Tuesday October 22nd 2019

EHRs and the glide path to value

Pamela Cipriano

Ask any health care professional about pain points in current care settings and at the top of most lists is “the EHR.” We have a love-hate relationship with electronic health records, yet very few would concede paper was better. The vision of a connected world, however, has fallen far short of expectations.

Like most other changes in health care, financial incentives helped accelerate the adoption of EHRs. Thanks to the Meaningful Use program that paid eligible hospitals and providers more than $33 billion between 2011 and March 2016 for achieving core objectives focused on electronic data capture and sharing, meeting quality measures, and facilitating greater patient access and control of their data, the Centers for Medicare and Medicaid Services reports almost all hospitals are now using a certified electronic record — from 94 percent of critical access hospitals to 99 percent of large hospitals. Almost a half million eligible providers received funding. However, even with certified electronic systems in place, many would argue we are still functioning in silos since systems lack interoperability.

One year ago, Congress passed the Medicare Access and CHIP Reauthorization Act of 2015 to accelerate payment for quality through two programs, the Merit-Based Incentive Payment System and the Alternative Payment Models. A number of prior programs were ended and revamped within MIPS payments, including the meaningful use of certified EHRs by eligible providers. Among the provisions of MACRA is a requirement to achieve “widespread” interoperability of health information by the end of 2018.

In 2009, the American Nurses Association supported the accurate and efficient collection, recording, protection, storage, utilization, reporting and analysis of health data and health care information. Our stand on interoperability, articulated in 2014, called for standardization and interoperability of health information technology. (See ANA position statements: “Electronic Health Record” and “Standardization and Interoperability of Health Information Technology: Supporting Nursing and the National Quality Strategy for Better Patient Outcomes.”)

Interoperability is critical for EHRs and IT solutions to ensure safety and best outcomes. But nursing finds itself in uncertain territory trying to assure standardized nursing data capture within all vendor products across settings.

We need inclusion of nursing data to inform care interventions and outcomes. In our desire to simplify documentation, pervasive use of templates for any information that could be automated, has led to the unintended consequence of losing the patient’s story. We neither reduced the documentation burden, nor reached the right balance between structured and unstructured data collection. As EHRs migrate from their current platforms to the cloud or evolve to address the need for rapid data analysis, IT experts believe free text will once again become an important source of data, as they are nuggets of extremely meaningful information.

ANA continues to work with the nursing informatics community, as well as the Office of the National Coordinator of HIT to achieve interoperable HIT. To that end, in April, ANA signed on to the ONC’s Interoperability Pledge.

In a letter to Dr. Karen DeSalvo, acting assistant secretary for Health and National Coordinator for HIT, we committed to support their three principles to advance interoperability among health information systems enabling free movement of data, which are foundational to the success of delivery system reform. These include:

  • better consumer access so that people can easily and securely access their electronic health information, and be directly involved in determining where and how their information is shared to benefit their health and that of their community;
  • no blocking/transparency so that providers can share an individual’s health information for care with other providers whenever permitted by law;
  • and use of federally recognized national interoperability standards and policies, as well as adoption of best practices related to privacy and security.

The ONC’s shared nationwide roadmap to interoperability sets a course to reach the destination between 2021 and 2024, with waypoints that provide for short-term and long-term interoperability goals. The endpoint aligns with a payment system where value-based payments are the predominant model. We will continue to collaborate with our federal partners, the vendor community, the HIT community and our interprofessional colleagues to do our part to achieve interoperability. Along that journey, we will also address a host of other issues including usability, better data movement and inclusion of recognized terminologies supporting nursing practice within EHRs and other HIT solutions.

— Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, is president of ANA.

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