Federal government efforts to improve EHRs

Ask physician practice leaders if they would get rid of their EHR and revert back to paper charts, the vast majority would probably say no. EHRs offer an amazing range of electronic functionalities that, optimized effectively, can improve both the clinical and administrative functions of a healthcare organization. However, ask those same practice leaders if they are completely satisfied with their EHR and the likelihood is that the vast majority would also say no.

The Medical Group Management Association’s most recent MGMA Stat poll asked healthcare leaders what they believe is the biggest opportunity for EHR improvement. Nearly half (46%) indicated that usability could improve their EHR the most, followed by interoperability (44%), security (2%) and other (8%). Respondents also noted what else they would improve in their EHR:

• "Clinical decision support, gaps in care/quality alerts"
• "The reporting and forecasting features"
• "High cost of replacing/managing EHR"
• "Integration with other equipment"
• "Efficiency and speed"   

This poll was conducted on April 9, 2019, with 1,018 applicable responses.

Earlier this year, the Office of the National Coordinator for Health Information Technology (ONC) released a proposed rule to implement EHR improvement provisions included in the 21st Century Cures Act (Cures Act). The Cures Act, passed in December 2016, was a wide-ranging and bipartisan effort to improve health IT and enhance patient access to their health information.
Among other items, the proposed rule updates the existing 2015 Edition EHR certification criteria to ensure certified systems can:

1. Send and receive electronic health information (EHI) in a structured format to make it easier to incorporate the data into an EHR;
2. Make that EHI available through the use of application programming interfaces (APIs); and
3. Export a single patient’s record to a location designated by the patient or multiple patients’ EHI from one EHR to another.

Congress required EHR software developers participating in the ONC Health IT Certification Program to publish APIs and allow patient health information from such technology to be securely accessed, exchanged and used through APIs. This technology would then facilitate patients using apps to get their EHI and practices to get data from other organizations or the patients themselves.

Under the Cures Act, these APIs are to be usable “without special effort.” While there are a variety of relevant healthcare standards for connecting labs, images, claims processing systems and other areas of the physician practice world, ONC identified an API approach it believes will solve the interoperability challenge — Health Level Seven’s (HL7) Fast Healthcare Interoperability Resources (FHIR®) standards. In its proposed rule, ONC proposes to adopt FHIR as the standard to which EHR software developers must certify their APIs and support the secure flow of information.

APIs in healthcare are proposed by ONC to use the same state-of-the-art security that other industry apps use to assure that patients are able to control which apps may access and use their data. As an example, OAuth 2 standards require specific consent for patients to authorize an app to access their data, helping patients maintain control of their data. While this standard protects the data as it flows to the app, how that data is secured (and disclosed) after it is captured by an app is a different story. Practices will need to advise their patients to use caution when selecting an app to access and store their sensitive health data.

In an effort to improve the quality of EHRs and ultimately the care patients receive, the Cures Act also included a requirement for ONC to develop an EHR Reporting Program. This reporting program will provide publicly available, comparative information on certified health IT. The program will reflect input from developers and voluntary feedback from users of certified EHRs and report criteria that should help to guide physician practice purchasing and implementation decisions.

The EHR Reporting Program will seek input from practice leaders on the following Cures Act-mandated categories:

• Security
• Usability and user-centered design
• Interoperability
• Conformance to certification testing
• Other categories as deemed appropriate by ONC

Once launched later this year, the reporting program will permit practice leaders to share their perceptions of their EHR software and provide feedback on their real-world clinical and administrative experiences. As feedback is gathered from the physician practice community, the hope is that market pressure will steer EHR software developers toward offering products that better meet practice requirements.

ONC will be accepting comments on its proposed rule until May 3, with the final rule expected out in late 2019 or early 2020. MGMA will be providing feedback to the agency on the rule and will emphasize the need for the final rule to minimize the administrative burden and cost for physician practices and ensure adequate security controls are in place to reduce the chance that patient information will be disclosed inappropriately.
 
MGMA Stat is a national poll that addresses practice management issues, the impact of new legislation and related topics. Participation is open to all healthcare leaders. Results of other polls and information on how to participate in MGMA Stat are available at: http://www.mgma.com/stat 
 
Resources

• MGMA Health Information Technology
• Office of the National Coordinator for Health Information Technology
• ONC list of Certified EHR Products
• Should your EHR system stay or should it go? (MGMA)

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