As directed by the 21st Century Cures Act, the Office of the National Coordinator for Health IT (ONC) and CMS worked together to gather clinician and other industry stakeholder feedback on the best ways to ease administrative and regulatory burdens tied to health IT and EHRs.
The resulting draft strategy centers on three goals:
- Improving EHRs to be more functional and intuitive;
- Reducing the time and effort clinicians are required to spend recording health information in EHRs; and
- Reducing the time and effort clinicians, hospitals, and health care organizations are required to spend meeting regulatory reporting requirements.
Inside the draft strategy
HHS Secretary Alex Azar said the draft strategy includes a number of incremental changes for clinicians, industry stakeholders, and HHS to adopt to gradually ease burdens related to health IT and EHRs over three to five years.
For example, the draft strategy suggests clinicians can reduce burdens from clinical documentation requirements tied to EHRs and health IT by:
- Partnering with stakeholders to promote best practices for documentation and advancing the best practices through CMS technical assistance;
- Using data already available in EHRs to reduce re-documentation in clinical notes; and
- Waiving documentation requirements when needed to test and run alternative pay models.
According to the draft strategy, health IT developers should standardize EHRs' medical information, order entry content, and standardize results display conventions. The draft strategy stated, "Health IT developers should consider implementing common approaches to basic clinical operations across EHRs, so that clinicians do not have to utilize a significantly different interface each time they switch between systems."
In addition, the draft strategy states, "HHS can play a role in helping to evaluate and address process and clinical workflow factors contributing to the burden associated with prior authorization." In particular, the draft strategy stated HHS could:
- Build on efforts to identify the common data elements and standardize templates for developers to use to bring more automation to the prior authorization processes;
- Coordinate efforts to design new approaches for prior authorization among stakeholders;
- Provide incentives for providers who adopt certified technology, which functions in accordance with recognized standards; and
- Support pilot programs for standardizing electronic ordering services.
According to the draft strategy, "Testing these new approaches is important, and HHS could engage a wide variety of payers, health care providers, and other third-party intermediaries in working toward robust standards-based automation of these transactions."
The draft strategy also included recommendations on health IT usability and public health reporting. Specifically, the draft strategy recommended HHS:
- Adopt common industry standards to improve interoperability between EHRs and prescription drug monitoring programs;
- Better align the design of EHR systems with real-world clinical workflow;
- Bring internal consistency to health IT products;
- Bring stakeholders together to identify data commonly reported from state and federal programs;
- Harmonize the steps users take for basic clinical operations across EHRs;
- Improve the usability of clinical decision support and the functionality and presentation of clinical data in EHRs; and
- Improve the user interface design standards of EHRs.
In terms of EHR reporting, the draft strategy recommends:
- CMS consider how feasible it would be to adopt a first-year test reporting approach for new electronic clinical quality measures;
- The improvement and development of health IT measures geared toward interoperability and relevant to providers' practice and patient improvement;
- The adoption of new data standards that would make it easier and less costly for providers to access, analyze, extract, and integrate data across EHRs.
HHS is accepting public comments on the draft strategy through Jan. 28, 2019. HHS intends to release the final strategy in late 2019.
Andrew Gettinger, ONC's chief clinical officer, and Kate Goodrich, CMS' CMO, in a blog post wrote, "This draft strategy includes recommendations that will allow physicians and other clinicians to provide effective care to their patients with a renewed sense of satisfaction for them and their patient."
Health IT Now Executive Director Joel White called the proposal a "worthy step" toward easing onerous burdens related to EHR reporting. "We are heartened by [the] release of ONC's draft strategy on reducing the burdens associated with use of health IT and EHRs, and are hopeful that this is the start of a new chapter in the federal regulation of health IT," he said (Stein, Inside Health Policy, 11/28 [subscription required]; Harris, Healthcare IT News, 11/28; Monica, EHR Intelligence, 11/28; Kim Cohen, Becker's Health IT & CIO Report,11/28).
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