Report details problems, solutions for EHRs

Last week, the American Medical Informatics Association released a report on the problems and potential solutions for electronic health records. The AMIA has long been a leading supporter of EHRs but has recently turned its attention to studying the criticisms of the technology and developing a list of improvements that could be made.

Tara Courtland

Communications Director Tara Courtland

The AMIA’s report concludes that “many clinicians are voicing concerns that EHR use has had unintended clinical consequences, including reduced time for patient-clinician interaction, transferred new and burdensome data entry tasks to front-line clinicians,and lengthened workdays.  Interoperability between different EHR systems has languished despite large efforts.These frustrations are contributing to a decreased satisfaction with professional work life.In professional journals,press reports, on wards and in clinics, we have heard of the difficulties that the transition to EHRs has created. Clinicians ask for help getting through their days, which often extend into evenings devoted to writing notes. Examples of comments include “Computers always make things faster and cheaper. Not this time.” and “My doctor pays more attention to the computer than to me.”

In order to improve the clinician and patient experience with EHRs, the AMIA has come up with 10 recommendations:

I. SIMPLIFY AND SPEED DOCUMENTATION

Recommendation 1. Decrease data entry burden for the clinician. Although medicine requires an entire team to care for patients and to document the care patients receive, interpretation of CMS’ requirements has placed the primary burden of office visit documentation on physicians …

Recommendation 2. Separate data entry from data reporting …

Recommendation 3. EHRs should enable systematic learning and research at the point of care during routine practice, including a better understanding of the costs (in time) and benefits (to care delivery, research, and billing) of different approaches to capturing and reporting clinical data …

 

II. REFOCUS REGULATION

Recommendation 4. Regulation should focus on 1) clarifying and simplifying certification procedures and MU regulations, 2) improving data exchange and interoperability, 3) reducing the need for re-entering data, and 4) prioritizing patient outcomes over new functional measures …

Recommendation 5: Changes in reimbursement regulations should support novel changes and innovation in EHR systems …

 

III. INCREASE TRANSPARENCY AND STREAMLINE CERTIFICATION

Recommendation 6. In order to improve usability and safety, to foster innovation and to empower providers and EHR purchasers, how a vendor satisfies a certification criterion, such as for the CEHRT program, should be flexible and transparent …

Recommendation 7. In order to improve usability and safety and to foster innovation, health care organizations, providers and vendors should be fully transparent about unintended consequences and new safety risks introduced by health information technology systems, including EHRs, as well as best practices for mitigating these risks …

 

IV. FOSTER INNOVATION

Recommendation 8. EHR vendors should use public standards-based application programming interfaces (APIs) and data standards that will enable EHRs to become more open to innovators, researchers and patients …

 

V. THE EHR IN 2020 MUST SUPPORT PERSON-CENTERED CARE DELIVERY

Recommendation 9. Promote the integration of EHRs into the full social context of care, moving beyond acute care and clinic settings to include all areas of care: home health, specialist care, laboratory, pharmacy, population health, long-term care, and physical and behavioral therapies.

Recommendation 10. Improve the designs of interfaces so that they support and build upon how people think (i.e., cognitive-support design) …

The full 11-page report can be viewed here: http://jamia.oxfordjournals.org/content/early/2015/05/22/jamia.ocv066

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About Tara Courtland

Tara Courtland is the communications director at NEMT.
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