AMA issues policy recommendations for telemedicine and EHRs

Outside a select number of health IT physician experts who have advised government bodies and companies developing telemedicine and electronic health record (EHR) products, most physicians have been in a reactionary mode as health IT has advanced. At the 2014 American Medical Association (AMA) Annual Meeting, the members approved two sets of recommendations that seek to take back some of the health IT leadership role they ceded in the years watching from the sidelines.

The new policies adopted included calls for changes to health IT to accommodate physicians and patients’ needs and a set of guiding principles that aim to ensure appropriate coverage of and payment for telemedicine services.

According to AMA president-elect, Steven Stack, M.D., a special AMA advisory committee will work for the next six to 12 months with software vendors on how EHR vendors can be more responsive to the concerns the AMA has about the poor usability of most systems from a physician’s perspective, including the problem of a lack of interoperability. They also plan to issue a set of top recommendations and predictions for future issues.

“They foisted this massive [EHR meaningful use] program on all of health care … and [the technology] wasn’t ready,” Dr. Stack said in an AMA article. “It still isn’t ready. And it’s going to take longer to fix it than it did to create it.”

For EHRs, the AMA is planning on becoming even more vocal in working with the government on its EHR policies. It also is recommending:

• Seeking a government requirement that all pharmacies—including those run by the government—should accept ePrescriptions.
• Addressing “data lock-in,” in which information stored in one EHR system cannot be easily transferred to another system.
• Promoting improvements in EHR usability for physicians.

For telemedicine, the AMA is generally supporting the same concepts as the voluntary telemedicine policy guidelines from the Federation of State Medical Boards (FSMB). It updated its guidelines in April to attempt to tighten up distinctions between what types of electronic communication would and would not rise to the definition of true telemedicine.

"Whether a patient is seeing his or her physician in person or via telemedicine, the same standards of care must be maintained,” the AMA’s press release stated.

However, some telemedicine developers expressed concern in the wake of the FSMB policy update that attempting to make telemedicine mirror traditional office-based physician-patient encounters could stifle innovation in new ways to deliver care. For example, the FSMB policy emphasizes video, in part because face-to-face communication is considered a key part of office visits. But researchers have not yet shown that physicians and patients being able to see each other makes a substantial difference in care quality or outcomes when compared to phone, text or email communication, and it could be that timeliness and ease in getting prompt medical advice are more important factors.