HELP committee gets a hand from physicians on the EHR user experience

The U.S. Senate Committee on Health, Education, Labor, and Pensions (HELP) held a hearing on “achieving the promise of health information technology.” The health information technology (HIT) hearing focused on what HHS and health care providers can do to improve the user experience—particularly the physician experience—related to electronic health records (EHRs). The panel discussed how to transform EHRs from something that burdens physician-patient interactions into something more useful.

Committee

Senator Bill Cassidy (R-La), a physician, chaired the hearing and was critical of the CMS Meaningful Use program and the documentation requirements pertaining to accountable care organizations (ACOs). Cassidy expressed the belief that taxpayers have funded expensive programs in the hopes that they would receive better care and better care coordination, with disappointing outcomes. Other Committee members expressed their beliefs that the hearing was an important step to allow the Committee to learn from providers’ experiences as to how EHRs can be better integrated into the health care system. Senator Sheldon Whitehouse (D-RI) took an optimistic view of EHRs and celebrated the success of HIT innovation and the developing EHR and HIT markets.

Witnesses

The hearing included testimony from Boyd Vindell Washington, President of the Franciscan Medical Group and Chief Medical Information Officer of the Franciscan Missionaries of Our Lady Health System. Washington testified that increased user adoption of EHRs has not had the desired effect of an improved physician user experience. Washington said that EHRs have prompted complaints regarding increased time burdens, loss of provider-patient interactions, and frustrations due to workflow interruptions. To improve the status quo, Washington made three recommendations: (1) remove superfluous documentation requirements as health care becomes focused on value instead of volume; (2) standardize terminology and improve interoperability; and (3) focus patient engagement efforts on information that patients actually find valuable.

Interoperability

Timothy Pletcher, Executive Director, Michigan Health Information Network Shared Services and Adjunct Faculty at the University of Michigan Medical School, testified in support of the interoperability roadmap developed by the HHS Office of the National Coordinator. Pletcher stressed that long-term success for EHRs means preparation for “ultra-large scale data sharing.”

‘Use Cases’

To address the need for improved interoperability, Pletcher recommended that HHS focus on what Pletcher called Use Cases, or a “valuable ‘package’ of health information sharing.” Pletcher gave the following examples of Use Cases: “a pharmacy updating a state registry with a person’s recent immunization, a hospital notifying a primary care doctor that her patient was discharged from the hospital, or a behavioral health specialist informing a primary care provider of a change to a mutual patient’s care plan.” Pletcher described the approach to data sharing governance as “a Henry Ford-style mass production assembly line combined with the modularity of container shipping, all linked to lean continuous process improvement.”

Using the EHR

Meryl Moss, the Chief Operating Officer at Coastal Medical (a physician owned and governed ACO) testified about the ACO’s changing perception of the EHR from seeing it as a glorified word processor to viewing it “first and foremost as an essential tool for population health management.” Moss listed some of the ways that Coastal Medical uses EHRs, including measuring and reporting quality of care, identifying cohorts of patients for specific interventions, identifying and closing “gaps in care,” and provider to provider performance analyses. Although Moss testified that work still needs to be done, she expressed support for the EHR incentive programs and recommended that “incentive programs continue to reward EHR adoption, interoperability, improved patient access, and improvement of performance on quality measures.”