The Department of Health and Human Services is firmly committed to reducing the regulatory and administrative burdens on clinicians who use electronic health records, as required under the 21st Century Cures Act.
That’s the message the Centers for Medicare and Medicaid Services and Office of the National Coordinator for Health IT delivered on Thursday during a listening session with stakeholders intended to get feedback on the challenges and opportunities for alleviating burdensome EHR requirements.
Kate Goodrich, MD, chief medical officer and director of the CMS Center for Clinical Standards and Quality, predicted that 2018 is going to be a “pretty significant year in terms of regulatory reform and administrative burden reduction.”
This past October, CMS launched the Patients Over Paperwork initiative to reduce regulatory burdens on providers to enable them to spend more time on clinical tasks. That same month, the agency announced the Meaningful Measures initiative intended as a new approach to quality measurement and to streamline current measure sets, moving from process measures to a focus on outcome-based measures.
Goodrich noted that CMS has already addressed some “very simple low-hanging fruit” when it comes to quality and safety oversight requirements “without going through regulation.” Likewise, Melanie Combs-Dyer, CMS director of the Provider Compliance Group at the Center for Program Integrity, touted the “sub-regulatory EHR accomplishments” to date.
Nonetheless, Goodrich observed that there’s “lots more work” remaining to be done with EHRs.
According to ONC’s Chief Medical Officer Thomas Mason, MD, the Cures Act calls for a “wide, sweeping range of policies” for ONC and CMS to work on that “leverage and support the effective use of health IT,” including “how EHRs can be made better to better support clinicians for a broad range of use cases.”
In particular, Mason said the law mandates that HHS—in consultation with a diverse group of stakeholders—develop a goal, strategy and recommendations “with respect to the reduction of regulatory and administrative burden, such as documentation requirements relating to the use of electronic health records.”
During the public comment part of Thursday’s CMS-ONC listening session, Brian Jacobs, MD, chief information officer and chief medical information officer at Children’s National Health System, remarked that the burden of EHR documentation is the “No. 1 source of dissatisfaction” for the organization’s clinicians, resulting in their inability to properly engage patients.
Jacobs called for reducing the volume of documentation, describing the time burden for providers at Children’s National Health System as “excruciating,” in light of the more than 500,000 patient encounters and 500,000 notes documented annually.
“We have physicians that are spending, two, three, four or more hours beyond their day—every day— doing documentation,” he observed. “If you look at the situation in other countries, where they’re not as heavily regulated in what needs to go into documentation, the notes can be very small.”
Jacobs recommended reducing the size of the notes and taking advantage of the structured and unstructured documentation that “permeates the electronic health record.”
Similarly, Epic’s Sasha TerMaat, chair of the EHR Association, said that “measures like note length and amount of time spent within the system—or other system activities—might be useful opportunities” to reduce the documentation burden.
According to John Fleming, MD, deputy assistant secretary for health technology reform at ONC, addressing EHR documentation is among the agency’s top priorities. “If we all provided care at the top of our license, rather than doing clerical jobs that someone else could do perhaps or can be done in a more streamlined way,” he suggested that patients would be better off.
In wrapping up the listening session, Fleming referenced a study that evaluated physician behavior over a three-year period, which reported that doctors spent 50 percent or more of their time working in the EHR instead of being with patients.
Andrew Gettinger, MD, ONC’s chief clinical officer, concluded the day-long event adding that “our work won’t be done until the EHR and other health IT tools are things that clinicians, who are taking care of patients, can’t imagine doing without because they need them—and, we haven’t gotten that sense today.”
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