Published 8/1/2010
Howard Mevis

AAOS Board approves new EMR position statement

By Howard Mevis

“Access to and correct usage of patient Electronic Health Records (EHRs)/Electronic Medical Records (EMRs) provide major benefits to patients and physicians alike. When properly designed and utilized, EHRs can improve patient safety, increase clinical efficiency, reduce costs, allow seamless transfer of vital patient information, and allow physicians to better use their time and expertise treating patients.”

So begins the newly adopted AAOS Position Statement on Electronic Health Records. An educational tool, the statement was developed by the members of the EMR Project Team, led by Thomas C. Barber, MD.

The AAOS position statement supports the implementation and use of EMRs by orthopaedic surgeons, noting the potential for improving the quality of patient care, patient safety, and outcomes measurements. It also states, however, that “Health Information Technology (HIT) should…not detract time and attention from the care of patients.”

According to Dr. Barber, “The Project Team has been actively engaged in advocating Congress and the Centers for Medicare & Medicaid Services (CMS) for changes in policy and regulations regarding the purchase and implementation of EHR technology and the establishment of meaningful use criteria. Orthopaedic surgeons will have great difficulty in meeting the current 25 meaningful use standards. Orthopaedics would derive greater benefits from standards promulgated by our medical specialty society rather than a set of generic requirements that mostly do not apply to musculoskeletal patient care.”

Noting the importance and value of sharing patient health information among EMR programs, the AAOS position statement strongly supports the development of interoperability standards for all commercially available systems.

“We have to be able to share data seamlessly with other physicians and our hospitals,” said Dr. Barber. “With interoperability, we can eliminate duplication of tests and reduce the cost of providing care.”

The push to adoption
In 2011, CMS will begin to make incentive payments to physicians who adopt and use EHR systems. Grants totaling up to $44,000 will be made over 5 years to any physician who meets the established criteria. Beginning in 2015, however, CMS plans to impose penalties on Medicare physician participants who have not adopted EHR for their practices.

The position statement outlines the following standards as “essential for the successful development of meaningful use standards and EHR systems certification.”

  • The collective wisdom of physicians actively caring for patients should be used to establish EHR standards.
  • EHR implementation should be phased in over several years and supported by sufficient incentives rather than required on a single, hard deadline with non-adoption penalties.
  • A comprehensive set of certification standards, including data and interoperability standards, should be established for all EHR systems.
  • Implementation thresholds should be established, because establishing an all-or-nothing requirement will serve to discourage adoption of EHR.
  • The different needs and uses of EHR by disparate medical specialties should be recognized. In particular, the differences between surgical specialties and primary care specialties should be acknowledged.
  • Meaningful use criteria must be HIPAA-compliant and protect patients’ privacy; safe harbors should be established so that physicians and other healthcare professionals are not subject to penalties for unintended HIPAA violations.
  • Because many aspects of EHRs—such as interactions with government, private payors, labs, patients, pharmacies, and other physicians—are still in development, criteria requiring interoperability for the sharing of data may not be attainable for reasons beyond the control of physicians.
  • Small private practitioners and practitioners in rural areas may face substantial cost burdens in adopting EHR, which should be recognized.

The AAOS endorses efforts to encourage the adoption of EHRs by physicians and patients, but also believes that unless the standards are appropriate and realistic, CMS will end up imposing an untenable and counterproductive burden on physicians that may disrupt the patient-physician relationship and access to care. The statement calls for involvement by physicians from many specialties and clinical practices in the discussions and deliberations.

The statement also calls on vendors to “consider the specific practice workflows and needs of orthopaedic surgeons in developing, implementing, and maintaining EHR systems.”

Opportunities and challenges
According to project team member Richard M. Dell, MD, who also served on the faculty of the recent course on EMR and Other Technologies: Revolutionary Change in Orthopaedic Practice, EMR creates opportunities for outcomes management.

“Orthopaedic surgeons finally have a tremendous opportunity to actually measure patient outcomes resulting from their efforts in clinics and operating rooms,” he said. “Medicine is the last major industry to take advantage of digital technology in performance and outcomes measurement.”

“Successful implementation of EMRs will change the way we practice, the way we engage our patients, and how we manage a typical day of practice,” agreed faculty member Jonathan L. Schaffer, MD, who also served on the project team.

“The position statement notes that systems need to support practice workflow,” he said. “Most clinicians, however, have not documented or evaluated their workflows. The EMR provides a platform for the systematic approach to clinical workflow and a thorough, efficient way to manage quality patient care and document outcomes.”

In conclusion, the statement encourages physicians to “weigh the benefits versus the risks and costs and to take into account the fact that in the near future, payors will likely make EHR a requirement for network participation. The AAOS recommends the adoption of well-designed EHRs; physicians should take the time to find the system most appropriate in terms of functionality and cost for their practices. The AAOS also recommends that payors and government agencies recognize variations in system capabilities in setting standards, incentives, and penalties.

Read the entire AAOS Position Statement on the Electronic Health Records.

Howard Mevis is director of the AAOS electronic media, evaluation programs, course operations, and practice management group. He can be reached at mevis@aaos.org