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. 


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.  


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:


Meaningful and Streamlined Documentation

An Overview of the EHRA & HIMSS Physician Committee Summit 2022

By Hans Buitendijk (Oracle Cerner), Chair, EHR Association 

A key role of the electronic health record (EHR) is to enhance clinical decision-making and enable clinicians to plan and document patient care – information that is then communicated with other systems. But there are challenges that impede the EHR’s ability to fulfill that role to its fullest extent. These challenges and proposed solutions were the focus of the 2022 EHRA & HIMSS Physician Committee Summit: Meaningful and Streamlined Documentation.

Whereas the 2021 Summit focused on the state of clinical notes – including publication of best practices for drafting ideal notes – this year’s event focused on challenges inherent with EHRs and documentation. These challenges fall into the categories of clinical, quality reporting, operational, billing, regulatory, and registry requirements, as well as ease of documentation, ingesting and integrating data, and achieving meaningful decision support. In short, there is a wide range of often overlapping or conflicting requirements that EHRs need to address while enabling clinician users to enhance their clinical decision-making and plan and document patient care – but challenges stand in the way. 


Putting Policy Before Standards Can Create Serious ePA Roadblocks

By Leigh Burchell (Altera Digital Health), EHRA Public Policy Leadership Workgroup Chair

This is part three in a four-part series examining the need for ePA, the barriers presented by the current environment, necessary capabilities and functionality for progress, and the EHR Association’s policy recommendations. Read part two here

There is a strong use case for electronic prior authorization (ePA), given the frustration providers have with the burdensome current processes, and health IT developers recognize the potential that exists for our technologies to assist with making our clients’ lives easier in this area. However, the road to success with ePA will be rocky if it is not broadly rolled out at a pace and with a legal/regulatory cadence that aligns with the ability of stakeholders to deploy and use solutions that follow consistent standards. Therefore, the EHR Association supports the promulgation of ePA requirements only when undertaken in a way that avoids prior policy mistakes of pushing faster than standards development can keep up. 

Rolling out ePrior Authorization will be complex, even moreso than similar efforts at digitization we’ve already accomplished. This complexity stems from the need for change – and adoption of agreed-upon standards – by multiple stakeholders with varying levels of readiness.  For example, it is important to work closely with payers to ensure their readiness for the required bidirectional information flow using standards and to ensure functionality can be sufficiently tested. This also helps avoid a scenario in which payers roll out individual requirements to which EHR developers and providers will have to respond, which would be highly inefficient. 


Standards will Make or Break Efforts Toward ePA

By Janet Campbell (Epic), EHRA Public Policy Leadership Workgroup Vice Chair

This is part two in a four-part series examining the need for ePA, the barriers presented by the current environment, necessary capabilities, and functionality, and the EHR Association’s policy recommendations. Part one can be read here.

Streamlining the electronic prior authorization (ePA) process will require significant coordination and standardization across multiple domains within individual healthcare organizations, across dozens of health plans covering their patients, and across the health IT tools in use by every participant in the process.

Progress is being made by various stakeholders in terms of standards development. Notably, the Coverage Requirements Determination (CRD), Documentation Templates and Rules (DTR), and the Prior Authorization Support (PAS) implementation guides – all a part of the Da Vinci Project’s efforts to understand functional requirements, build consensus on a technical approach, pilot, and iterate – have resulted in significant progress toward the enablement of highly automated prior authorization workflows.

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