On May 29 the EHR-2020 Task Force of the American Medical Informatics Association issued a report with recommendations on the status and future directions of EHRs. Thomas Payne, M.D., medical director of IT services at University of Washington Medicine and chair of the task force, called me from AMIA’s iHealth 2015 Clinical Informatics Conference in Boston to discuss the recommendations.
I mentioned to him that several of the recommendations, including the very first one, target cutting down on the amount and complexity of documentation clinicians have to do. I asked Dr. Payne why the task force put such a strong emphasis there?
“The reason we focused on that area is because it is causing a great deal of problems in practices,” Payne said. “Providers are very vocal in describing the burden this poses to them. And people who go to see those providers are also noticing that they don’t get the attention and focus that they used to. They see their doctor and nurse staring at a computer screen. It is lengthening the days of providers, interfering with the interaction that people have with providers and taking providers away from what they do best. That is why it is in the first set of recommendations.”
He added that practitioners do not mind documenting if it impacts the person they are caring for. They understand how important it is. “They question when documentation requirements don’t directly benefit the person sitting across from them,” he said. “It is occupying a fair amount of time in the patient encounter. Patients notice this too.”
Although the group did not offer specific recommendations about Stage 3 of meaningful use, it did make some more general observations about CMS calling for more functionality as opposed to focusing on improving outcomes. “Our group feels that we have adequate functionality to accomplish a great deal of good as things stand today,” Payne said. “We are hopeful we will give providers and vendors time to fully capitalize on the functionality in place. We are not discussing the specifics of Stage 3 in this report. But in general we believe it is a good time to consider solidifying the functionality there today and carefully consider any additional requirement that extends the time at the point of care. That is having an impact that we all didn’t anticipate.”
Other recommendations call for more transparency both in the certification and EHR safety realms. Payne said that although in some cases there are legitimate concerns about intellectual property and a competitive marketplace, the task force felt that more openness would lead to a better match between EHR vendor and provider, and that better match will lead to more satisfactory use of that product.
“We also feel that transparency is important when things don’t go as planned,” he said. “When safety risks are identified, those should also be transparently available to others, and the workarounds to mitigate those risks should also be available to others. We think it would be helpful if we have some means of aggregating these discoveries that would permit everyone to reduce the risks. The specifics of how that would happen, is a topic AMIA will take up at its policy conference this fall, Payne added, “because it is important we get that right.”