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New ONC health IT draft report aims to improve EHR usability

A new draft report from the ONC acknowledges the challenges with EHRs and provides suggested solutions, including decreased regulation and more stakeholder cooperation.

The U.S. Department of Health and Human Services' Office of the National Coordinator for Health Information Technology has released a draft strategy aimed at making EHRs easier to use.

The "Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs" report outlined three goals: to make EHR charting less difficult for doctors, to reduce the time and energy involved in regulatory reporting, and to improve the functionality and ease of use of EHRs. The Office of the National Coordinator for Health Information Technology (ONC) health IT draft strategy is open to public comment until Jan. 28, 2019.

'A narrow piece of the puzzle'

The draft report comes at a time of simmering frustration with the pace of health IT innovation generally, and cumbersome and costly EHRs specifically.

But the ONC health IT draft doesn't break a lot of new ground, said David Harlow, a Newton, Mass.-based attorney who specializes in healthcare law and the author of HealthBlawg.

"This report is a very narrow piece of the puzzle, and it is talking about improving functionality and reducing effort around inputting information into EHRs and to do the requisite reporting by hospitals and physicians," he said. "There's nothing in here about the plumbing. This just documents what people have been saying for years."

The ONC health IT draft represents a year of conversations and research into EHR use in the real world.

"Although clinicians and other health care providers point to the implementation, use, and regulation of health IT and the EHR as a key support tool for care delivery, it remains a source of ongoing frustration," the draft report said.

"They argue that the EHR has introduced new challenges or failed to address existing ones despite intending to improve the practice and experience of medicine. We have heard from health care providers, practice managers, and hospitals that they experience challenges with EHR system design and the regulatory and administrative burdens associated with the use of EHRs during care delivery, required reporting activities, and documentation of claims for payment. These challenges affect productivity, increase organizational cost, and detract from patient focus, resulting in negative experiences using health IT."

Report's suggested steps

The ONC health IT report outlines a number of suggested steps, beginning with the issue of documentation, or what is referred to as note bloat. Not only did doctors complain about having to take too many notes, but there were also problems with duplication, excessive cutting and pasting, and an inability to find relevant information.

Tied to this were frustrations about constant logins, templates that did not match the clinician workflow and an overall lack of ease of use. The draft strategy recommended fewer regulations around documentation and better use of best practices and tech solutions to streamline prior authorizations and ordering, which would require providers, payers and EHR vendors to work together.

The second area the ONC health IT report examined was health IT usability, again with an eye to making EHR systems easier to use for doctors and staff. Medical records systems need to do a better job of matching actual clinical workflow, the report suggested, with a particular emphasis on decision-making tools and documentation. With a nod to semantic interoperability, the report offered the idea of data harmonization, where all the stakeholders agree on where certain types of content should be stored and on the names of drugs and procedures.

The third major focus was on EHR and public health reporting, both of which could benefit from streamlined regulations and smarter use of technology to decrease administrative and financial concerns, the report said.

The bottom line, Harlow said, is the report finally acknowledges the reality of doctors working with EHRs, an issue Atul Gawande, M.D., and head of a new -- and as yet unnamed -- healthcare startup, addressed in an article in The New Yorker.

"At the outset of the big EHR rollouts under the Meaningful Use Act, a lot of effort was made to change the workflow in the physical world to accommodate the machine," said Harlow. "Here we have first glimmer of acknowledgment of the need to perhaps understand the workflow in the physical world and have the software accommodate that. That's progress in my book."

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