HELP panel persists on EHR usability

Top of mind from experts testifying: Interoperability
By Bernie Monegain
10:44 AM
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"We're here today to announce an intensive review of electronic health records," Sen. Lamar Alexander, chair of the Senate Committee on Health, Education, Labor & Pensions, announced at the start of a hearing before the panel Wednesday.

Alexander, R-Tenn., noted there is wide bipartisan interest in the issue. Patty Murray, D-Wash., a ranking member of HELP, has joined Alexander to form a working group on EHR usability.

It's not the first time Alexander has made his concerns over EHRs known to the committee. On Wednesday, though, he and Murray entered their remarks into the record and moved onto testimony from four invited experts:

  • Thomas H. Payne, MD, board chair elect of the American Medical Informatics Association and medical director, IT services at University of Washington School of Medicine. Payne leads the AMIA EHR task force that recently published a plan on how to make EHRs more effective.
  • Craig D. Richardville, senior vice president and CIO of Carolinas HealthCare System
  • Christine Bechtel, advisor to the National Partnership for Women & Families, chair of the Health IT Policy Committee Consumer Workgroup and president of Bechtel Health.
  • Neal Patterson, co-founder, chairman and CEO of Cerner, which, along with Epic Systems, provides more EHR systems in the market than any other EHR vendor. Cerner's projected revenue for 2015: $4.7 billion.

See also: [Senate panel to look into EHR usability.] and [Senator blasts EHR program.]

The HITECH Act and meaningful use may not be perfect, Patterson told the panel, "but they are helping move healthcare onto a digital platform," he said. Making industries digital can lead to profound transformation, he told the panel.

"As a society, we may be closer than we think to a golden era when science, intelligence and insights from big data can become a natural, unforced part of healthcare," he said. "Two qualities are important to enable this type of transformation. Health IT platforms must be open, and they must be interoperable."

Patterson offered the panel a personal experience about why interoperability is critical.

"My wife has been fighting breast cancer since 2007. I have her permission to share her story. She has had procedures in the last eight years ranging from mastectomy, radiation and chemo to brain surgery and genome sequencing. Her diagnostic and treatment journey has taken her to multiple providers, and her records have wound up in more than 20 different health organizations' EHRs. Everyone has a piece of Jeanne's record, but no one has the whole picture."

Payne highlighted the recent AMIA report on EHRs, which puts forth four broad categories for improvement:

1. Improve documentation requirements and functionality to empower patients so that all members of the care team can contribute their perspectives and information.

2. Refocus regulations so that patients and their caregivers can derive the most benefit from a networked healthcare ecosystem.

3. Increase transparency to improve usability and safety of EHRs.

4. Foster innovation so that we can build toward the next generation of EHRs and realize the benefits of the "learning health system."

For more details on AMIA's recommendations, read: What will EHRs look like in 2020?

Richardville of Carolinas HealthCare System, with 39 hospitals across the Carolinas, 900 care locations and 3,000 physicians and advanced care practitioners, also pressed the interoperability theme.

"Despite its potential, the current HIT ecosystem continues to be challenging for healthcare providers because of a lack of interoperability between systems," he told the panel. "Today, in order to build the bridges that connect disparate data sets necessary to provide comprehensive and informed decisions or care, providers must either pay their original system vendors thousands and sometimes millions of dollars to custom code linkages so they can 'talk' to other systems, or they often find paper-based workarounds that are fraught with potential for both errors and wasted resources and expense," he said.

Bechtel made the case for patient control of their own data.

"The fact is, as the patient, I am the only one present at all of my healthcare encounters – so I can potentially amass more data, more quickly and more comprehensively than any single healthcare entity can today because I know where it all is," she said.

"And, in theory, I know how to get it. If I have the data, I can spot errors, avoid repeat tests, detect fraud, help facilitate coordinated care and much more. I can be the curator of my own health record, sharing it where and when it is needed to improve my care, and for other important purposes like research into precision medicine."

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