AMA wants limits on insurers’ use of EMR, claims data

Delegates said payers now have too much power over the process of evaluating physician quality and efficiency.

By Kevin B. O’Reilly, AMNews staff. Dec. 4, 2006.


The AMA House of Delegates adopted principles it said should govern the collection, use and warehousing of electronic medical records and claims data to protect physicians from economic profiling, and patients from privacy violations.

With insurers increasingly using claims data to evaluate physician quality and efficiency as part of pay-for-performance programs, doctors have become concerned because payers “control the entire process,” according to the American Medical Association Council on Medical Service report the house adopted at its November Interim Meeting.

Principles the AMA says payers, vendors and other entities should follow include:

  • Gathering only the minimum necessary electronic medical records and claims data to accomplish the intended purpose.
  • Complying with the Health Information Portability and Accountability Act.
  • Informing physicians on a case-by-case basis of any analysis undertaken, the criteria for the analysis, what data is being studied and how the results will be used.
  • Reimbursing physicians for any additional compliance burden.
  • Allowing doctors to appeal any adverse decisions based on data analysis.
  • Limiting clinical data searchability to access only for payment and health care operations.

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