By 2020, electronic health records should support person-centric care delivery, according to an American Medical Informatics Association panel. To get there, health IT developers and policy-makers should work on: simplifying and increasing the speed of clinical documentation; refocusing government regulations; increasing transparency of EHR certification; and promoting innovation, the AMIA EHR-2020 Task Force said.
In an article published Friday in the Journal of the American Medical Informatics Association, the EHR-2020 Task Force, made up of 14 veterans of medical informatics, issued 10 recommendations in those four areas, with the goal of a person-centric, learning health system in the next five years.
“We really believe that medicine is a team sport,” AMIA President and CEO Dr. Doug Fridsma told MedCity News. “Documentation needs to be inclusive of all perspectives and also make sure that patients can be first-order participants” in care decisions, he added.
On the regulatory front, Fridsma said he sees a “tension between saying we’re moving too fast and the need to accelerate safety efforts.” The federal Meaningful Use EHR incentive program seems to be taking incremental steps, according to Fridsma, who was chief science officer in the Office of the National Coordinator for Health Information Technology for four years before taking over Bethesda, Md.-based AMIA last November.
“We need to accelerate toward a final end state, not just the next step,” Fridsma said. For example, all clinical decision support measures in Meaningful Use or other federal EHR rules should be linked to specific Centers for Medicare and Medicaid Services quality measures, according to Fridsma.
“While we recognize that there are challenges with implementing and using EHR technology, this report is aimed at practical solutions that we believe will improve health and health care for patients and their caregivers. We are hopeful that it will generate the thoughtful conversations and innovations that will make what is possible, real for all patients,” EHR-2020 Task Force Chairman Dr. Thomas Payne said in an AMIA press release.
The EHR-2020 Task Force recommendations include:
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
- Lessen the data entry burden for clinicians.
- Separate data entry from data reporting. Let nonphysicians, including patients and their families, enter some of the data.
- EHRs should support systematic learning and research at the point of care during routine practice for both billing and care-delivery purposes.
- Regulators should: clarify and simplify EHR certification procedures; emphasize health information exchange and interoperability; cut the need for duplicate data entry; and make patient outcomes the goal of certification rather than EHR functionality.
- Reimbursement rules should “support novel changes and innovation in EHR systems.”
- There should be more transparency for the EHR certification process in order to improve usability and patient safety.
- Healthcare providers and vendors alike “should be fully transparent about unintended consequences and new safety risks introduced by health information technology systems, including EHRs, as well as best practices for mitigating these risks.”
- Vendors should use application programming interfaces and follow public, open data standards.
- EHRs should be integrated into the “full social context of care, moving beyond acute care and clinic settings to include all areas of care: home health, specialist care, laboratory, pharmacy, population health, long-term care and physical and behavioral therapies.”
- User interfaces should be intuitive because, as the article says, “Usability is a real science and goes beyond screen design.”
“The problems we face today in EHR use are complex and solutions will not be simple or quick. Solving these problems will require regulatory stability, the development of an acceptable threshold ‘barrier to entry’ into the EHR marketplace, and a supportive national policy,” the task force wrote. “We recommend a focus on these five areas during the next 6-12 months, while we develop a long-term framework for innovation for EHRs.”
AMIA said in the article that it will dedicate its entire invitation-only health policy meeting this year to EHRs.
Payne is scheduled to discuss the findings Friday at AMIA’s iHealth clinical informatics conference in Boston.
