HHS Releases Plan to Reduce Clinician EHR Burdens

Ken Terry

February 25, 2020

The Department of Health and Human Services (HHS) has finalized its strategies to lower the burden of electronic health records (EHRs) on physicians and other clinicians to help them "focus their attention on patients rather than paperwork," according to an HHS news release.

Some of the recommendations can be accomplished by HHS alone, but many of them require the cooperation of the private sector.

Required by the 21st Century Cures Act, the 73-page strategic report was developed by the Office of the National Coordinator for Health IT (ONC) in collaboration with the Centers for Medicare & Medicaid Services (CMS).

The three primary goals of the HHS initiative are to reduce the time and effort to document patient encounters, to reduce the time and effort to meet reporting requirements, and to improve the functionality and usability of EHRs.

HHS can directly affect these areas through its rule-making process, the report states. For example, CMS recently announced changes in the evaluation and management (E/M) coding process that will take effect in 2021.

These changes, which have yet to be implemented in EHR software, make it easier to justify E/M codes on the basis of the complexity of medical decision making or the time spent on delivering care to a patient. According to the report, this new policy "can impact the EHR-related burden."

Another major thrust of the clinical documentation strategy is to simplify the prior authorization process. ONC should identify common data elements and templates that EHR developers could implement to automate prior authorization, the report states. The government should also engage with commercial payers, healthcare providers, and standards development organizations to make this happen.

The report recommends that to improve the usability of health IT, the government should focus especially on more effective clinical decision support, as outlined in a recent article from the National Academy of Medicine. Developers should also improve how EHRs present information and should standardize user interfaces to minimize disruption when clinicians switch systems.

"The industry should also consider options to develop and adopt health care–specific GUI [graphic-user interface] design components (such as flowsheet list generation and navigation components suitable to the busy clinical environment) that could better support the clinician's cognitive process and the clinical workflow," the report states.

Notably, the report also recommends that EHR companies "standardize medical information within health IT" and "standardize order entry content within health IT."

Although IT developers would have to make decisions about this kind of standardization, ONC is continuing to designate common clinical data elements as part of the US Core Data for Interoperability. Some of these data elements are part of the Consolidated Clinical Data Architecture summaries that all certified EHRs must be able to exchange with each other.

Reporting Requirements

The report notes that the former meaningful use provisions of the quality payment program (QPP), now known as Promoting Interoperability, have increased providers' EHR-related burden. CMS recently reduced the number of required measures and simplified the scoring method for clinicians and hospitals, the report states.

Nevertheless, ONC said, it's still very difficult for many practices to report quality data electronically. Addressing this challenge will require collaboration between the government and EHR developers. For example, the report notes, the government could require adoption of best practices for data mapping to improve data accuracy and reduce the reporting burden.

CMS should also continue to invest in technical assistance for providers, such as the QPP program for small practices and those in underserved rural areas, the report states.

It's still challenging for providers to report electronically to public health programs, partly because of the patchwork quilt of government regulations at the federal, state, and local levels, ONC pointed out. The report's recommendations in this area focus mainly on state prescription drug monitoring programs (PDMPs) and electronic prescribing of controlled substances (EPCS).

The report suggests that HHS work with states to increase the ability of clinicians to query PDMPs at the point of care. Under this recommendation, ONC and the states could adopt common industry standards that would integrate EHRs with PDMPs. The government could achieve this by conditioning PDMP-related federal grants on a requirement that PDMPs facilitate integration of medication histories into provider workflows.

HHS can increase the adoption of EPCS by implementing the SUPPORT for Patients and Communities Act, the report states. Pursuant to this legislation, CMS will require controlled substances covered by Medicare Part D drug plans to be electronically prescribed.

Public reporting can also be enhanced — and the EHR burden reduced — by developing a process to address the problem of inconsistent data collection by federal, state, and local public health programs, according to the report. In addition, the report states, HHS should continue to work to harmonize reporting requirements across federally funded programs.

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