New National Coordinator of Health IT Defends EHRs

Ken Terry

September 20, 2016

In his first press conference as national coordinator of health information technology (IT), Vindell Washington, MD, strongly defended the government policy to incentivize electronic health record (EHR) adoption, despite a recent American Medical Association survey that showed that physicians were spending more time on EHR documentation than on patient care.

Dr Washington also said that under his leadership, the Office of the National Coordinator for Health IT (ONC) would focus heavily on promoting interoperability among disparate EHRs, as well as other forms of information sharing.

With a national election looming in November, Dr Washington was hesitant to talk about ONC's specific plans past the end of this year. But, responding to a reporter who asked whether ONC would still have a role if its proposed rule on oversight of EHR certification were successfully challenged in court, he said, "At this point in time, I can't conceive of ONC's role as being anything less than vital to the Administration's priorities. We have a long opportunity in front of us to push interoperability, to push standards forward, and to push information sharing for precision medicine, the cancer moon shot, and delivery system reform."

Several of the questions directed to Dr Washington concerned the growing pushback against what many doctors perceive as the crushing burden of EHR documentation on their practices and their personal time. One reporter asked him whether he believes EHRs will become more usable or whether this is just the new reality that physicians must become accustomed to.

Dr Washington replied that EHR documentation is better than it used to be with paper charts. Also, he said, "I don't hear anymore about illegible orders from physicians. I don't hear things about missing information in the same magnitude as before. And the main change is that as we talk about delivery system reform, we're doing different things across the care continuum. In many ways, this technology is critical to doing the new things as we switch from providing care just patient to patient to looking at groups of patients."

Different physicians have very different experiences with EHRs, Dr Washington noted. "Some providers implement systems, they do well, they have great patient encounter times, and they go home early or earlier than they did."

When he was chief medical information officer at Franciscan Missionaries of Our Lady Health System in Baton Rouge, Louisiana, and president of that system's medical group, he recalled, there was a pulmonologist who improved his efficiency by using an EHR to review radiology reports before he came to the hospital. On the other hand, he admitted, other physicians "are spending time at home [completing EHR documentation] when they'd rather be with their families.

"When the picture is so diverse," he added, "that means we're still in an early evolutionary phase where it comes to the usability of EHRs."

Interoperability Focus

Dr Washington sketched out the three elements that he believes are crucial to the advancement of interoperability: national IT standards, payment changes, and cultural changes related to the sharing of information between providers and patients. Regarding these cultural changes, he said, ONC is working closely with the Office of Civil Rights "to make sure that patients know that [their health] information should be available when and where they need it for their care."

Before Dr Washington joined ONC as principal deputy national coordinator under Karen DeSalvo, MD, he told a Senate committee that to improve interoperability among EHRs, the government should set IT standards in certain areas. Asked at the press conference whether he still believed that, he said he did. He cited ONC's 2016 Interoperability Standards Advisory, which lists a number of standards that the office categorizes as the "best available," although it does not mandate any.

Dr Washington further noted that as these standards mature, the government can draw attention to the specificity required to exchange information. However, he said, "you leave enough room for innovation across the [health IT] sector."

At another point, he said, "Standards will always be a white-board exercise until they are in wide and deep use. So even if you and I decide we're going to use certain standards, what we're particularly interested in is having specific use cases, which will help us get to standards adoption."

What will really move the needle on interoperability, he said, are the ongoing changes in how physicians are reimbursed as part of the larger delivery system reform that public and private payers are driving.

"If you're in an environment where 25% of patients are in accountable care arrangements and the rest are in fee for service, you're not in a position to reap the full benefits [of health IT], and you're straddling the fence in terms of your workflow and your patient care," Dr Washington explained. "There will be improvements for physicians as we work our way through delivery system reform."

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