Physicians speak out: How can electronic health records be improved?

Troy Parks
Staff Writer
AMA Wire
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How can electronic health records (EHR) and regulations be designed to positively affect you in your practice? With the meaningful use program reportedly on the cusp of change, physicians gathered in Seattle for a town hall meeting to discuss both the difficulties and benefits of EHRs while also citing ways that they can be improved. Find out what your colleagues on the West Coast had to say.

The meaningful use program has been successful in “forcing the adoption of EHRs … but they weren’t ready for prime time,” said AMA President Steven J. Stack, MD, Tuesday night during the town hall meeting on EHRs at the Swedish Medical Center in Seattle. This is the third AMA town hall on EHRs and was co-hosted by the Washington State Medical Association (WSMA).

The focus of this special session: What is wrong with current EHRs and how they could be designed to benefit physicians in practice.

Earlier this month Centers for Medicare & Medicaid Services Acting Administrator Andy Slavitt said the agency is changing its culture to focus more on listening to physician needs and will implement better policy in place of the meaningful use program when the new streamlined Medicare reporting program is created. With this statement, there’s never been a better time to speak up and offer constructive solutions to regulatory missteps that have stolen time from physicians that they would rather have spent with patients.

Taking control: Regulations should not hinder care

As it did in Boston and Atlanta last year, the physician voice resounded through Seattle during Tuesday night’s town hall, emphasizing that EHR design should be focused on usability and interoperability and the physician voice must be heard.

“Administrative burdens are strangling medical practice and creating unnecessary and costly inefficiencies in health care delivery while adding stress to physicians and their teams,” said WSMA president Ray Hsiao, MD, kicking off the discussion. “It can make a cynic out of the happiest people and can lead to discouragement, professional dissatisfaction and burnout, and even drive physicians to leave the profession. We cannot let that happen.”

Regulations force physicians to do “a lot of busy work that has nothing to do with the quality of care we provide,” said Jane Fellner, MD, a primary care physician at the University of Washington School of Medicine. “It needs to stop.”

How we can make EHRs more functional in practice

Speaking to what they really need from these tools to help them in their practices, many physicians offered solutions and suggestions for how EHRs should work for the end-users who depend on them daily.

Interoperability proved top of mind as the current EHRs struggle to communicate. “My EHR does not necessarily have the tools to interoperate well with other EHRs,” Dr. Fellner said. “But within the universe of the other medical centers who use the same software—it is magic. I can import an entire record from Florida in 20 seconds.” If all EHRs could talk to each other in this way, it would have a very positive effect on the way physicians treat patients nationally, she said. “It has revolutionized the care I provide.”

Another focus for improvement during the discussion was the need for more data usage focused on population health to show physicians how their patients’ health compares to national trends.

“What we don’t see is our information going in to create this big picture that we can then [see] in real time,” said Reena Koshy, MD, a family physician in Seattle. This capability is currently available but not to everyone using EHRs. Dr. Koshy said it would be very helpful if national patient data coordination were available to all practices.

Thomas Payne, MD, medical director of information technology services at the University of Washington School of Medicine and board chair of the American Medical Informatics Association, said he uses his EHR in every patient visit. “We need to address documentation because that is the source of a lot of unnecessary new time that [we] spend,” he said. “Natural language processing is a great example …. As we speak as we are this evening … we can use that same capability to communicate in the medical record and … be able to record what kinds of care people have received.”

“When you’re searching for billing codes, you have to type it exactly correct or it boots it out,” said Carrie Horwitch, MD, a primary care physician in Seattle. She suggested physicians could work much more efficiently if EHRs had the same kind of spell-check and search option drop-down menus as Internet search engines.

The effort to change meaningful use and fix EHRs

Early last year, the Medicare Access and CHIP Reauthorization Act of 2015 repealed the sustainable growth rate formula and called for the new Merit-Based Incentive Payment System (MIPS), which is intended to sunset the three existing reporting programs and streamline them into a single program.

The AMA and 100 state and specialty medical associations recently submitted 10 principles to guide the foundation of the MIPS, and the AMA provided detailed comments (log in) as part of its ongoing efforts on this issue and submitted a detailed framework for what needs to change.

The AMA and MedStar Health’s National Center for Human Factors in Healthcare last year developed an EHR User-Centered Design Evaluation Framework to compare the design and testing processes for optimizing EHR usability. 

Visit BreakTheRedTape.org, the AMA’s grassroots campaign to advocate for ways to solve medicine’s regulatory and legislative challenges.

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Comments

We should recognize that the EHR is integral to medical practice. That includes linkages between point-of-care and public health agencies. Accordingly, physicians, through organized medicine, need to step up and take control of the EHR out of the hands of vendors and government. Where was organized medicine in 2009 when Congress passed the "meaningful use" requirement? Or in 2004 when the President issued the Executive Order that aimed to have universal electronic health records by 2014?<br/> <br/> You can read more at The EHR Debacle: Has Organized Medicine Failed Us? | Open Health News , <a href="http://www.openhealthnews.com/story/2015-09-18/ehr-debacle-has-organized-medicine-failed-us" rel='nofollow'>http://www.openhealthnews.com/story/2015-09-18/ehr-debacle-has-organized-medicine-failed-us</a> (reprinted from Bulletin of the Allegheny County Medical Society, 2015;105:338).<br/> <br/> Or at The Politics of the EHR: Why we're not where we want to be, and what we need to do to get there, Open Health News, 10/1/13, <a href="http://www.openhealthnews.com/articles/2013/politics-ehr-why-we%E2%80%99re-not-where-we-want-be-and-what-we-need-do-get-there" rel='nofollow'>http://www.openhealthnews.com/articles/2013/politics-ehr-why-we%E2%80%99re-not-where-we-want-be-and-what-we-need-do-get-there</a>
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