AMA approves HIT policies to aid improvements in care

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The American Medical Association has adopted policies and principles to support the use of information technology by physicians, including electronic health records and mobile applications.

While the nation’s largest physician group has expressed serious reservations regarding digital health technologies in the past, the AMA now appears to believe that the medical benefits of EHRs and mHealth apps outweigh the disadvantages. The organizations affirmed the use of IT at its interim meeting this week in Orlando.

When it comes to mobile healthcare, in particular, the group’s members voted to approve a “list of principles to guide coverage and payment policies supporting the use of mHealth apps and associated devices that are accurate, effective, safe and secure,” with the “potential to be integrated into everyday practice.”

Nonetheless, at the same time, the AMA noted that these apps and related devices, sensors and trackers “can vary greatly in functionality, accuracy, safety and effectiveness,” adding that some may “pose threats to the health and safety of patients” while acknowledging the need to expand the evidence base demonstrating their accuracy, effectiveness, safety and security.

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To address these shortcomings, the AMA approved the following principles to support the use of mHealth apps and associated devices, sensors, and trackers by physicians—as well as patients—that

• Support the establishment or continuation of a valid patient-physician relationship.

• Have a clinical evidence base to support their use in order to ensure mHealth app safety and effectiveness.

• Follow evidence-based practice guidelines, to the degree they are available, to ensure patient safety, quality of care and positive health outcomes.

• Support care delivery that is patient-centered, promotes care coordination and facilitates team-based communication.

• Support data portability and interoperability in order to promote care coordination through medical home and accountable care models.

• Abide by state licensure laws and state medical practice laws and requirements in the state in which the patient receives services facilitated by the app.

• Require that physicians and other health practitioners delivering services through the app be licensed in the state where the patient receives services, or be providing these services as otherwise authorized by that state’s medical board.

• Ensure that the delivery of any services via the app be consistent with state scope of practice laws.

“The new AMA principles aim to foster the integration of digital health innovations into clinical practice by promoting coverage and payment policies that are contingent upon whether mHealth apps and related devices are evidence-based, validated, interoperable and actionable,” said AMA Immediate Past President Steven Stack, MD. “It is essential for mHealth apps support care delivery that is patient-centered, promotes care coordination and facilitates team-based communication.”

In addition, the new AMA policy encourages physicians and mHealth developers to promote patient awareness of the varying levels data privacy and security afforded by these apps.

“To best secure patients’ personal health information, mHealth apps and associated devices, trackers and sensors need to abide by applicable laws addressing the privacy and security,” stated the group. “According to the new AMA policy, physicians should consult with qualified legal counsel if they are unsure of whether mHealth apps meet standards required by federal or state privacy and security laws.”

The group also acknowledged that “questions remain regarding liability risks to physicians who use, recommend or prescribe mHealth apps” and that the AMA will “assess the potential liability risks to physicians for using, recommending, or prescribing mHealth apps, including risk under federal and state medical liability, privacy, and security laws.”

During the AMA’s interim meeting this week, its members also approved new policies related to EHRs including strengthening the interoperability of medical records by ensuring that physicians who are not affiliated with hospitals or healthcare organizations are not hindered by the electronic blocking of clinical data.

“Just because physicians are not affiliated with a hospital does not mean that they should not have access to patients’ records,” said Russell Kridel, MD, a member of the AMA Board of Trustees. “Timely, safe and optimal care depends on physicians’ ability to access electronic health records. A cornerstone of interoperability is that data is accessible to physicians, regardless of their connection to a hospital or health organization.”

Further, the AMA approved a policy supporting the voluntary inclusion of a patient’s biological sex, current gender identity, sexual orientation and preferred pronoun(s) in medical documentation and related forms, including EHRs. The AMA also said it will advocate for collection of patient data that is inclusive of sexual orientation/gender identity for the purposes of research into patient health.

“The addition of this voluntary recordkeeping will benefit patients by giving their physicians more accurate personal health information. This is a step to ease the unique obstacles that keep the transgender population from receiving healthcare,” said Carl Sirio, MD, a member of the AMA Board of Trustees.

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