With physicians spending more time entering data into electronic health records and less time engaged in direct patient care, the Office of the National Coordinator for Health IT is making the streamlining of the EHR documentation process and reduction of clinical burden one of the agency’s top priorities.

John Fleming, MD, deputy assistant secretary for health technology reform, is ONC’s point man for working with the Centers for Medicare and Medicaid Services to reduce the documentation burden on providers.

According to Fleming, about 50 percent of physicians’ time is being spent in the EHR rather than patient care, which is hindering their ability to practice medicine at the top of their license.

To address the problem, Section 4001 of the 21st Century Cures Act directs ONC in partnership with CMS to establish a goal and develop a strategy for reducing regulatory and administrative burdens related to the use of EHRs.

Under this mandate, ONC and CMS have set their sights on reducing the burden of Evaluation and Management (E&M) codes on physicians. E&M coding is the process by which physician-patient encounters are translated into five-digit Current Procedural Terminology (CPT) codes, which are submitted to insurers for payment.

“What everybody says is that the one probably biggest burden is the E&M codes,” said Fleming on Wednesday between speaking engagements at the HIMSS18 conference in Las Vegas. “The E&M codes are really the flashpoint in all of this.”

Last year, the American College of Physicians published a position paper with a set of policy recommendations on reducing excessive administrative tasks, including E&M codes.

On Tuesday at the HIMSS18 conference, CMS Administrator Seema Verma announced the launch of the MyHealthEData initiative aimed at putting patients in control of their own health data. As part of the effort, Verma said the agency will be instituting a “complete overhaul” of the Meaningful Use program, including streamlining policies around documentation guidelines for E&M codes to modernize documentation requirements and reduce clinician burden.

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While Fleming noted that CMS and ONC “have not come to any specific solution yet” with regard to E&M codes as part of the MyHealthEData initiative, he added that the current code documentation guidelines were created in 1995 and revised in 1997 and are in desperate need of modernization.

“We look forward to working with the administration in fleshing out the details to ensure that physicians get to spend more time caring for their patients and less time on administrative tasks,” said David Barbe, president of the American Medical Association, in a written statement. “There is room for improvement, and we are excited that Administrator Verma agrees.”

“It’s very proscriptive,” Fleming said of the E&M coding guidelines, adding that “the runner up—if you will—for the most burdensome (requirements) is quality measurement and quality reporting.”

For its part, the College of Healthcare Information Management Executives applauded the administration’s MyHealthEData initiative aimed at working to streamline documentation and billing requirements for providers to allow doctors to spend more time with their patients.

“We also agree that the Meaningful Use program and Quality Payment Program warrant substantial changes,” said CHIME Board Chair Cletis Earle in a written statement. “We welcome a renewed focus on interoperability and one that reduces the cost and time required for compliance.”

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