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At AMDIS, AMIA’s Fridsma Promotes the Rethinking of MD Documentation for EHR Usability

June 26, 2015
by Mark Hagland
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On June 24 at the AMDIS Physician-Computer Connection Symposium, Doug Fridsma, M.D., Ph.D. urged CMIOs to help rethink usability and function in EHRs

On June 24, Doug Fridsma, M.D., Ph.D., in a presentation to the AMDIS Physician-Computer Connection Symposium being held at the Ojai Valley Inn and Spa in Ojai, Calif., shared with CMIO attendees some of the latest activity going on with regard to the American Medical Informatics Association (AMIA), the association of which Fridsma became president and CEO last fall, after having served as chief science officer in the Office of the National Coordinator for Health IT.

Fridsma shared with his CMIO colleagues some of the highlights of the recently released “Report of the AMIA EHR 2020 Task Force on the Status and Future Direction of EHRs,” referred to in shorthand as “EHR 2020.”

Doug Fridsma, M.D., Ph.D.

As part of the opening of that report, published online on May 29 in the Journal of AMIA (JAMIA), notes, “Over the last five years, stimulated by the changing healthcare environment and the HITECH Meaningful Use (MU) EHR Incentive program, EHR adoption has grown remarkably, and there is early evidence of benefits in safety and quality as a result. However, with this broad adoption many clinicians are voicing concerns that EHR use has had unintended clinical consequences, including reduced time for patient-clinician interaction, transferred new and burdensome data entry tasks to front-line clinicians, and lengthened workdays.” Further, the report’s introduction stated that “Interoperability between different EHR systems has languished despite large efforts. These frustrations are contributing to a decreased satisfaction with professional work life. In professional journals, press reports, on wards and in clinics, we have heard of the difficulties that the transition to EHRs has created.”

With regard to the way forward, the authors of the report said in their introduction, “Ultimately, our goal is to create a robust, integrated, inter-operable health system that includes patients, physician practices, public health and population management, and support for clinical and basic sciences research. EHRs are an important part of this ecosystem, along with many other clinical systems, but future ways in which information is transformed into knowledge will likely require all parts of the ecosystem working together. This ecosystem has been referred to as the ‘learning health system.’”

What’s more, the report’s authors noted, “Potentially every patient encounter could present an opportunity for patients and clinicians alike to contribute to our understanding of health care and participate in research and clinical trials. As part of the learning health system, EHRs have long been touted as beneficial to the safety and quality of health care, and studies have shown potential benefits related to information accessibility, decision support, medication safety, test result management, and many other areas. However, implementation of any new technology leads to new risks and unintended consequences; these too have been well documented.”

Speaking of the release of “EHR 2020,” Fridsma told the AMDIS audience on Wednesday that Senator Lamar Alexander, chair of the Senate HELP Committee, “was running around at Vanderbilt, saying, ‘This is something that addresses a lot of the concerns we have.’”

Fridsma noted in his comments that the effort that led to the “EHR 2020” report predated his tenure at AMIA, but reflects the broad focus of the association at this point in time. “We brought together experts to say, what will the EHR look like in the next few years, and what kinds of things could we discuss? And then the Senat HELP Committee testimony that occurred ten days after this was done” created results. “Lamar Alexander took the five principles and said, ‘I’m going to have five hearings on those principles.’” And that, Fridsma said, is what is expected to happen.

Fridsma summarized the learnings shared in the report by noting four main areas of focus. “The first thing we had in the report,” he said, “was that we need to simplify documentation. We went through a series of discussions on why documentation is so complex. We are accelerating to the next stage, but we’re not necessarily getting to the end goal. So we create a whole series of activities” around physician documentation, as a health system, he said, “one set around what is required by regulation, and the other necessary for patient care. Some of this is tied to how our reimbursement works. But the most important development at ONC was the CMS [Centers for Medicare & Medicaid Services] targets for alternative payment models, because that gives physicians and other providers financial incentives to move forward in this area. That will be more of an incentive than Stage 3 of meaningful use, which was really front-loaded.”

The other areas of focus of the report were the need to make regulation more focused; the need to increase transparency around EHR functions; and the need to encourage innovation. As for encouraging innovation, Fridsma told his audience, “That really speaks to a lot of the work going on at ONC right now around FHIR, etc. We’re moving from document-centered ways of viewing information to data-centered ways of viewing information. The EHRs we are using today are not the EHRs that the people we are training today are going to be using. And the way we’ll get there is to encourage APIs and other solutions.”