AMIA, other groups join call to ease EHR burdens

As the Office of the National Coordinator for Health IT comments period drew to a close, a number of organizations weighed in about how to improve electronic health records platforms.
By Diana Manos
04:14 PM

Comments closed Jan. 28 on the Office of the National Coordinator for Health IT's draft recommendation to make electronic health records more user friendly with support over the recommendations and a host of cautions that included going slow with changes and creating panels to help oversee them.

The comments come a day after Pew Charitable Trusts urged ONC to focus on patient safety in EHRs, pediatric systemss in particular. 

ONC and the Centers for Medicare an Medicaid Services incorporated stakeholder feedback into a draft strategy they released Nov. 28, that included proposals to reducing the time and effort it takes for physicians to enter data into an EHR; reducing the effort and time it takes to meet regulatory reporting requirements, and; helping to improve the overall ease of using EHRs.

AMIA and other groups responded with a variety of requests that included:

Fix the root cause

CentriHealth, a subsidiary of UnitedHealth Group, called ONC’s draft strategy “noteworthy and commendable,” but said it only addresses the symptoms. “The root cause is the lack of a useful and usable system that supports overall individual care in a complex, diverse health care economy,” CentriHealth said. “In the absence of such a system, the administrative functions have filled this ‘system of care vacuum’ leading to the problems identified.”

How to relieve this? CentriHealth said: “ensure we have the systems for individual care that meet the needs of contemporary medicine and practice. Until then the problems identified will persist and the approaches proposed in the ONC Draft Strategy will be at best damage limitation.”

Streamline requirements for substance use disorder records

The Partnership to Amend 42 CFR Part 2 called for new guidance to align Part 2 (a measure that deals with the federal confidentiality of substance use disorder patient records) with HIPAA, to allow for the transmission of Part 2 records without written consent for treatment, payment, and healthcare operations. The group says Part 2 is an “outdated regulation” and limits the use and disclosure of patients’ substance use records from certain substance use treatment programs.

Currently, patients must submit written consent prior to the disclosure of their substance use disorder record. “Obtaining multiple consents from the patient is burdensome and creates barriers to whole-person, integrated approaches to care, which are part of our current health care framework,” the Partnership said.

Measure the pace of changes

Based on the collective perspectives and experiences of its 35-member companies who serve the majority of hospitals and ambulatory care providers using EHRs across the U.S., the Electronic Health Records Association believes that ONC should use a “measured pace” for introducing change.

“This will be important to successfully updating the systems and workflows, which have been used for many years,” the association said. EHR clinical documentation is embedded with algorithms for clinical care reimbursement needs. “As with all changes that are introduced to health information and technology, especially those that impact clinical workflows, clinicians and clinical support staff need time to learn about the changes and adapt to using new, less prescriptive approaches,” the group said.

Decouple clinical documentation from billing, regulatory, and administrative compliance requirements

In a Jan. 29 announcement, the American Medical Informatics Association “strongly supports” ONC’s proposed strategy to decouple clinical from billing documentation to reduce burden on clinicians. However, AMIA warned, “the core challenge and dominant threat” to this strategy is that “most EHRs are designed to support transaction-based, fee-for-service billing requirements and business processes for regulatory/administrative compliance, rather than reflect clinical observation and treatment.”

To make the decoupling work, the federal government, developers, providers, and payers will all have to agree to the decoupling, AMIA aded, “with the expectation that documentation will be used downstream for clinical decision support and quality/performance reporting as a biproduct of care delivery.”


AMIA CEO Douglas Fridsma, MD, in the group’s comment letter: “Rather than be the focal point of a clinical visit, technology should be invisible to our clinicians’ workflows. Our regulatory and policy approaches need a paradigm shift so that our informatics tools can realize their potential to heal healthcare.”

Diana Manos is a Washington, D.C.-area freelance writer specializing in healthcare, wellness and technology.

Twitter: @Diana_Manos
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