage devoted to assisting you in the evaluation, purchase, and implementation of an EHR system. We have partnered with other medical societies to create additional resources through www.americanehr.com.
    • We have re-constituted the CHIT into the Alliance for eHealth Innovation. The Alliance will continue its work to influence EHR and HIT policies, and it will also work more aggressively with vendors to create EHR systems that are congruent with a physicians’ workflow and practice processes.
    • We are investing staff resources into workflow and EHR design to better align technology solutions with a physician's practice. This is a priority for the AAFP, and you will be hearing more on our efforts in this area over the next few months.
    • We have written numerous letters to CMS calling for improvements to the meaningful use program to ensure that family physicians can qualify and thus avoid the penalties associated with non-compliance.
    • We have called for a delay in the implementation date of meaningful use stage three until 2017.
    • In April, the AAFP wrote a letter to the Federal Trade Commission on a number of issues impacting the health care marketplace, one of which is our growing concern with the anticompetitive behavior of health information technology vendors that reduce access to patient health information and create silos in care delivery.

      We recognize that many of you continue to struggle with your EHR systems. And although the kind of retaliation so artfully visualized in Office Space is fun to think about, we urge you to be patient and work with us to improve our nation’s information technology system. Health care must follow the banking industry and the rest of our economy into the technology era. It won't be easy, but we continue to believe that an interoperable health information system will be beneficial for patient care, population health, and, ultimately, physician productivity.


    Stephanie Quinn, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.  Read author bio »


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