• AAFP Nudges ONC Toward EHR Interoperability

    Developer Transparency and Increased Competition Are Key Factors, Letter Advises

    October 30, 2018 04:00 pm News Staff – Someday you might see it: a 13-letter crossword fill, clued as "What health IT systems should be but still are not."

    Nonphysician players will be stumped, but you'll know the answer: interoperable.

    The real-life puzzle of interoperability remains unsolved, but the Academy has once again filled in some blanks for a questioning federal agency. In a blunt assessment, the AAFP this month told the Office of the National Coordinator for Health IT (ONC): "Some interoperability tasks are beyond the capability of certified electronic health record technology (CEHRT) products."

    The Academy was responding to an ONC request for information (RFI) published in the Federal Register on Aug. 24 that sought comments about electronic health records (EHR), especially regarding interoperability, usability and certification testing. (Calls for EHR feedback are mandated by the 21st Century Cures Act.)

    The AAFP's Oct. 17 letter,(7 page PDF) signed by Board Chair Michael Munger, M.D., of Overland Park, Kan., added that certain CEHRT interoperability tasks work "only with customization and substantial effort during implementation and use -- which can contribute to physician/provider dissatisfaction and burnout, especially if it involves a task related to either the critical window of the physician-patient interaction at point of care, or a high-frequency task."

    These limitations, and other potential CEHRT burdens that the Academy has previously noted, fall heavily on small, independent practices, the letter pointed out. For family physicians in such settings, usability and interoperability are critical; replacing a dysfunctional CEHRT could be a crippling expense.

    "Smaller practices often do not have the resources to fully vet a CEHRT product/developer without assistance," the letter said. "The lack of easily accessible and useful data to inform purchasing decisions for small practices has significantly greater residual impacts. Solo and small practices are most often unable to afford to switch CEHRT based on poor performance or usability."

    The Academy's response also pointed to a physician's ability to rate CEHRT products -- and to consult feedback or reviews by other doctors -- as key to successful interoperability. This reflects the letter's substantial input from Steven Waldren, M.D., M.S., whom the AAFP named vice president and chief medical informatics officer earlier this month.

    Waldren's work at the AAFP has long bolstered the call for a vibrantly competitive health IT marketplace as a vehicle toward unyoking physicians from documentation overkill. The letter pointed to transparent software development as important to that effort.

    "Requiring CEHRT developers to provide transaction volumes and the percentages of installations that perform a significant volume would provide some data to potential health IT customers as to the likelihood that a particular transaction could be expected to work without significant effort or modification," the letter said. "For example, if a family physician notes that many CEHRT products have a high transaction volume but this particular CEHRT product has a low volume and a low percentage of installations performing the transaction routinely, the doctor may decide to look at other products or learn more about that product or developer."

    However, the Academy warned ONC against overtaxing physicians with requests for feedback about recordkeeping systems. Responding to a question in the RFI about "what user-submitted information would make the EHR Reporting Program a valuable addition to the existing landscape of market research and analysis," the AAFP said that such calls for data should be issued sparingly.

    "Physicians are already heavily burdened while using their EHR, and that burden needs to be significantly decreased, not amplified," the letter said. "Where possible, all reporting should be automated and integrated within the CEHRT product."

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