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CMS eHealth Summit: Physicians Call for Simplification

 |  By smace@healthleadersmedia.com  
   May 20, 2014

One doctor attending the eHealth Summit in Baltimore challenged electronic health records system vendors to simplify their implementations, saying "things that should be very simple… get very complicated when they get handed off to the vendor."

Simplification of everything from quality measures to physician workflow in electronic health record systems turned out to be a main theme of CMS's fourth annual eHealth Summit in Baltimore Monday.

An official of the HHS Office of the National Coordinator for Health IT said the agency recently pared down a list of 60 diabetes measures to five measures to be implemented agency-wide.

"Some of that is going to take a while for the rest of the world to see, because if you follow federal rulemaking cycles, you know that when we make decisions like this in the government, it takes two or three years for those to end up being the ones that you've living under," said Kevin Larsen, MD, medical officer for meaningful use at ONC.

Last week, ONC met with a group called the Buying Value Coalition, a project of the National Quality Forum, to align quality measures across federal, state and private sectors, Larsen said.

"The ultimate goal of that measurement is a low-burden exercise and it's an attribute of the EHR you have. So you spend most of your time improving care, but you have the tools in your lap or in your office to actually see the care that you're giving and understand where your opportunities and care gaps are," Larsen said.

Another speaker at the summit, Margot Savoy, MD, challenged EHR software vendors to simplify their EHR implementations.

"What vendors say and what vendors provide are not the same thing," said Savoy, a physician with Delaware-based Christiana Care Health System Family Medical Centers, who was selected by ONC's Health IT Vanguard Program to be a member of the spring 2014 health IT fellow class.

"Things that should be very simple, from my standpoint, they get very complicated when they get handed off to the vendor," Savoy said.

For instance, what had been a two or three-page patient sheet of instructions for patients "has now turned into a six-page document full of stuff that I don't think most patients actually want to read or care about. My instructions are now the very last thing on the document, because that's what the vendor thinks that you thought that you wanted them to say somehow."

When patients receive the longer instruction sheets, they sometimes throw it away, figuring if the instructions had said anything important, the physician would have said something to the patient.

Other patients cannot understand why they have to log into a patient portal, why instructions can't just show up on their mobile phones or in a text message, Savoy said.

"I grew up with computers, so for me, the computer's not that big a deal, and having one in my pocket doesn't really bother me," Savoy said.

She also challenged current guidelines implementing use of EHR care measures.

"Do you really want me to check off a box that says I gave a patient a patient instruction sheet, or do you want the patient to actually understand what the instruction were at the end of the visit?" Savoy asked.

"Because they're not the same thing, and sometimes, I can get so wrapped up in trying to click off all the boxes to make the instruction sheet look correct that I don't have enough time to sit and talk to you about what I actually wanted to say. I think that's the part where patients are complaining that we're not really engaged with them."

The summit also highlighted some innovative uses of EHR technology.

"We recognize that you can't expect to get clinical data from all the places that care is given, and so we actually also access the claims data on our patients and load those directly back into the EHR, not just the data warehouse."

"But we take the claims data and populate our EHR on a weekly basis, so we're not waiting for it to be staged somewhere, and six months behind," said Larry Garber, MD, chief medical information officer of Reliant Medical Group, a Worcester, Massachusetts division of Atrius Health.

"Prescription claims we load on a nightly basis, and with this, we populate medication lists," Garber said. "I know when patients are filling their prescriptions the day after they've actually picked it up. We also have population health maintenance, so if someone gets a mammogram or a colonoscopy across town, even though I may not be interfaced with them, that shows up automatically in the electronic health record."

Garber added that immunizations are automatically populated regardless of where they're given. The last diabetic eye exam is also automatically recorded in Reliant EHRs. "By doing this, when I get an alert, or when a registry shows up that a patient's overdue for something, they truly are overdue for that, and we focus our energy on making sure that those are taken care of."

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Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

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