The Ideal Clinician Note and Barriers to its Creation

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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2022 Clinical Workflow Flexibility Challenges in the EHR: Defining the Problem (Part Three)

In our two previous articles, we described an “as-is” exercise with the EHRA workgroup and the HIMSS Physician Committee members where one issue became the focus: the flexibility of workflows. This series of blog posts reviews the results of the exercise and describes a path forward. So far, this series has covered Learning the EHR, Personalizing the EHR and Understanding the Patient. In this article we discuss the fourth and final topic that was raised: Providing Care.

Providing Care
Providing medical care for the patient necessitates “last mile” flexibility that allows clinicians to jump in and out of the expected workflow. It has been demonstrated that a defined “workflow” that physicians agreed upon during development most commonly erodes after the first several steps. (1,2) The ability to step back into the workflow after a short detour needs to be readily available in an intuitive and simple manner. There should also be flexibility in how the EHR is used, both to conform to an individual’s working style as well as to respond to the demands of a clinical situation. Along these lines, but not limited to them, is the ability to have more than one patient record open with safeguards that ensure the correct data is always entered into the right patient’s chart.

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What Role Can Health IT Play When an Epidemic Meets a Pandemic?

By David Bucciferro (Foothold Technology), co-chair of the EHRA and the Opioid Task Force, and Renee Han (Epic), Opioid Task Force member

Over the past several years, community service and health professionals have fought hard to gain ground in the battle against the opioid epidemic. From 2017 until 2020, the number of patients receiving buprenorphine, methadone, or naltrexone – common medications for opioid use disorder (MOUD) – consistently increased as more patients at risk for OUD and overdose were identified and treated, according to a report from Epic Research

First-time MOUD, buprenorphine, and naltrexone patients over time. Solid colored capsules show the last observed value. Dashed outline capsules show the predicted value for May 2020. (Source: Epic Research.)

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“No Surprises Act” Regulations Raise Concerns

By Leigh Burchell (Allscripts), Chair, & Janet Campbell (Epic), Vice Chair,
EHRA Public Policy Leadership Workgroup

The growth in high deductible health plans requiring patients to shoulder more of their healthcare costs and the lack of transparency in healthcare pricing has exacerbated the issue of patients left with surprise medical bills that many cannot afford to pay. The urgent need to address these serious issues is why the EHRA supported the No Surprises Act when it was developed and welcomed the regulations published last year as a foundation upon which it can be implemented. 

However, we have several concerns about rulemaking to date as it relates to workability and the unnecessary burden it creates for industry stakeholders. To that end, we reached out proactively to regulatory agencies to provide feedback in four key areas that we believe – based on our member companies’ experiences and our ongoing advocacy for reasonable timelines and requirements – will be informative when it comes to additional regulatory actions expected later this year. 

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Congratulations & Thank You

By Barbara Hobbs, Chair, EHRA Membership Committee

The EHRA would not be possible without members – backed by their organizations – who are willing to dedicate time, expertise and other resources needed to work toward our mission of accelerated health IT adoption and interoperability, use of data to improve the efficiency of care delivery and advancing patient outcomes through enhanced quality.

As we move on from 2021, we want to take this opportunity to extend a very special thank you to the volunteers who keep EHRA running. In particular, we’d like to congratulate Barbara Hillock of Harris Healthcare, who was named our 2021 Most Active EHRA Individual Member, and Medsphere, the 2021 Most Active EHRA Member Company.

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New Guide Offers Guidance for Digitizing Opioid Tapering Plans

By Daniel Seltzer, Co-chair of the EHRA Opioid Crisis Task Force

Care disruptions due to the COVID-19 pandemic and other ongoing events have put long-term opioid therapy (LTOT) patients at increased risk for opioid-related harm and heightened the urgency around addressing the opioid crisis. This has, in turn, presented a significant opportunity to leverage technology to improve certain care processes around opioid therapy, starting with digitizing the tapering plan and incorporating existing clinical practice guidelines into clinical decision support (CDS) tools. 

These are areas that have been researched extensively by EHRA’s Opioid Crisis Task Force, which was formed in 2018 to explore and recommend ways EHR technology can help solve the complex opioid crisis puzzle. This research culminated in the newly released Opioid Tapering Implementation Guide for Electronic Health Records, a set of clinical practice guidelines that can be operationalized to improve opioid stewardship and opioid tapering in clinical practice. 

EHRA’s goal with this Opioid Tapering Guide is to enable an organization’s health IT team to implement tapering best practices more rapidly using EHR-based CDS tools. The EHR developer community can also use it to steer the future development of new or updated products and services that can help hospitals, physician practices and other care environments implement these and other best practices. 

In developing the guide, the Task Force leveraged evidence-based guidelines on opioid tapering published by several organizations and agencies with subject matter expertise, including clinical recommendations from the United States CDC, VA/DOD, and HHS. These referenced guidelines include tapering plans for pain lasting longer than three months or past the normal tissue healing time frame, outside of active cancer treatment and palliative or end-of-life care. 

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