ONC Needs to Address HTI-1’s Burdens on Healthcare Providers, Health IT Developers

By David Bucciferro, Chair, EHR Association

While the EHR Association has long supported the goals of ONC’s proposed rule to advance interoperability, improve transparency, and support further access, exchange, and use of EHI, we have several serious concerns about the impact HTI-1 (ONC’s Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing Proposed Rule) will have on the industry if finalized as proposed. 

Among the most significant are the insufficient implementation timeframes associated with various concepts included in HTI-1 and a failure to accurately consider the significant burden compliance would place on both provider organizations and health IT developers. Vendors need more time than proposed in HTI-1 to accommodate the substantial lift required to deliver safe, compliant, and high-quality versions of their certified products – 18-24 months is the commonly accepted necessary timeframe – while providers need sufficient time to implement, test and become proficient on that upgraded software. 

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Good Information Sharing Practices Released

By Leigh Burchell (Altera Digital Health), Vice Chair, EHRA Information Blocking Compliance Task Force

The EHR Association is committed to preventing information blocking and supporting efforts to share electronic health information to better patient care. As such, our Information Blocking Compliance Task Force collaborated over the past two years with stakeholders across the industry to address regulatory questions and further information exchange.

Our collaboration has produced “Good Information Sharing Practices,” a collection of best practices for health IT developers. The Practices are a practical list of proactive actions health IT developers can undertake to demonstrate their strong support for access, use, and exchange of health information and compliance with information blocking regulations. These include detailed recommendations on:

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Next Steps Towards ePA

By EHRA Chair David Bucciferro (Foothold Technology)

Health information technology (IT) holds great promise for contributing to efforts to streamline and improve the efficiency of the highly complex prior authorization process, and the EHR Association is confident that electronic health record (EHR) systems have a vital role to play in doing so. However, the adoption of electronic prior authorization (ePA) is not without its challenges – challenges that will require time, significant cross-stakeholder coordination, and standardization of access to and exchange of related data to overcome.

As we laid out in the previous three blogs in this series, the EHR Association supports streamlining the ePA process, provided the effort is appropriately supported by accepted standards and care is taken to avoid past mistakes of rolling out policy requirements faster than standards have been developed to support the work. 

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Barriers to the Creation of the Ideal Clinician Note

By Rakhal M. Reddy, MD MSHI ACHIP FACHE, EHR Association Liaison & Chair of the HIMSS Physician Committee

This is the fifth in a blog series highlighting the discussions from the 2022 EHRA & HIMSS Physician Committee Summit: Meaningful and Streamlined Documentation.

There is little doubt that documentation burden has been and will continue to be an evolving topic in healthcare and informatics over the next few years. The American Medical Association (AMA) has certainly made strides with coding guidelines that help decrease the burden of clinician notes becoming “data dumps” that capture every minute detail of a clinical encounter, regardless of that data’s relevance. Over the course of this series, we have examined the findings of our Summit’s discussion groups, which Dr. Brian Jacobs, Dani Nordin, and Dr. Bryan Bagdasian summarized.

The first breakout group was tasked with defining “The Ideal Note.” Dr. Jacobs shared the consensus opinion that notes should be concise, with information that is valued by all stakeholders. There was a desire to move towards APSO (Assessment, Plan, Subjective, Objective) notes to bring the most sought-after part of the notes to the forefront and avoid repetitive information. Essentially, the EHR does not need to be recreated in a clinical note, with every section representing data that resides elsewhere in the system. Finally, Dr. Jacobs summarized the individual and organizational barriers which put a spotlight on clinicians’ unfortunate perception of what an ideal note “should” look like (i.e. the more documented, the better) and “copy-forward” culture that bloats our notes.  

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Documentation Burden: Receiving the Ideal Note

Dani Nordin (athenahealth), Chair, EHRA User Experience Workgroup, and Bryan Bagdasian, MD, MMM (MEDITECH)

This is the fourth in a blog series highlighting the discussions from the 2022 EHRA & HIMSS Physician Committee Summit: Meaningful and Streamlined Documentation.

While the ability to create an ideal clinical note is obviously important to the delivery of healthcare, equally essential to the process is the ability for other providers and systems — as well as the clinician’s future self — to use those historical notes to understand the patient’s history and inform future care decisions.

In our second breakout session, we focused on the problem of receiving and comprehending clinical notes received from others. Participants in the group included a mix of behavioral health specialists, hospital nurses, and informatics experts, including representatives from multiple EHR vendors. Using a combination of verbal prompts and a live-updated Mural board, we facilitated a discussion to answer the following questions:

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The Ideal Clinician Note

By Brian R. Jacobs, MD, FHIMSS (eClinicalWorks)

This is the third in a blog series highlighting the discussions from the 2022 EHRA & HIMSS Physician Committee Summit: Meaningful and Streamlined Documentation.

When the EHRA and the HIMSS Physician Committee came together for a virtual Summit on meaningful and streamlined clinician documentation, three multidisciplinary breakout groups addressed key issues related to the topic. These included the ideal clinician note and barriers to creating such notes, which is the focus of this blog, as well as the exchange of the ideal note between providers and barriers to such exchange, and the specific EHR-related barriers to creating and/or consuming the ideal note. 

As noted in Documentation Burden: Addressing the Elephant in the Room, few disagree “that the focus of the note should be on the clinical encounter and ensuring the information entered clearly captures the problem, medical decision making, and ultimately help with communication between clinicians and our patients while meeting coding and regulatory compliance requirements. To continue this theme, this third blog will highlight the findings of the first Summit breakout group – which included physician, nursing, informatics, and EHR vendor representatives – discussing the topic of creating the ideal note, as well as the various barriers to creating that ideal note.

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