White Paper Outlines Recommendations to Improve EHR Usability

DirectTrust Urges Physicians to Provide Feedback

February 21, 2017 02:16 pm Sheri Porter

A brand new draft white paper that addresses issues related to the usability and interoperability of electronic health records (EHRs) has the potential to rock the world of family physicians -- and in a very good way.

The paper's authors are asking the companies that develop EHR systems to make long-overdue improvements to products physicians need to support health record sharing for care coordination and transitions of care.

The white paper(www.Directtrust.org) from DirectTrust lays out 50-plus feature and function recommendations aimed at jump-starting action among the more than 350 vendors who provide information exchange through Direct Interoperability, a protocol for secure electronic sharing of health care information.

Some of the top-priority Direct Interoperability recommendations outlined in the paper include assurances that a system is able to provide

Story Highlights
  • A recently released white paper lays out more than 50 recommendations for how health IT vendors can improve their products with secure electronic sharing of health care information.
  • Some of the top-priority recommendations are delivery of messages in real time; inclusion of patient-specific attachments; and reconciliation of active patient medications, problems, allergies and immunizations.
  • The paper was authored by a clinician steering workgroup within DirectTrust, a nonprofit association that is urging family physicians and other clinicians to read the paper and provide feedback to strengthen the recommendations.
  • delivery of messages and attachments in real time rather than in prescheduled batches;
  • triggering of messages automatically, initiated by specific events such as a patient's hospital discharge;
  • inclusion of patient-specific attachments;
  • reconciliation of active patient medications, problems, allergies and immunizations;
  • automatic matching of incoming messages to patients for whom a record already exists in the recipient EHR; and
  • support for a variety of attachment types, including Word files and PDFs, as well as image files such as JPGs and GIFs.

In a Feb. 13 press release(www.marketwired.com) introducing the paper, Steven Lane, M.D., M.P.H., co-chair of the clinician steering workgroup responsible for its drafting, explained the importance of the project.

"Sharing patients' clinical information across commonly encountered boundaries of health IT systems is critically important to clinicians and their teams who are coordinating their patients' care across different providers and organizations," said Lane, clinical informatics director at Sutter Health Palo Alto Medical Foundation in Palo Alto, Calif.

"Right now, in the typical medical community, there is great diversity in the brands of EHRs and other health IT systems used by clinicians for Direct messaging. We're calling for all these vendors to make available more consistent and standardized software features to manage Direct clinical messages and their attachments," said Lane.

He called the current "variability in usability" unacceptably high and said it posed a barrier to interoperability, secure messaging and care-coordination workflows.

Impact on Family Physicians

In an interview with AAFP News, Lane noted his personal frustration with the status quo. He said he suggested the creation of a white paper after his own health IT vendor remained unconvinced that additional work to improve products should be prioritized.

"I'm a 30-year practicing family physician," said Lane. "I use an EHR that has Direct messaging capability, and I get to enjoy the benefits of Direct messaging around transitions of care. So when my patients are discharged from hospitals, I get an automated message, and I find that valuable in order to know what's going on with patients and to be able to arrange for appropriate follow-up care.

Calling All FPs: Comment on Health IT White Paper Recommendations

Within 24 hours of releasing a draft white paper(www.Directtrust.org) on what electronic health record (EHR) vendors need to do to make their systems truly useful and interoperable, DirectTrust, the entity overseeing the creation of the paper, received responses from four of the top 10 EHR vendors in the country.

But the authors of the paper are equally anxious to hear from physicians. "We want to hear from real live doctors who are in the trenches taking care of patients," said co-author Steven Lane, M.D., M.P.H. "Chime in and tell us what we got right, what we got wrong and what we missed."

Read the paper. Ponder the contents. Then respond by email no later than March 30 with your feedback.  

"But I know, because I'm also an informaticist, that we could be using Direct messaging for much more," he said. For instance, Direct Interoperability has the capability of supporting care coordination.

"When I'm caring for a patient and my colleague across town and in another system or clinic is caring for the patient, we could use this as a means of sending secure messages back and forth and even sharing clinical information -- like medication lists -- between our respective offices and potentially between our electronic medical records, even if they are supplied by different vendors," said Lane.

The problem, explained Lane, is that vendors did the minimum amount of work necessary during the implementation stage of meaningful use. Standards were published, but vendors were not required to meet those standards. Instead, each vendor made its own assessment as to which pieces it would implement, he added.

The speed with which vendors marketed products seemed appropriate at the time.

"That allowed us all to 'check the box' for meaningful use participation, which was great," said Lane. "Now what we want to do is say, 'That's fine, meaningful use is behind us, we've all checked that box. But now we really want to be able to use Direct to improve care, to be able to communicate securely between our systems so that all of the clinicians involved in a patient's care can ideally be using this secure medical email and more.'

"We've got to improve care coordination and we've got to improve transitions of care, and it's really pretty straightforward," said Lane.

More About DirectTrust

About five years ago, DirectTrust(www.Directtrust.org) was created as a nonprofit association of health IT and health care provider organizations that wanted to support secure and interoperable health information exchange via Direct Interoperability and other electronic protocols.

The association is 130 organizations strong and counts the AAFP among its members. Family physician David C. Kibbe, M.D., M.B.A., of Oriental, N.C., is the president and CEO of DirectTrust. He also serves as a senior adviser to the AAFP on health IT issues.

Kibbe told AAFP News that the Academy has been a proponent of Direct Interoperability since the very beginning.

"In 2016, 100 million messages were transferred across 70,000 health care organizations. The technology has to be built into every system on the market," said Kibbe. But there are issues with some of the 350 vendors and the 1,500 health IT products that have been certified, he added.

And those lapses in quality occur in vendors of all sizes, from the biggest, most recognizable names to much smaller companies, said Kibbe.

Next Steps

"We're hoping to gain some good momentum around this effort," said Kibbe. "I would say to clinicians around the country, 'Take heart and be encouraged that we are speaking to a very large number of vendors about features and functions that must be there if this technology is going to be useful to us all.'"

Lane reminded readers that what they're seeing now "is only a draft of the white paper that we plan to issue in final form later this year."

"Our desire is to have clinicians, IT vendors and other stakeholders send in their comments and suggestions," he added. "Ours is a small group of passionate and frustrated clinicians with our own perspectives and experience.

"We want this document to reflect the needs of the broader clinician community, so we sincerely want family physicians and their colleagues and staff to review the recommendations and priorities and tell us where we can refine them to capture their needs accurately," Lane concluded.

Related AAFP News Coverage
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(2/21/2017)

Governors Look to Ease Nationwide Health IT Interoperability
National Governors Association Releases New Resource

(12/15/2016)

AAFP Expertise on EHRs Guides ONC
Key Message: FPs Need Interoperability, Not Administrative Burden

(6/8/2016)

AAFP Blasts ONC's Final EHR Interoperability Road Map
(10/12/2015)

Q&A With David C. Kibbe, M.D., M.B.A.
Direct Exchange of Health Care Information Fuels Meaningful Use Stage Two

(12/11/2013)