Senators Look to Improve EHRs from Physician Perspective

A Senate committee on Tuesday examined how to improve electronic health record systems, focusing on the physician experience with EHRs which continue to be a source of widespread dissatisfaction.

Sen. Bill Cassidy (R-La.), himself a doctor, told the Senate Health, Education, Labor, and Pensions Committee that unfortunately physicians are spending more time entering data into EHRs and less time speaking to and examining patients. “As a physician, time is better spent looking into a patient’s eyes as opposed to clicking on a computer screen to document something unimportant to the patient but required by someone far removed from the exam room,” said Cassidy.

Tuesday’s hearing was the second in a series of hearings on developing possible solutions—either through administrative or legislative action—to address the failed promise of EHRs, which have the potential to make healthcare more efficient while also reducing costs and medical errors.

Also See: Senate Committee Targets EHR Improvements, HIE

Sen. Sheldon Whitehouse (D-R.I.) argued that health information technology is the key to enabling national healthcare priorities such as the Obama administration’s $215 million Precision Medicine Initiative and the industry’s transition from fee-for-service to value-based payment models. Health IT is “critical national infrastructure that should be seen just like our highway system,” said Whitehouse, who argued that EHR adoption is necessary to achieve healthcare transformation “but not sufficient and it needs to be done well.”

However, he asserted that EHRs must be significantly improved in the areas of usability and interoperability before the nation can achieve a learning, improving health system. “There’s a lot of frustration to go around,” Whitehouse added. “We have a lot to learn from providers’ experience integrating EHRs into the practice of medicine.”

Boyd Vindell Washington, M.D., president of the Franciscan Medical Group and chief medical information officer of the Franciscan Missionaries of Our Lady Health System in Baton Rouge, La., cited increased data-entry and documentation burdens on physicians, loss of provider-patient interaction, and frustration with new meaningful use requirements as clinical workflows change. “There’s really been a lot of stress as providers try to meet these requirements.”

To improve the physician user experience, he recommended adjusting the required documentation for billing and quality to more accurately align with new care models. “Too much effort is spent recreating the attestation and documentation check boxes that existed in the paper world, which are just no longer relevant as we switch to electronic medical records,” according to Washington, who made the case that checking boxes to show that data was reviewed or that tests were performed place unnecessary burdens on providers and do not substantially improve patient care.   

Cassidy called the requirements of the meaningful use EHR program “overly burdensome,” referencing the fact that only 11 percent of eligible professionals have successfully attested to Stage 2 even though penalties for non-compliance begin this year. “Meaningful use requirements are so burdensome that many doctors will take a financial penalty because of an inability or unwillingness to comply,” he commented. According to the Centers for Medicare and Medicaid Services, EPs will pay about $200 million in 2015 in the form of Medicare payment reductions for their failure to become meaningful users of EHRs.

Nonetheless, Meryl Moss, chief operating officer of Coastal Medical, the largest physician-owned and primary care-driven accountable care organization in Rhode Island, testified about the importance of federal EHR incentive programs and the value of EHR certification standards.

“We would recommend that incentive programs continue to reward EHR adoption,interoperability, improved patient access, and improvement of performance on qualitymeasures,” said Moss. “These programs help us to focus on what is most important, and provide revenue for infrastructure support that is in short supply in many physician groups.In addition to financial support, the meaningful use program organized providers and vendorsaround a single set of measures designed to positively impact patient care.”

She also said that Coastal Medical “greatly appreciated” the EHR testing and certifying body Certification Commission for Health Information Technology, given that “physicians and physician groups often do not have the expertise, sophistication or bandwidth to differentiate between individual electronic health records and ensure that the required functionality truly exists in an EHR product.” As a result of CCHIT certification, Moss concluded that physicians “could be certain that the record would allow the practice to achieve meaningful use if used appropriately.”