Whether you nod your head in recognition or shake it in aggravation, your reaction to a new report on the state of electronic health records (EHRs) -- and the future of their interoperability -- is likely to be visceral.
Today's lack of interoperability "imposes an exhausting litany of clerical tasks for the clinical staff, contributing to staff burnout and waste," says Procuring Interoperability: Achieving High-Quality, Connected, and Person-Centered Care,(www.nam.edu) a special publication released last month by the National Academy of Medicine (NAM).
"Unlike in other industries, where computerization has made work easier, deployment of EHRs in their current state -- coupled with growing requirements for high-quality reporting and regulatory compliance -- create additional work and exacerbate clinician burnout," the report continues.
Numerous mentions of administrative burden and burnout follow, echoing urgent advice the AAFP recently provided to the federal government on the same topic.
In October, the Academy wrote to the Office of the National Coordinator for Health IT (ONC) that "some interoperability tasks are beyond the capability of certified electronic health record technology products."
NAM's publication seeks to provide at least some possible solutions.
Specifically, the report recommends that health care organizations prioritize five actions:
- Declare interoperability a priority and form a group to champion an IT acquisition strategy.
- Charge that group with identifying interoperability goals, requirements and model use cases to support organizational priorities and patient outcomes.
- Align with other stakeholders on requirements and specifications.
- Include clear interoperability requirements in proposals, purchases and contracts.
- Establish and monitor short- and long-term metrics "for the progress and contributions of interoperability to systemwide learning and improvement of health outcomes."
EHR interoperability is central to the mission of AAFP vice president and chief medical informatics officer Steven Waldren, M.D., M.S. His input helped shape the Academy's October letter to ONC, in response to a request for comments about EHRs, interoperability, usability and certification testing.
The NAM document notes in its foreword that it summarizes a project commissioned by the science-oriented nonprofit Gordon and Betty Moore Foundation(www.moore.org) "to explore procurement approaches health care systems can use to activate systemwide demand for interoperability in health care, and to work together for its accomplishment." The report reflects input from some 70 IT, health, policy and insurance figures, and seeks to offer "elements of a roadmap for moving forward."
The authors' emphasis on shared goals and partnerships doesn't preclude a key tenet of Waldren's approach to the interoperability puzzle.
"Dramatic advances in EHR features and usability will not be the norm until we have market forces that incentivize the right competition," Waldren told AAFP News in October. "We need to have a system that lets a doctor decide on Friday that he doesn't want to work with an EHR vendor anymore and have a new EHR in place on Monday, or be able to easily integrate new apps into an EHR."
The NAM report offers a similar viewpoint: "In the marketplace, it is also a critical time to ensure that competition among health care providers and technology vendors is focused on quality and value, rather than on exclusivity and proprietorship of data."
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