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AMIA on meaningful use: Invest in people and technology

AMIA, the association for professionals in biomedical and health informatics, sent comments to the federal Office of the National Coordinator on Health Information Technology (DHHS/ ONCHIT), which has actively supported and incentivized the adoption and meaningful use of electronic health records (EHRs) over the last year, and which solicited comment, through the HIT Policy Committee (HITPC), on the continuation of support for achieving meaningful use of EHRs in 2013 and 2014.

"We applaud the very rapid pace at which the HIT Policy and HIT Standards Committees have worked to advise the Department of Health and Human Services (DHHS) as it implements the electronic health record incentive program," said AMIA President & CEO Edward H. Shortliffe, MD, PhD, FACMI.

Dr. Shortliffe briefly summarized AMIA's position on EHR adoption and meaningful use. "AMIA strongly believes that three principles are essential to achieving meaningful use of certified EHR technology: 1) We must invest in people as well as technology; 2) Users need EHR systems that provide cognitive support and evidence-based functionalities; and 3) Adoption of EHR systems requires a balance of benefits and burdens that users will accept."

In a letter that accompanied AMIA's comments, Dr. Shortliffe stressed that the development of a true "meaningful use" pathway for EHRs "requires support of basic and applied informatics science to underpin and address issues of design safety, change implementation, error monitoring and reduction. A safe electronic platform that can improve healthcare delivery and quality requires investment in people across a broad range of expertise."

Further, AMIA states, "We believe that meaningful use criteria and quality measures should be carefully designed and tested to minimize the burden required to process and connect new pieces of information cognitively with the existing clinical record." AMIA members, who contributed to the organizational comments, are concerned that EHR- and EHR module-testing may fall short of ensuring that HIT systems reliably provide effective cognitive support to users in clinical settings. AMIA members would like to see systematic testing and evaluation that demonstrates achievement of meaningful use, interoperable health systems, and attainment of the desired effects on improved quality of care.

"Showing that a user can record, modify, and retrieve a single piece of information," said Dr. Shortliffe, "is very different from demonstrating that the EHR fully supports the user in applying that information in a way that meaningfully affects the delivery and quality of care."

AMIA provided a number of answers to specific questions about EHRs posed in the solicitation for comments, and stated its preference that meaningful use criteria specific to research should also be included in Stage 2, along with criteria specific to clinical care.

AMIA also recommended that the HITPC continue to consider options for Population Health / Public Health Criteria for Meaningful Use in an ongoing effort to advance quality outcomes and improvements.

"AMIA supports the ultimate goal of electronic case reporting from EHRs for public health reporting," added Dr. Shortliffe.


Contact: Nancy Light
American Medical Informatics Association

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