'Leadership Gap' Threatens MU Momentum, Says AMA

Reacting to the departure of two more ONC leaders, the head of the AMA calls for more flexibility with meaningful use certification requirements "so that vendors have more freedom to innovate and tailor their products to meet physicians' needs."

UPDATE: On Tuesday the Department of Health and Human Services clarified that Karen DeSalvo, MD, was not leaving the Office of the National Coordinator, but was stepping aside temporarily to help coordinate the federal government’s Ebola response. In response to the clarification, AMA President-elect Steven J. Stack, MD issued this statement: "The American Medical Association is pleased to learn that Karen DeSalvo will remain involved in the Office of the National Coordinator for Health Information Technology. We look forward to continuing to work with her to fix the Meaningful Use program and achieve an interoperable technology infrastructure."

The second leadership shuffle in less than one year at the Office of the National Coordinator for Health Information Technology could "jeopardize the growing momentum around [Meaningful Use] interoperability," the American Medical Association said.

AMA President Robert M. Wah, MD, in remarks released by his office Monday, said the announced departures last week of ONC Director Karen DeSalvo, MD, and Deputy Director Jacob Reider, MD, "leaves a significant leadership gap" at the office charged with overseeing and coordinating the nation's adaptation of interoperable electronic health records.

DeSalvo was named national coordinator for HIT in December 2013, replacing Farzad Mostashari, MD. Last week, DeSalvo stepped down temporarily from the job to become the Acting Assistant Secretary for Health at the U.S. Department of Health and Human Services, where she will concentrate primarily on the Ebola response.

Providers Ask HHS to Address EHR Interoperability Barriers

Reider said he was leaving ONC to practice medicine closer to his family in Albany, NY. Lisa A. Lewis has been named acting national coordinator.

Wah renewed the AMA's call for ONC to be more flexible with MU certification requirements "so that vendors have more freedom to innovate and tailor their products to meet physicians' needs."

"Interoperability and data portability are critical components for transforming clinical practice and improving health outcomes," Wah said. "Unfortunately, physicians have been facing challenges with several poor performing EHRs that are not interoperable. Without widespread interoperability, the value proposition of EHRs has not been realized and the adoption of new innovative models of care has been hindered."

Earlier this month AMA released a blueprint to improve MU Stages 1 and 2 and provide suggestions for Stage 3, as well as a framework outlining eight priorities for more usable EHRs.

Interoperability Needs More Than Fired-Up Buyers

The AMA, the American Academy of Family Physicians, and several other professional organizations and health systems earlier this month asked HHS Secretary Sylvia M. Burwell to address systemic snags and glitches around the interoperability of electronic health records that they say are frustrating providers and doing little if anything to improve patient care or reduce costs.

"Currently, health information stored in most EHRs/EMRs and other HIT systems and devices do not facilitate data exchange but 'lock-in' important patient data and other information that is needed to improve care," the letter says.

Citing data from the Office of the National Coordinator for HIT, the letter notes that only 14% of physicians can electronically transmit health information outside of their organizations. The main barriers to data exchange continue to be "strict MU requirements and deadlines that do not provide sufficient time to focus on achieving interoperability."

The eight co-signers recommend a handful of changes that they say could improve the meaningful use process, including:

• Streamline and focus meaningful use certification requirements on interoperability, quality measure reporting, and privacy/security.
• Remove certification mandates and instead allow for a flexible and scalable standard based on open system architectural features such as application program interfaces. This will allow data to move more freely across the healthcare system, reducing data lock-in and promoting more usable systems.
• Foster stakeholder collaboration to promote new HIT that is focused on clinical care needs.
• Remove restrictive MU policies that stifle HIT innovation.
• Allow vendors and providers adequate time to develop, implement, and use newly deployed technology and systems before continuing on with subsequent stages of the MU program. Testing and achievement of specific performance benchmarks should occur before providers are held accountable for any new MU requirements.

The ONC's push for MU has been riddled with delays and criticism from providers and vendors.