Standards, Certification, and ePA: Proceed with Caution

By Hans Buitendijk (Oracle Cerner), EHRA Chair

This is part one in a four-part series examining the need for electronic prior authorization (ePA), the barriers presented by the current environment, necessary capabilities and functionality, and the EHR Association’s policy recommendations.

The prior authorization process required by health plans and payers frustrates patients and providers alike because of inconsistent requirements and associated delays, and it isn’t going away. 

It is clear that there is an opportunity to apply health information technology (IT) toward the goal of improving efficiency in this area, but doing so will be a challenge that requires significant cross-stakeholder coordination and standardization of related data. The need for a collaborative focus is further exacerbated by the widely varying approaches to the adoption and deployment of health IT systems among providers. Further, the process itself touches many different points and players in administrative, clinical, and financial workflows. 

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

In our 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 that exercise and describes a path forward. This article will focus on the second of the two topics: Personalizing the EHR and Understanding the Patient.

Personalizing the EHR
A common thread for “personalizing the system” is that while there are often tools available to personalize and configure the system, they can be difficult to discover, challenging to scale and share, and overwhelming to interact with in the clinician workflow. If it were simpler to personalize or optimize one’s own EHR experience, there would be little need for an organization to conduct optimization exercises after the initial implementation. After spending eight or more hours in formal training, and then significant time post go-live with practical EHR use, having some simple means available for self-configuration might remove additional hours of optimization, which will in turn reduce physician frustration.

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Enhanced EHR Usability Starts With Understanding Users’ Needs and Challenges

By the EHRA Clinician Experience Workgroup

EHR utilization places a number of burdens on clinicians that can impact decision-making, workflow and satisfaction. This has been confirmed by recent studies, including one published earlier this year by the Journal of Biomedical Informatics which found that clinicians face numerous cognitive demands when using EHRs. The study concluded that the management of those demands ultimately limits clinicians’ agency to work individually and collaboratively while failing to help them develop awareness of, or reason about, the big picture or their patients’ current and future states, including effects of potential treatments. 

A study in Journal of the American Medical Informatics Association (JAMIA) found that when goal-based decision-making, sense-making, and agency/autonomy are overlooked in EHR design, it results in increased cognitive load, emotional distress, and unfulfilling workplace environments. And a study from Mayo Clinic and the American Medical Association (AMA) and published in Mayo Clinical Proceedings, gave EHR usability a grade of F, which is “markedly lower” than for most other technologies. Researchers further noted a strong relationship between usability and risk for physician burnout.  

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