Wednesday, July 12, 2017

ONC Set to Address Information Exchange, Compliance Burden


Can too much information and/or data be a bad thing?

Reducing the burden of electronic health records (EHRs) on physicians and promoting health information sharing will be the major priorities of the Office of the National Coordinator for Health Information Technology (ONC) going forward, Donald Rucker, MD, the new national coordinator, told reporters at a news conference today.
Interoperability between EHR systems has long been at the top of ONC's agenda, but the emphasis on EHR usability and lowering the administrative burden on small practices has not. Dr Rucker noted that, along with interoperability, this goal is very important to Tom Price, MD, Secretary of Health and Human Services (HHS). In introducing John Fleming, MD, deputy assistant secretary for health technology reform, HHS, at the press conference, Dr Rucker also observed that Dr Fleming, a former solo practitioner in Louisiana, is the first senior-level HHS appointee "who represents small practices."
Dr Fleming said that he'd heard many complaints from doctors and patients about physicians' inability to focus properly on patient care because of the administrative requirements they had to meet, including EHR documentation. One reason for this regulatory burden, he said, is Medicare's guidelines for documentation of evaluation and  management (E/M) codes, which were formulated in the 1990s, before most physicians had EHRs.
"Now that EHRs are online, we see how the two [EHRs and E/M coding guidelines] create even more problems: we get voluminous, sometimes nonsensical health notes that can be unreadable or make it difficult to determine where the real information is," he noted.
The challenge of improving EHR usability, Dr Fleming continued, goes beyond the technology itself: it also involves the fee-for-service reimbursement system, which forces doctors to document their work in certain ways in order to get paid.
Dr Rucker agreed. "The CPT [Common Procedural Technology] rules were done in an era before computers, so it's time to rethink that," he said. ONC, he added, is working with the Centers for Medicare and Medicaid Services (CMS) to look at how the burden on physicians might be reduced.
However, Dr Rucker noted, CMS has to balance EHR usability against "honest fair payments" to doctors and program integrity. Later, responding to a question from Medscape Medical News, he said, "Part of what [CMS] is looking at is the interaction of the coding system with the provision of care and the burden of documentation."
While he declined to say whether changes in the E/M coding system were being contemplated, he said CMS is considering how it could help developers design smarter EHRs that would make it easier to document visits.

In addition, Dr Rucker said, ONC is looking at ways to ease the burden on practices of quality reporting in the Merit-Based Incentive Payment System (MIPS). "For a lot of practices, this has become a challenge," he pointed out. "At some point, the expense of complying with the quality measures is much greater than the value of the quality measures."
Interoperability between EHR systems has long been at the top of ONC's agenda, but the emphasis on EHR usability and lowering the administrative burden on small practices has not. Dr Rucker noted that, along with interoperability, this goal is very important to Tom Price, MD, Secretary of Health and Human Services (HHS). In introducing John Fleming, MD, deputy assistant secretary for health technology reform, HHS, at the press conference, Dr Rucker also observed that Dr Fleming, a former solo practitioner in Louisiana, is the first senior-level HHS appointee "who represents small practices."

ONC Set to Address Information Exchange, Compliance Burden

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