- Improving EHR usability and promoting efficient application programming interface (API) use may help to cut down on regulatory burden on clinicians, according to Pew Charitable Trusts.
The organization submitted these recommendations to ONC in response to the federal agency’s draft strategy designed to reduce administrative burden related to EHR use.
The draft, called Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health it and EHRs, is a joint effort between ONC and CMS designed to fulfill the aims of the 21st Century Cures Act.
“In the report, ONC underscores two key challenges with the use of EHRs that can increase provider burden: poor system usability — which refers to how EHRs are designed, implemented, and used — and ineffective exchange of health data,” wrote Pew Charitable Trusts.
“These same challenges can also introduce patient safety problems and hinder the coordination of care. ONC, through several policies under development, can take steps to address these challenges,” the organization continued.
To boost EHR usability and reduce the likelihood of patient harm, Pew recommended ONC ensure some criteria part of the EHR Reporting Program focus on safety.
“In previous comments to ONC, organizations representing clinicians, hospitals, health information technology professionals, and other key stakeholders emphasized the importance of embedding safety into the usability-related criteria,” wrote Pew.
Pew also suggested ONC focus on EHR usability and safety when establishing a voluntary certification program for pediatric EHR systems.
“In implementing this provision from Cures, ONC should focus on the safety and usability of EHRs, including by incorporating some of its own recommendations from the burden reductions report — such as by requiring input from end-users such as pediatricians,” stated the organization.
Pew also stressed the importance of improving the way health IT systems share and interpret patient health information.
“The inability to effectively exchange information results in clinicians and patients not having the data they need to inform medical decisions, which leads to unnecessary tests and introduces safety problems—among other factors that can hamper the quality of care,” wrote Pew.
Pew urged ONC to take several steps to ensure APIs used to extract data from patient health records can effectively enhance data exchange, reduce clinician burden, and improve patient care.
First, Pew recommended ONC expand the data available through open APIs beyond the Common Clinical Data Set (CCDS).
“While the CCDS contains some information, such as medication lists, it lacks other needed data — including clinical notes,” stated the organization.
Next, Pew suggested ONC ensure APIs support access to individual data elements without requiring that clinicians send or receive the entire patient record.
“Use of the FHIR standard can enable this type of access,” wrote Pew. “Recent data from ONC has shown that more than four out of five hospitals and approximately two-thirds of clinicians report using EHRs that have implemented some version of the FHIR standard.”
Finally, Pew advised ONC to ensure data can be exchanged even when information is not documented using common terminology, such as LOINC or Systemized Nomenclature of Medicine—Clinical Terms standards.
“Similarly, any information that is coded in a standard or otherwise formatted so that it can be processed by a computer should remain in that structure and not converted to a less-usable configuration, such as a PDF,” stated Pew.
Overall, Pew stated the principles in ONC’s report have the potential to address problems related to clinician burden.
The public comment period for ONC’s draft strategy about reducing administrative burden related to EHR use closed on January 28, 2019.