MOS testifies: licensure should never be tied to use of EHR or MU

Testimony Submitted To the Board of Registration in Medicine In Support of Proposed Changes to 243 CMR 2.01(4), 2.02 and 2.06

October 3, 2014

Submitted by William M. Foley, DO on behalf of the Massachusetts Osteopathic Society (MOS)

As president of the Massachusetts Osteopathic Society, I have been asked by our board to write this public comment.  The MOS wishes to go on record in supporting these changes.  The MOS understands the background of this legislation and will support all proposals that have a positive impact on care in the Commonwealth.

The MOS believes that licensure should never be tied to use of electronic health records (EHR) or “meaningful use”. There is little to no evidence showing that using an EHR improves patient care or clinical outcomes.  As physicians, we should be given the right to choose what is best for our patients based on the best evidence currently available and strongly support evidence based medicine.  Legislative mandates have increased for medical licensure with little debate or consideration of the evidence or cost benefit analysis.

We are wary that electronic health records can be detrimental in patient care. Evidence and anecdotes are starting to accumulate that many electronic medical records systems are not performing as anticipated and that the impact of the use of computers during and following primary care visits may have unintended consequences on the physician patient relationship and clinical outcomes.

Last year, a Task Force from the American Medical Informatics Association was formed “In response to mounting evidence that use of electronic medical record systems may cause unintended consequences and even patient harm.”

Even timelier, the first case of Ebola in the United States was mishandled in a Dallas hospital that mistakenly sent home a man who had Ebola.  As reported by NBC news the hospital says flawed software and not human error caused doctors to miss the diagnosis.

Here is a quote from the article (http://www.nbcnews.com/storyline/ebola-virus-outbreak/texas-hospital-makes-changes-after-ebola-patient-turned-away-n217296)

“Health officials and local residents have been asking how the hospital could have missed what would have appeared to be an obvious potential case of Ebola: a Liberian citizen who said he recently traveled from Liberia, with fever and abdominal pain.  “Protocols were followed by both the physician and the nurses,” the hospital said in a statement issued Thursday night.

The nurse who took Thomas Eric Duncan’s medical history did the job correctly, they said.

“However, we have identified a flaw in the way the physician and nursing portions of our electronic health records (EHR) interacted in this specific case,” it added.”

The Institute of Medicine in its report from Nov. 2011, Health IT and Patient Safety: Building Safer Systems for Better Care states that poorly designed health IT “can create hazards in the already complex delivery of care.” (Institute of Medicine (IOM). Health IT and Patient Safety: Building Safer Systems for Safer Care. Washington, DC: The National Academies Press, 2012.)

In a 2011 Pediatrics article, “Legal, Ethical, and Financial Dilemmas in Electronic Health Record Adoption and Use”, the authors call for a national forum for key stakeholders to identify and find solutions for legal, ethical and financial dilemmas inherent in EHR. (Sittig DF, Singh H. Legal, ethical, and financial dilemmas in electronic health record adoption and use. Pediatrics 2011;127:e1042–7.)

The evidence in these articles alone show that EHR has many downsides.  The MOS agrees that there are upsides too.  We feel that individual physicians and physician groups should be allowed to make their own decision on what is best for their practice when it comes to EHR use.  We ask the Board to support us, help us to care for our patients efficiently and effectively, and implement regulations that will foster physician-patient relationships.

Thank you for your time and support.

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