Physicians outline improvements to EHR certification process

AMA Wire
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Physicians can’t meet meaningful use requirements without certified electronic health records (EHR), but the current EHR certification program ties EHR design and testing too closely to the meaningful use program. Medical associations recommended three broad changes to improve the EHR certification process and make it easier for physicians to use EHRs and care for patients.

In a letter (log in) to the Office of the National Coordinator for Health IT, 36 physician groups said there are many issues with EHRs, but addressing EHR certification is an improvement that can be made in the short-term to guide further efforts in the long-term.

“Ensuring patient safety is a joint responsibility between the physician and technology vendor and requires appropriate safety measures at each stage of development and implementation,” the letter said. “Ultimately, physicians must have confidence in the devices used in their practices to manage patient care.”

In 2014, regulators made some improvements to the meaningful use program, including allowing physicians to use new, old or a combination of both versions of certified software to meet meaningful use. But the changes didn’t go far enough, and only about 3 percent of physicians and other eligible providers had attested to Stage 2 of meaningful use in 2014, highlighting the difficulty of the program.

To make improvements to the EHR certification process, physician groups told ONC it should focus on three areas:

  • Usability. The method used to test EHR usability is underdeveloped, and testing  doesn’t often mimic real-world medical practice. More rigorous testing to include a variety of different scenarios, including test cases that represent the needs of medical specialists, would help to improve how the technology is used in real-life workflows. EHRs should also demonstrate their ability to handle input errors, bad data or system malfunctions. For optimal performance, an EHR should be able to flag and manage erroneous data entered by mistake to protect patients from unsafe events.
  • Interoperability. “The act of two computers sending and receiving data does not constitute functional interoperability—the ability for information to be exchanged, incorporated, and presented to a physician in a contextual and meaningful manner.” the letter said. Rather, efforts should be placed on ensuring the necessary health information follows patients during transitions of care. For example, currently EHRs exchange lengthy documents that provide little value if they’re simply imported in to a patient’s record. ONC must clarify and standardize how these documents should be exchanged and create tests to verify their conformance to those standards.
  • Security. Protecting the privacy and security of patient information is crucial, yet current methods for accessing data, like passwords and tokens, are cumbersome and can still be compromised. Health IT regulators and EHR vendors should look toward advancements in consumer electronics and developing identification solutions to reduce many of the authentication difficulties medical professionals face.

Last year, the AMA released a blueprint outlining ways to improve the meaningful use program and a framework that details eight priorities for moving toward more usable EHR systems.

Read more about EHR improvement at AMA Wire®.

Tell us: What would make the EHR certification process easier for physicians? Tell us in a comment below or at the AMA Facebook page.

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The vernacular meaningless use is pervasive for us doctors in the trenches doing the care. The constant struggle is wearing down the troops. Just note the diminishing numbers in primary care, etc. It is not rocket science to make the chief complaint, present illness, major findings, differential and presumptive diagnosis locked into interchangeable data blocks. Just the stuff that reflects human thinking and directs care for the patient. So much time is spent making the chart look good to get the money, it is detracting from the eye to eye patient quality of care. The doctors know it and the patients know it.
No one seems to have succinctly stated the two main design flaws of the documentation provided by the EHR. <br/> <br/> FIRST: The designers of these systems need to realize that "The provision of more data is not equivalent to the provison of more useful information", or more concisely stated, "More data does not equal more information". We are swamped by useless data. We can count on easily discerning who made a specific entry, and when. Thus, te systems appear to be designed to quickly identify whom to credit or whom to blame. However, it is bulky and burdensome to search for the data we actually need. The designers have not enabled the central purpose of an effective EHR.<br/> <br/> SECOND: The designers of these systems also seem to have completely overlooked actually spending time with the end-users of these systems, because they don't format communication in the manner that doctors and nurses have evolved, over decades, to communicate efficiently. For instance, in Epic, when I open "Review Visit", why is the first thing I encounter a note of how the patient arrived to my emergency dept, and whether or not they have a primary care doctor? The first thing I need to know their chief complaint. Is it really so hard to understand that? It must be, or else the system would not be so inefficiently designed, as regards the needs of the end-users. <br/> <br/> In summary, the EHR is supposed to increase efficiency of care processes, toward making medical care less costly. So far, the EHR has done neither. <br/> <br/> The failures of the EHR systems, as sold to hospitals and doctors, do not do what they are designed to do or what they claim to do. Since Federal dollars get expended as a consequence, it would seem that the EHR companies like Epic and Cerner should fear having to defend themselves against Federal False Claims lawsuits. The reason is that any claims to increase efficiency are fraudulent. <br/> <br/> As a consequence of EHR implementation, doctors see less patients per hour, and this results in a need to train more residents, which is underwritten to a degree by Medicare payments.<br/> <br/> I wonder if anyone else feel so strongly about this that they would like to be co-plaintiffs in a Federal False Claims suit?<br/> <br/> [email protected]
Well, no surprise here. Organized medicine missed the boat when it passed up the chance to take a proactive role in the implementation of the EHR. The EHR is much more than a digital version of the paper chart, and should be thought of as integral to the practice of medicine. As such it never should have been out-sourced to technology companies. Doesn't the community of medical practitioners know that it had (and still has) the means and the power to hire people with the technical expertise to adopt or develop and update an open source EHR distributed at low cost to practitioners in exchange for crowd-sourced innovation to suit its needs. Instead, organized medicine has left itself in the position of being largely an onlooker to government- and tech industry- driven HIT development, and spending its time and resources kvetching about the EHR as it is presently structured, and only hoping that things will get better.<br/> <br/> The AMA was presented with a strategy for controlling the deployment and content of the EHR in 2008. Between that time and the adoption of the proposed resolution in June, 2009, Congress passed HITECH, along with "meaningful use," and a lot of other governmental control over the EHR. Details at <a href="" rel='nofollow'></a> if anyone is interested. In the meantime, the AMA did nothing (or maybe did, but we may never know). <br/> <br/> The payments for physicians for adoption of EHR seemed (to some) like a good idea at the time, but it should be clear by now that those payouts were a deal with the devil. Not only were the amounts not worth it, but the tens of billions of dollars were more a subsidy to the proprietary HIT industry than a boon to physicians. <br/> <br/> I suggest to the AMA and the 35 other medical societies that sent a "love letter [as she has termed other communications from the AMA]" to ONC DeSalvo, that they take a look at <a href="" rel='nofollow'></a> for some innovative ideas for the EHR (The ONC has shown little interest in OSEHRA, and in fact recently handed off its involvement with pophealth to OSEHRA). Of course there will still be the task of undoing the damage of HITECH.
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