- Healthcare organizations still searching for the key to unlocking the full potential of their electronic health records systems need to turn their eyes back to the basics by adhering to strong data governance principles and strategies that emphasize usability without compromising patient safety, states a newly released report by the AMIA EHR 2020 Task Force. If EHRs are to fulfill their promises of providing higher quality care in an efficient, data-driven, interoperable environment, the healthcare industry must make a concerted effort to overhaul the way health IT systems are developed, deployed, and utilized for documentation and reimbursement.
Led by the American Medical Informatics Association (AMIA), the Task Force has brought together stakeholders from across the industry, including members of the vendor community, academic representatives, policy makers, and providers in order to recommend solutions to healthcare’s most intractable technology problem.
As big data that supports predictive and prescriptive analytics and population health management becomes an increasingly important strategic asset for providers, regulators and developers must ensure that EHR products are up to the challenge of analyzing and presenting big data in a meaningful way.
“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 Chief Executive Officer, AMIA in a press release. “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.”
“While we recognize that there are challenges with implementing and using EHR technology, this report is aimed at practical solutions that we believe will improve health and health care for patients and their caregivers. We are hopeful that it will generate the thoughtful conversations and innovations that will make what is possible, real for all patients,” added Thomas Payne, MD, Chair, AMIA EHR 2020 Task Force and Medical Director of IT Services at University of Washington (UW) Medicine, as well as Associate Director of the UW Medicine Center for Scholarship in Patient Care Quality and Safety.
The report outlines five fundamental tasks for the healthcare industry to undertake as new generations of EHR technology hope to meet increasingly tough federal standards related to meaningful use. As developers and providers inch towards the goal of meeting the Triple Aim through an interoperable, learning healthcare system, balancing patient safety and the patient experience with EHR optimization and efficient use remains a challenging proposition. AMIA suggests the following steps to jumpstart a new focus on data governance in the big data era.
Streamline the EHR documentation process
EHRs can help to decrease the burden of data entry on physicians if providers allow other members of the integrated care team – including patients – to contribute to the task. “Clinicians remain uncertain regarding who can and cannot enter data into the record, placing a tremendous data entry burden on providers, the most expensive members of the care team,” the report says. “Clinician time is better spent diagnosing and treating the patient rather than charting. Regulatory guidance that stipulates that data may be populated by others on the care team including patients would reduce this burden.”
Clinicians should be reminded that copying and pasting information between patient notes represents a poor data governance practice that should only be used sparingly, if at all. Allowing other members of the care team to engage in clinical documentation may make this habit less of a necessity, the report adds.
Additionally, as wearable devices and patient portals provide patients and caregivers more opportunities to contribute data to the treatment process, this information must be considered and presented in a way that highlights its value. Automated collection of patient-generated health data that is reported back to providers in a meaningful way can add to the care narrative, especially in cases of chronic disease where constant monitoring is important.
As developers learn how to accept and display passively collected patient-generated health data, they are using these lessons to design more automated templates and data entry systems that harness standardized data elements to reduce the data entry burden on clinicians. Through natural language processing and other cognitive computing technologies, EHR data can not only become more efficient for users to collect, but will also be increasingly useful for future research and reporting.
Align federal regulation with industry needs and capabilities
Healthcare providers have been calling for the simplification of meaningful use since the very beginning of the EHR Incentive Programs, and the cries have only intensified as the latter stages have been revealed. With the recent release of Stage 3 guidelines complicated by the sustainable growth rate repeal’s massive structural changes to a number of quality reporting programs, understanding the underlying regulations that govern EHR development is a difficult ask for most organizations.
These convoluted regulatory requirements have forced vendors to focus on federal building blocks while “[diverting] resources away from client-requested enhancements, efforts to streamline workflows and enhance usability, and innovation in general,” the report says. Future certification requirements should allow vendors to turn their attention back to usability and design elements while fostering improved health data interoperability that will aid population health management and care coordination.
Regulatory frameworks should also promote meaningful quality reporting without overburdening providers, the Task Force adds. Data reporting must be made simpler for providers and the results must be easy to interpret for patients as the industry moves towards more transparent quality reporting and value-based reimbursement.
