What can your electronic health record (EHR) system do? It may be able to send and receive information to other EHRs. However, the ability for information to be exchanged, incorporated and presented in a contextual manner still is lacking, physicians told the Office of the National Coordinator for Health Information Technology (ONC) last week.

In a letter to National Coordinator Health Information Technology Karen B. DeSalvo, MD, the AMA outlined key facets of achieving true interoperability between EHRs based on the ONC’s Interoperability Roadmap:

Prioritize cornerstone issues to lay a strong foundation

Issues that are fundamental to information exchange should be among the top priorities. For instance, unified standards and data vocabulary for EHRs and clinical data registries is a necessary building block to achieve better results later on. Physicians also need uniform clinical data definitions so data elements mean the same thing across registries and EHRs. The letter also outlined the necessity for functional standards.

“For example, when a patient complains of shortness of breath, this is simply typed into the EHR, but for performance improvement you need to know exactly what the patient means by shortness of breath,” the letter said. “Is it shortness of breath because the patient just walked a mile or due to a particular condition? These functional status types of definitions, while important for quality improvement activities, are not widely defined because it is neither needed nor relevant for payment.”

Don’t use a punitive approach

Penalizing physicians and other health care providers for not using certified systems will not help achieve a more robust health IT system.

“This is simply a flawed and misguided means of removing the current barriers to interoperability,” the letter said. “The reality is that the penalty program created by the government has created an artificial marketplace that requires physicians to use poor-performing systems that do not facilitate data exchange.”

Physicians and care providers can’t control whether systems are interoperable, so punishing them for lackluster EHRs isn’t fair, the letter said.

Address cost and usability barriers

The cost to exchange, extract and analyze data from an EHR can be prohibitively pricey for many physicians, especially since doctors might not realize these costs are on top of the initial EHR purchase price.

The ONC proposed in the Version 2015 EHR certification rule that all vendors seeking certification must publish their fees online and in marketing material. Because this requirement would be a major step towards addressing this barrier, the letter urged the agency to implement this proposal.

The AMA also is urging the ONC to work with the Centers for Medicare & Medicaid Services to publish the costs of transmitting data through a health information service provider in a central online location. Such a report should be easily accessible and understandable.

Usability barriers also exist, which the AMA continues to work on as outlined in its framework for improved EHRs.

Acknowledge the meaningful use program’s impact

The notoriously burdensome EHR meaningful use program stymies innovation, limits resources and prioritizes the wrong efforts to improve usability, safety and interoperability, the letter said. The AMA continues to advocate for meaningful use changes that make it easier for physicians to meet the program requirements.

“I always say this: Physician’s aren’t afraid of technology,” AMA President Robert M. Wah, MD, said in a recent AMA Viewpoints blog post. “We will always embrace innovative tech that actually improves patient care. We are also the first to push back when technology hinders our work.”

Through its Professional Satisfaction and Practice Sustainability initiative, the AMA is helping physicians successfully navigate the health care environment by promoting sustainable practices. The AMA also is using the collective physician voice to work with vendors, policymakers, health care systems and researchers to drive EHR improvements that doctors can use to take better care of their patients.

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