New HHS recommendations focus on freeing clinicians from EHR burdens

Doctor at desk with notes, smartphone, tablet, computer, and stethoscope
Doctors haven't gotten along with EHRs. A new federal report offers some strategies to change that. (Getty Images/cyano66)

It’s no secret that physicians are bogged down by EHRs. Now, the federal government says it has some solutions.

A new draft strategy issued by the Department of Health and Human Services (HHS) on Wednesday details three overarching goals to reduce clinician burden revolving around entering information into the EHRs, meeting regulatory requirements and improving EHR ease of use. In several recommendations, the agency vowed to continue is work stripping down regulations and working with the industry to find solutions to growing problems. 

“When using their EHRs, clinicians increasingly rely on checkboxes, templates, cut-and-paste functionality, and other workarounds that may counter the intended benefits of EHRs,” senior officials with the Office of the National Coordinator for Health IT and the Centers for Medicare & Medicaid Services (CMS) wrote in a blog post. “We have heard from many clinicians that they continue to spend more time entering data, leaving less time for patient interaction.”

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EHR burdens have been a near-constant complaint from physicians that see the technology as an impediment to their relationship with patients. Numerous studies have documented the time suck of the technology.

The draft strategy, required under the 21st Century Cures Act, fully acknowledges the burdens clinicians face and the impact on productivity. Based on feedback in four workgroups, federal officials highlighted EHR burdens involving clinical documentation and associated billing requirements, usability and experience as it pertains to workflow, EHR reporting requirements through federal incentive programs and public health reporting requirements.

“With the significant growth in EHRs comes frustration caused, in many cases, by regulatory and administrative requirements stacked on top of one another,” HHS Secretary Alex Azar said in a statement. “Addressing the challenge of health IT burden and making EHRs useful for patients and providers, as the solutions in this draft report aim to do, will help pave the way for value-based transformation.”

The document is open for public comment through Jan. 28, 2019.

ONC outlined 42 specific recommendations across those domains. Some included ongoing work CMS has done through payment rules to reduce evaluation and management (E/M) coding, reduce documentation requirements for providers in certain alternative payment models and overhaul the Promoting Interoperability (formerly Meaningful Use) program.

Others identified focus areas for HHS around optimizing prior authorization and partnering with payers to streamline electronic ordering. It also called on developers to consider collaborative partnerships with clinical groups to improve workflow and usability.

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ONC also pointed to the need for industry standardization around medication information, order entry and results display, as well as the need to integrate open APIs into EHR solutions.

ONC National Coordinator Donald Rucker, M.D., wrote in the report’s opening statement that the industry is “on the verge of realizing the incredible potential of health IT to interact with clinical care in a radically different way than what we have seen thus far.” He said the recommendations outlined in the report offer important next steps to manage the growing issues around clinician burden.

“We envision a time when clinicians will use the medical record not as an encounter-based document to support billing, but rather as a tool to fulfill its original intention: supporting the best possible care for the patient,” he said.