- The American Hospital Association (AHA) emphasized the need to reduce EHR-related burden on hospitals in two letters to federal entities this week, demonstrating the association’s dissatisfaction with the present state of regulations governing EHR use nationwide.
According to a 2017 Medscape Lifestyle Report, over half of practitioners across specialties — including primary care — are suffering from physician burnout. Regulatory burden has persistently nagged physicians in recent years and put a damper on practicing medicine for many providers now vocal about the rising rates of physician burnout.
A lack of EHR usability is mostly to blame. A 2016 STAT news survey of 425 physicians and healthcare organization leadership listed improving EHR use as the top priority for ways to positively transform healthcare delivery.
Many healthcare organizations see reducing regulatory burden — and by extension, the amount of time providers spend at their monitors — as the most effective method of improving provider outlook on EHR technology.
AHA is among the many healthcare organizations urging ONC, CMS, and others to address regulations that have become a hindrance instead of a help.
Reducing EHR regulations at CMS
In a recent letter addressed to the House Ways and Means Health Subcommittee, AHA requested CMS eliminate Stage 3 Meaningful Use requirements in an effort to ban the direct supervision of EHR use in critical access and small or rural hospitals.
“Hospitals face extensive, burdensome and unnecessary “meaningful use” regulations from CMS that require significant reporting on use of electronic health records (EHRs) with no clear benefit to patient care,” wrote AHA. “These excessive requirements are set to become even more onerous when Stage 3 begins. They also will raise costs by forcing hospitals to spend large sums upgrading their EHRs solely for the purpose of meeting regulatory requirements.”
Along with 41 other recommendations, AHA suggested the House suspend electronic clinical quality measure (eCQM) data reporting requirements due to associated costs.
“It is difficult and costly to bring information from other systems into the certified EHR for electronic quality reporting, the same information must be entered in several places in the EHR to support electronic measure reporting and the clinical processes need to be revised to support data capture for eCQM data reporting,” wrote the association. “Hospitals are able to compare the chart-abstracted measure reported and the eCQM reported for the same quality measure and see the eCQM does not yield the same result.”
AHA also requested the quality measures that do remain be as focused and necessary as possible.
“Public transparency regarding hospital and other provider quality would be supported by thinking strategically about the information most useful to the public,” advised the association. “CMS currently publishes data on nearly 90 measures of hospital quality. In addition, it publishes star ratings and data on what Medicare pays for services at each hospital.”
“All of this provides a complex, confusing and sometimes conflicting set of signals to the public about a hospital’s quality,” the letter continued.
AHA recommended CMS work with a cross-section of industry stakeholders — including AHA — to identify which measures are most critical to gauging the quality and safety of patient care delivery.
Reducing regulatory burden on health data exchange
The stakeholder roundtable AHA envisions is similar to that of the group that participated in the first ONC stakeholder meeting for the development of a trusted exchange framework and common agreement on July 24, 2017.
The health data exchange framework will be centered on promoting interoperability across networks and overcoming existing challenges to secure, standardized exchange in accordance with provisions outlined in the 21 Century Cures Act.
In a letter addressed to ONC National Coordinator for Health IT Don Rucker, AHA expressed its support for the federal agency’s efforts to involve stakeholders in the development of the framework but advised ONC against implementing additional regulations to improve interoperability.
“The creation of a nationwide approach to efficient and effective sharing of health information is central to the efforts of hospitals and health systems to provide high-quality coordinated care, support new models of care and engage patients in their health,” stated the association. “A shared trusted exchange framework and common rules of the road are essential to transforming health care.”
While the exchange framework will improve interoperability, AHA believes most of the heavy lifting in enabling secure health data exchange has been done by existing networks-of-networks including CommonWell, Surescripts, and the eHealth Exchange.
With these successful interoperability initiatives in mind, AHA urged ONC to avoid disrupting the work of functioning exchanges and instead focus on fine-tuning the network-of-networks approach already established by these groups.
As with federal regulations related to EHR use, AHA emphasized keeping requirements as minimal as possible.
Specifically, AHA recommended the ONC framework and common agreement address the following:
- The minimum standards and implementation requirements that must be met to ensure efficient exchange, including standards to secure information;
- The permitted purposes for exchange
- A clear understanding of the means to identify and authenticate participants of an individual exchange
- A clear understanding of how the identity of individuals will be matched and managed across networks
- Assurance that each network will be transparent in the terms and conditions of exchange, including any technical prerequisites and costs of participating in exchange.
Moreover, AHA emphasized the need for ONC to keep its efforts focused only on improving connections across HIEs and HIE networks and cementing guidelines for such entities.
ONC should steer clear of imposing any additional regulations on providers regarding EHR use or health data exchange, according to the association.
“The agency should not simultaneously look to prescribe the behavior of those who use health information exchange networks, including hospitals, health systems, other providers and consumers. The actions of health care providers are already subject to the information sharing, privacy, and security requirements (including restrictions on information blocking) contained in meaningful use, the Medicare Quality Payment Program for clinicians, HIPAA HITECH, 21st Century Cures and myriad other federal, state and local laws,” wrote AHA.
Recommending that ONC refrain from augmenting already burdensome federal requirements will ensure the trusted exchange framework and common agreement avoids repeating the mistakes of past federally-enforced programs such as the EHR Incentive Programs.