Better EHRs Vital to Value-based Care, AAFP Tells ONC

Academy Provides Detailed Response to Latest Strategy Draft

February 04, 2019 08:46 am News Staff

Horseshoes, hand grenades and health IT: Close enough counts for the first two, but the consequences of imprecision when it comes to the third are increasingly dire.

[physician entering information into laptop]

Likewise, many -- but not all -- of the Academy's goals related to health IT and electronic health records (EHRs) are reflected in recent strategy aims outlined by the Office of the National Coordinator for Health IT (ONC), which is charged by the 21st Century Cures Act(www.congress.gov) with issuing policy guidance.

"The AAFP is pleased with the draft report's in-depth discussion on administrative burdens related to health IT," the Academy told National Coordinator for Health IT Donald Rucker, M.D., in a Jan. 28 letter.(8 page PDF) "However, there are some fundamental issues not addressed in the draft report findings."

The letter, signed by Board Chair Michael Munger, M.D., of Overland Park, Kan., came in response to the ONC's draft report "Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs."(www.healthit.gov)

"The AAFP is concerned that gaps in EHR functionality to support primary care practices are widening with the additional requirements of value-based payment models, particularly in regard to the timely aggregation of data from multiple sites; the ability to access, analyze and interpret an overwhelming amount of data; and the actionability of the data," the AAFP advised.

Story Highlights
  • "The AAFP is concerned that gaps in EHR (electronic health record) functionality to support primary care practices are widening with the additional requirements of value-based payment models," the Academy told the Office of the National Coordinator for Health IT (ONC) in a Jan. 28 letter.
  • The letter urged the ONC to focus on EHR system designs centered on small tasks.
  • The AAFP also strongly advocated the elimination of health IT utilization measures as part of the Quality Payment Program.

The ONC's report, the Academy added, did not address in enough detail the clinical work that physicians and other clinicians perform or need to perform in value-based care models.

"First, current health IT solutions are not yet designed to support that work," the AAFP said. "Second, the need to articulate the clinical work performed is different than ensuring that health IT matches optimal clinical workflow. Third, workflow is the process through which the clinical work is completed, and it is not true(academic.oup.com) that that workflow can be standardized."

Therefore, the AAFP said, "in addition to ONC working to ensure optimal workflows, HHS should work to support the physician community in better articulating 'clinical work' so that developers better understand the higher-level cognitive processes physicians go through so that health IT design can best support this work."

Other key guidance from the AAFP included:

Better align EHR system design with real-world clinical workflow.
"ONC should look at smaller units of work than the (office) visit as areas for potential standardized workflow," the letter said. "The AAFP encourages ONC to focus on EHR system design for small tasks. This will support a more dynamic, real-time, data-driven creation of workflows that are patient-, physician- and encounter-specific. A focus on large clinical tasks is counterproductive for primary care."

Improve clinical documentation functionality.
Noting the Academy's initiative to harness next-generation tools such as speech recognition, natural language processing and computer vision to reduce the burdens of EHRs, the letter called on the administration to support innovative pilot programs as they emerge within the health IT industry.

Promote and improve user interface design standards specific to health care delivery.
The letter pushed back against a proposed ONC strategy labeled "Promote user interface optimization in health IT that will improve the efficiency, experience and end user satisfaction," writing: "The AAFP believes that mandating use, such as through certification, should not be part of federal policy. Instead, private sector competition will more efficiently lead to adoption of best practices."

Simplify scoring for the Quality Payment Program (QPP) promoting interoperability performance category.
"The AAFP strongly urges ONC to eliminate health IT utilization measures as part of the (QPP)," the letter said. "It is time to move completely beyond the policies of the meaningful use program. Simplification in scoring has not decreased the burden on physicians."

Build innovation incentives and promote interoperability among Medicaid health care providers.
"Providing bonus points to physicians that are using health IT in innovative ways is appropriate," the letter said. "Ultimately, however, health IT utilization measures should be eliminated from base QPP scoring."

Rather than penalizing areas that struggle with health IT, the AAFP advised, "CMS should identify geographic areas where health IT gaps exist and funnel new resources to those areas to improve equity and access."

Ease the electronic quality measurement burden through pilot programs and incentives.
"Alternative, less burdensome approaches are desperately needed," the Academy said. "Efforts to achieve a state where electronic clinical quality measures can be deployed in an EHR to produce accurate measurements without special effort by the physician or practice must be prioritized."

Following up on the AAFP's letter, Steven Waldren, M.D., M.S., vice president and chief medical informatics officer for the Academy, met Jan. 30 with ONC staff, including Tom Mason, M.D., its chief medical officer.

"The meeting was good," Waldren told AAFP News. "I was able to discuss our letter and our efforts to drive innovation to significantly reduce family physician burden around EHR documentation. We were able to hear about the direction they are working toward to reduce administrative burden. I think we share many of their goals, and the work to do is to figure out how changes can be made to achieve those goals.

"We plan to continue the dialogue as ONC finalizes the report to Congress."

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