“Changes in reimbursement regulations should support novel changes and innovation in EHR systems,” the report states. “We applaud changes to payment models as well as federal guidance designed to accommodate innovation in health information technology. There is a natural tension between using EHR systems to guide and document care, and to provide adequate documentation to ensure appropriate reimbursement. Working together with CMS and other payers, is essential to ensure that the EHR of the future can fulfill the need for comprehensive, usable documentation as well as reimbursement.”
Encourage transparency and competition in the EHR vendor community
Providers are supposed to feel comforted by the fact that EHR products are certified to meet certain industry-wide criteria, but customers don’t always believe they are getting value for their money. Overly restrictive certification criteria are constraining EHR workflows and stifling innovation, the Task Force believes, and a lack of transparency and insight into the process makes it difficult for consumers to select the products that best fit their needs.
“This lack of transparency inhibits an effective, competitive marketplace,” the authors write. “Those choosing EHRs need clear knowledge of what commercial EHR systems offer and, importantly, what workflows are incorporated into their use for frequent tasks such as creating notes, entering data, reconciling medications, responding to decision support, and extracting data for reports or research—so they can make more informed choices.”
Healthcare providers and EHR developers must also work together to collect better data on the unintended patient safety consequences of health IT adoption, and should share this information with other members of the care continuum in order to develop best practices that improve workflows while ensuring quality care.
Increase healthcare big data analytics and foster innovation through open standards
The use of application programming interfaces (APIs) and data standards like FHIR will increase the prevalence of big data analytics as EHRs become the healthcare’s hub for the growing Internet of Things. Open data standards “should support extension and innovation from both the academic informatics community as well as from innovators inside and outside traditional health IT communities,” the report suggests.
“Access to EHR data and functionality will drive innovation and research into better systems and empower patients to engage in their care. The public APIs and data standards should be consensus based, transparent, well documented, and openly available in a fair and non-discriminatory way.”
Healthcare providers should build partnerships with researchers and academic organizations to increase the flow of standard data elements and interfaces that support the development of patient engagement technologies, predictive analytics, clinical decision support, business intelligence applications, and population health management.
Support patient-centered care and care coordination
At a fundamental level, the purpose of EHRs has always been to improve the quality, safety, and effectiveness of patient care. To truly achieve the promises of the Triple Aim, EHRs must do a much better job of fostering care coordination across the healthcare continuum. EHRs geared towards primary care providers must be able to conduct health information exchange with other members of the care process, including behavioral health providers, pharmacies, laboratories, and specialists in order to develop a comprehensive portrait of a patient’s needs.
“The ability to incorporate data from different sources is essential,” the report urges providers to remember. “Including patient-generated data, population data and community contexts into an EHR will spur development of new care delivery models, improve population health, aid in the development of precision medicine and support other healthcare transformations.”
Healthcare big data analytics can be centered in the EHR if these systems are able to synthesize information from the full spectrum of providers as well as emerging data sources such as genetic testing encouraged by precision medicine initiatives. EHRs must be able to compile all of this data in a patient-centered manner that provides tailored clinical decision support, risk stratification, chronic disease management, and appropriate remote monitoring – all while ensuring that healthcare providers aren’t overwhelmed with the input and presentation of this conglomeration of data sources. Creating intuitive interfaces and workflows that help providers make better decisions instead of becoming the enemies of patient care will be a critical step towards realizing these goals.
“Manifesting this vision requires much more than simple interoperable platforms, but a new conceptualization of the nature of health care data,” the authors said. “Abstracted and summarized patient data should be available and configurable for different goals across a myriad of views. The principles of person-centered care can be much enhanced with the integration of new systems, such as smart phones, biometric sensor information, genomics, big data, etc.”
Electronic health records can be the instruments of revolutionary innovation if healthcare providers and health IT developers work together to reform data governance practices, overhaul regulation, and create big data analytics best practices that embrace the wide and growing variety of novel technology tools available to the industry.
“We look forward to working with other groups, government agencies and professional organizations to find creative ways to solve EHR problems we face today and to further create a sustainable framework for innovation in EHRs,” AMIA concludes. “We look forward to continuing work with policymakers on their critical role in moving our nation toward better use of EHRs to achieve the Triple Aim. We also share the sense of urgency other organizations have expressed about addressing current EHR problems. These problems are soluble and the future for EHRs is bright.”