On May 29, the American Informatics Association (AMIA) released a task force report on Electronic Health Records (EHRs). The Report of the AMIA EHR 2020 Task Force on the Status and Future Direction of EHRs was published in the Journal of the American Medical Informatics Association; findings were presented last week at the AMIA iHealth 2015 Clinical Informatics Conference in Boston.
The report recommends changes to EHR systems that will support patient engagement, improve provider workflow, support innovation and set the stage for future improvements. "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 healthcare for patients and their caregivers," said Thomas Payne, MD, Chair, AMIA EHR 2020 Task Force. "We are hopeful that it will generate the thoughtful conversations and innovations that will make what is possible real for all patients."
The report makes 10 recommendations in the following five areas: 1) simplifying and speeding documentation; 2) refocusing regulation; 3) increasing transparency and streamlining certification; 4) fostering innovation; and 5) supporting person-centered care delivery.
Here is what you need to know about the 10 recommendations:
1. Decrease data entry burden for clinicians.
According to the report, much of the information relevant to patient diagnosis and treatment could be entered by other members of the care team, captured automatically by devices or other information systems or captured and entered by patients themselves, which would save time for clinicians.
2. Separate data entry from data reporting.
The task force suggests that the patient, family members and members of the care team enter the data, which can then be used in multiple ways to generate customized reports, including formal visit notes, letters to referring providers, billing records and quality assessment reports. It also says that vendors should enhance their patient portals to support data collection from the patient and increase support for multiple modes of data entry to accommodate provider preferences.
3. Enable systematic learning and research at the point of care during routine practice.
This would require studies by major research organization, such as the Agency for Healthcare Research and Quality or the National Institutes of Health, to gain a better understanding of the costs (in time) and benefits (to care delivery, research, and billing) of different approaches to capturing and reporting clinical data.
4. Refocus regulation.
According to the report, regulation should focus on clarifying and simplifying certification procedures and meaningful use regulations, improving data exchange and interoperability, reducing the need for re-entering data and prioritizing patient outcomes over new functional measures.
5. Support novel changes and innovation in EHR systems when changes are made to reimbursement regulations.
The task force points out that reimbursement regulations are changing with healthcare reform, which necessitates new EHR documentation and reimbursement models. It also says that working with CMS and other payers is essential to ensure that the EHR of the future can fulfill the need for comprehensive, usable documentation as well as reimbursement.
6. Make methods of vendor satisfaction of certification criterion flexible and transparent.
The report says this will improve usability and safety, foster innovation and empower providers and EHR purchasers by informing the market and enhancing competition among vendors. It also says the information should be made public on the certifying body's website.
7. Make unintended consequences and new safety risks introduced by health information technology systems, as well as best practices for mitigating these risks, fully transparent.
This applies to healthcare organizations, providers and vendors. The intent is to improve usability and safety and to foster innovation.
8. Use public standards-based application programming interfaces and data standards that will enable EHRs to become more open to innovators, researchers and patients.
According to the task force, access to EHR data and functionality will drive innovation and research into better systems and empower patients to engage in their care.
9. Promote the integration of EHRs into the full social context of care, moving beyond acute care and clinic settings to include all areas of care.
The task force says that the ability to incorporate data from different sources is essential, and that including patient-generated data, population data and community contexts into an EHR will spur development of new care delivery models, improve population health, aid in the development of precision medicine and support other healthcare transformations.
10. Improve the designs of interfaces so that they support and build upon how people think (i.e., cognitive-support design).
According to the report, these designs would include empirical findings from such areas as human factor engineering, as well as traditional social sciences (e.g., anthropology, psychology, sociology, economics).