In a detailed letter sent to both CMS Administrator Marilyn B. Tavenner and National Coordinator Karen B. DeSalvo, MD, the American Medical Association has put forth a long list of ideas to make meaningful use work better for physicians.

[See also: EHRA has complaints about 2015 criteria]

While EHRs and other health IT have "the potential to help improve patient quality of care and drive practice efficiencies," writes AMA Executive Vice President and CEO James Madara, MD, "(u)nfortunately, the existing MU program and many of the EHRs certified for use in meeting the program’s requirements stand in the way of these goals."

AMA makes the case that overly rigid requirements and financial penalties will only dissuade docs who are otherwise open to IT adoption. "Unless significant changes are made to both the current program and future stages," Madara argues, it's probable that:

• Physicians will drop out of the meaningful use program;
• Patients will suffer as existing EHRs fail to migrate data for coordinated care;
• Thousands of docs will incur financial penalties that hinder future IT purchases;
• New delivery models, which require data-driven approaches, will be jeopardized.

To prevent these from happening, AMA is asking CMS and ONC to make changes to meaningful use and its EHR certification program.

As physicians struggle with Stages 1 and 2, AMA suggests that 1) MU’s all-or-nothing approach be replaced with a 75 percent pass rate and that, 2) docs who meet at least half of the MU requirements be protected from financial penalty.

[See also: ONC proposes 2015 certification criteria]

When it comes to Stage 3, a 75 percent pass rate should also be acceptable, since "adding flexibility, both to the threshold required to earn the MU incentives and to avoid the penalties, is the single most pressing change needed to ensure physicians can successfully participate in the MU program," Madara writes.

"Expecting every physician to meet the same set of requirements despite varying specialties and patient populations is an ill-defined approach that is not working," he argues. "The existing requirements are too primary care-centric, yet even some primary care physicians are still struggling with the program.

"An analysis of CMS’ own data, which does not include the entire year of 2013, shows a 20 percent drop-out rate in the MU program," he adds. "We expect this to grow substantially unless the all-or-nothing approach is removed."

Likewise, the bar to avoiding a financial penalty should be lowered to 50 percent for Stage 3, according to AMA, which also suggests:

• Eliminating the division between "menu" and "core" requirements;
• Streamlining and refocus the number of requirements;
• Removing any mandates that are outside the control of physicians;
• Better aligning quality reporting programs;
• Making MU mandates evidence-based;
• Tying those mandates to "tested and high-performing standards" and implementation guides;
• Considering the costs of implementation, which can "run into tens of thousands of dollars."

AMA makes the case that many of the problems it lays out out "are rooted in certification requirements that include rigid and overly complex" mandates for EHR functionality.

"We are deeply concerned with the volume and prescriptiveness of these requirements and believe they are hindering many vendors from being able to deliver high- performing systems," writes Madara. "EHRs and other health technologies can promote a future healthcare system that ensures data migration, interoperability, and a more coordinated care system."

Toward that end, AMA suggests a rethink of the certification process with much more of an emphasis on interoperability, data synthesis, emerging technologies and testing.

"The course that is charted now for EHRs will have a significant impact on the future state of technology and the adoption of new care delivery and payment models," writes Madara. "We therefore encourage ONC and CMS to consider these changes and work with physicians to improve EHRs and other technologies."