What will EHRs look like in 2020?

AMIA's 5-point call to action for a better EHR in the future.
By Bernie Monegain
10:12 AM
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Crystal ball

In an article published online today in JAMIA, the Journal of the American Medical Informatics Association, an AMIA task force takes on the thorny issues associated with the use of electronic medical record systems and offers recommendations for improvement.

“Health information technology is a key part of enhancing health and health care, and empowering patients to be first-order participants in their care," said Douglas B. Fridsma, MD, president and CEO of AMIA, in a statement. "As part of this report, we listened to our members who work closely with EHRs to understand the current challenges. We think these recommendations will improve the value that EHRs will provide to patients, and set the stage for more significant benefit in the future."

Members of the AMIA EHR 2020 Task Force on the Status and Future Direction of EHRs are: Thomas H. Payne, Sarah Corley, Theresa A. Cullen, Tejal K. Gandhi, Linda Harrington, Gilad J. Kuperman, John E. Mattison, David P. McCallie, Clement J. McDonald, Paul C. Tang, William M. Tierney, Charlotte Weaver, Charlene R. Weir and Michael H. Zaroukian.

[See also: Object of beauty, or ungainly nuisance? and Senate panel to look into EHR usability.]

The task force outlines five broad goals:

1. Simplify and speed documentation

AMIA calls for decreasing the burden of data entry for the clinician, noting that information entered by other care team members and patients should be as valued as information entered by the physician. The task force also recommends separating data entry from data reporting. Data could be entered by the patient, family members and the care team, and then used in multiple ways to generate customized reports, it suggests. Also, EHRs should enable systematic learning and research at the point of care during routine practice, writes the task force.

2. Refocus regulation

Among its recommendations, the task force calls for clarifying and simplifying certification procedures and MU regulations; improving data exchange and interoperability; reducing the need for re-entering data: and prioritizing patient outcomes over new functional measures.

3. Increase transparency and streamline certification

The task force writes: "In order to improve usability and safety, to foster innovation and to empower providers and EHR purchasers, how a vendor satisfies a certification criterion, such as for the CEHRT program, should be flexible and transparent. To inform the market and to enhance competition among vendors, additional data about the certification process should be made available."

4. Foster innovation

The task force calls for EHR vendors to use APIs that will enable EHRs to become more open to innovators, researchers and patients. The public APIs and data standards should be consensus based, transparent, well documented, and openly available in a fair and non-discriminatory way, it writes.

5. Support person-centered care delivery

The group calls for promoting the integration of EHRs into the full social context of care, moving beyond acute care and clinic settings to include all areas of care: home health, specialist care, laboratory, pharmacy, population health, long-term care, and physical and behavioral therapies. Finally, it also calls for improving the designs of interfaces to support and build upon how people think.

"The problems we face today in EHR use are complex and solutions will not be simple or quick," the task force concludes. "Solving these problems will require regulatory stability, the development of an acceptable threshold 'barrier to entry' into the EHR marketplace, and a supportive national policy. We recommend a focus on these five areas during the next 6-12 months, while we develop a long-term framework for innovation for EHRs."

Read the task force's full report in JAMIA.