Testimony In Support of Proposed EHR/Meaningful Use Licensure Requirements

Before the Board of Registration in Medicine

Re: 243 CMR 2.01(4), 2.02 and 2.06

Submitted by James S. Gessner, M.D., MMS Vice President

Thank you for the opportunity to present the testimony of the Massachusetts Medical Society. As vice president, I am pleased to be here on behalf of our 24,000 members and also to speak for the over 40,000 licensed physicians in Massachusetts on an issue of critical importance. The proposed regulations are the single most discussed area of concern for our physicians that we have seen in many years. The 2012 legislation has been viewed prior to your issuance of regulations as the most direct threat to maintaining a license and the ability to treat and care for patients in Massachusetts our members have ever seen.

The MMS strongly endorses the regulations as drafted and the work the Board members and staff have done to understand the background of this legislation and to create regulations which will have a positive impact on care in the Commonwealth.

So how did we get to this point? In 2012, the Massachusetts Legislature passed Chapter 224 of 2012. One of the 308 separate sections of that 253 page law required the Board of Registration in Medicine to establish as a condition of licensure that “applicants demonstrate proficiency in the use of computerized physician order entry, e-prescribing, electronic health records and other forms of health information technology, as determined by the board. As used in this section, proficiency, at a minimum shall mean that applicants demonstrate the skills to comply with the “meaningful use” requirements, as set forth in 45 C.F.R. Part 170.” This section originated in Senate Ways and Means when a House version of a prior bill was rewritten. This language referencing meaningful use was never a stand-alone bill, never subject to a public hearing and never debated on the floor in the two days of debate in the Senate prior to adoption of the law.  

The Board has been left to interpret this statutory requirement on its own in a logical manner that is productive and serves the interests of the public. No other state has ever passed a similar law so there is no model to follow. The Massachusetts Medical Society strongly supports the proposed regulatory approach the Board has taken in compiling a thoughtful way to implement this requirement.

According to the Massachusetts eHealth Institute, only 15,000 of the over 40,000 physicians who hold a Massachusetts license and who practice in Massachusetts have or are expected to meet meaningful use federal requirements for stage one meaningful use. Most of the remaining physicians are, under law, ineligible for Meaningful Use incentives and could lose their license if this statute were interpreted to require meaningful use as a standard for licensure. Therefore the MMS supports the implementation plan the Board has taken that the requirement will be for physicians to have the skills to integrate electronic medical record systems into their clinical work in direct patient care.

The Board’s proposal to exempt approximately 4800 medical residents and interns is completely logical when one considers the experience these individuals have with electronic records. These young people clearly have the required skills, are engaged in direct patient care and are immersed in integrating their work into the patient’s clinical record.

Massachusetts has among the highest rate of computerized medical records in the country. We operate overwhelmingly in large, technologically sophisticated groups, hospitals and increasingly Accountable Care Organizations. Licensees who treat patients within such systems cannot practice through one patient encounter without demonstrating the ability to work with electronic records. Therefore, the MMS strongly supports the provision that applicants may demonstrate their skills through assertion of their employment with, credentialing by, or contractual agreements with an eligible hospital or critical access hospital with a CMS-certified Stage 1 Meaningful Use program.

Physicians who have participated in a meaningful use program as an eligible physician need do no more.

Massachusetts is a complex practice environment which meets the needs of patients in a wide variety of settings and formats. Electronic communication among various sites is critical to the future of healthcare. Therefore we support the additional category for meeting the licensure requirements of being either a participant or an authorized user in the Massachusetts Health Information Highway.

We recognize that most physicians practice in ways that integrate their clinical work into electronic records, however this integration may not meet the categories above. Therefore, we support an additional means of meeting the requirement through completion of three hours of a Category 1 EHR-related CPD course that discusses, at a minimum, the core and menu objectives and the CQMs for Stage 1 Meaningful Use.

The MMS has received many calls from physicians concerned about losing their licenses based on the 2012 statute. Since the proposed regulations have been made public we have large numbers of physicians who will comply with the requirement through participation in at least one of the proposed categories. Should any of these categories be eliminated or substantially changed, the impact would be profound on physicians, patients and the Board itself to process such denials of licensure.

The MMS strongly supports the exemptions section of the regulations. These exemptions also cover a number of the physicians who have called to express their concerns and fears on the proposed requirements.

We specifically support an exemption for those who will not be engaged in the practice of medicine. Massachusetts has many researchers and other physicians who are fully licensed productive members of society who are not involved in electronic medical records.

Administrative Licensees who are not involved in direct patient care should also be exempted.

An applicant for a Volunteer License should be exempted as they often provide direct clinical care to our most vulnerable patients with minimal support services. We do not wish to close volunteer treatment and assessment programs that help the homeless and other unfortunates through a requirement that they participate in an electronic system to which they have no access.

The MMS strongly supports physicians who serve our country and proudly supports an exemption for a license applicant on active duty as a member of the National Guard or of a uniformed service called into service during a national emergency or crisis.

Finally, the MMS supports the provision allowing renewing licensees to apply for a brief waiver to meet the conditions and suggest that applying this provision to new applicants as well would allow physicians coming in to Massachusetts who have never been exposed to these requirements have the opportunity to be licensed in MA and complete the requirements either through their employment site or other categories after arrival.

The MMS wishes to strongly commend the Board members and staff for a good job done in implementing an unclear and potentially damaging statute. The medical community overwhelmingly supports the approach taken by the Board. We urge the Board to adopt the regulations as currently drafted.

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