Curtailing EHR developers’ information-blocking actions, eliminating barriers to value-based care opportunities, and improving access to—and the use of—medical records provided by patients and physicians could help unlock opportunities for better chronic-disease management and population health efforts.
“Today’s health data systems often force patients to choose between care and privacy,” the AMA wrote in a letter (PDF) to Centers for Medicare & Medicaid Services (CMS) Administrator Mehmet C. Oz, MD.
“Patients should be able to share the information they want safely, securely and on their own terms,” says the AMA’s letter. “Ensuring that individuals’ data-sharing preferences are met is a critical component of advancing safe, effective, and patient-centered value-based care and chronic-disease management.”
The letter was in response to a request for information issued by CMS and the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC). The request was specifically soliciting input on “the market of digital health products for Medicare beneficiaries as well as the state of data interoperability and broader health technology infrastructure.”
One specific question raised by CMS asked how the agency could encourage patients and caregivers to submit complaints about information blocking.
“The AMA applauds CMS’ goal of empowering patients to flag true information-blocking incidents, but success hinges on making the process intuitive and accurately aimed at the real culprits—technology developers that hide behind ‘technical limitations’ and exorbitant fees,” the letter says.
To help achieve this goal, the AMA recommends:
- Embedding a one-click “Report a Sharing Problem” button in every certified patient portal and Blue Button–enabled app that route complaints first to the patient’s physician to help clarify the request and forward—with relevant files—to ASTP/ONC’s information blocking claim portal with the developer clearly identified.
- Requiring developers to post plain-language, in-portal notices explaining patients’ access rights and step-by-step instructions for filing a complaint with the developer.
- Partnering with national and local patient-advocacy groups to launch a public-awareness campaign using clear, nonlegal language and real-world examples.
“Done this way, higher-quality complaints will spotlight systemic developer barriers, guiding ASTP/ONC enforcement and hastening interoperability,” the AMA said.
If the CMS acts to boost reporting without these guardrails, the letter warned that the portal will be “flooded with misdirected grievances” that waste oversight resources.
From augmented intelligence (AI) implementation to EHR adoption and usability, the AMA is fighting to make technology work for physicians, ensuring that it is an asset to doctors—not a burden.
Improving patient access to records
The AMA’s letter describes how patients want secure access to their complete longitudinal medical record, but they often hit roadblocks caused by fragmented technology and inconsistent EHR-developer practices that make it “nearly impossible to assemble or trust a single source of truth” about their health.
These roadblocks include:
- Separate logins for every portal.
- Office notes released only as low-quality, portable document formats (PDFs).
- Imaging locked on compact disk read-only memory (CD-ROM) files.
- Inconsistent, non-standardized use of established terminology.
The letter noted that the AMA welcomes CMS examination of consumer-facing digital assistants and other care-navigation apps.
“When designed well, AI-enabled tools can reduce administrative friction for both patients and physicians,” says the letter, which was written and sent in June under the tenure of previous AMA Executive Vice President and CEO James L. Madara, MD. New AMA CEO John J. Whyte, MD, MPH, took over the role July 1.
Fighting for Physicians
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The AMA said that CMS must include safeguards that address patients’ top concerns: Data breaches, billing errors from faulty insurance data, lack of AI transparency, data misuse and AI interfering with the patient-physician relationship.
These concerns must also be addressed while simultaneously preserving the innovation needed to deliver truly helpful digital health assistants, the letter says.
Accessible digital health tools require reliable connectivity, clear instructions and device features that synchronize seamlessly with clinical workflows.
To meet these requirements, the AMA says CMS must:
- Close the access gap. Many beneficiaries still lack affordable broadband; CMS should expand subsidy and infrastructure programs so medical grade devices can transmit data without interruption.
- Focus on clinically actionable devices. CMS should prioritize coverage for tools that capture medical metrics and can drive real care decisions. In other words, cover BP cuffs before step counters.
- Keep the user experience simple. Devices should offer Bluetooth or cellular auto-upload, require minimal setup, and feed data directly into the EHR. Websites and portals must use large fonts, high contrast, and straightforward “share with my doctor” buttons to support seniors and novice users.
Automated prior auth for all
CMS should also seize the opportunity to remove prior authorization workflow burdens and response delays.
The lack of uniformity among health plan prior-authorization processes contributes to poor transparency, practice hassles, physician burnout, and lapses in patient care.
CMS should standardize the services subject to prior authorization and the associated clinical criteria to facilitate implementation of an end-to-end electronic process, the AMA letter says.
The letter notes that CMS “has taken important steps toward such automation for Part D and Medicare Advantage plans,” and the AMA is advocating for electronic prior authorization standardization across all plans.
The AMA urges the Health and Human Services Department to “go a step further and require transparency and standardization around what services require prior authorization, the criteria used, and the data elements required by payers,” the letter says. “Doing so would go a long way in simplifying and streamlining the process for physicians.”
The AMA is fighting to fix prior authorization by challenging insurance companies to eliminate care delays, patient harms and practice hassles.
