Weekly roundup: HIT Policy Committee, HIE governance, thoughts on EHR use

At this week’s Health IT Policy Committee meeting, Farzad Mostashari, MD, ScM, national coordinator of health IT, called for workflow improvements to achieve better outcomes.

Mostashari said that while progress has been made moving healthcare into the digital realm, “we are about 5 percent on the way from changing workflow and redesigning care to take advantage of those technologies.”

Mostashari said the best providers achieve an 85 to 95 percent rate control among patients with diabetes and heart disease, with 40 to 45 percent of patients with diabetes achieving good LDL control. To move the dial further on the challenging proposition of controlling LDL in diabetes patients, providers must identify where the system is failing, not where people are failing, he said.

While process redesign could yield some positive results, the next step is how to scale this “hard fought knowledge of what works and how to make it work,” Mostashari said. “How can we do this not just in 3,000 hospitals, but in 180,000 practices? How do we get it to spread?”

After issuing a Request for Information (RFI) last year to gather public input on a potential regulatory approach for validating organizations as legitimate participants in the Nationwide Health Information Network (NwHIN), the ONC released the Governance Framework for Trusted Electronic Health Information Exchange. The Governance Framework discusses four key categories of principles, including trust, business, technical and organizational.

Mostashari said participants can expect ONC to ask them how they're addressing these principles. He also added that ONC intends "for the Governance Framework to be a living document. As we learn with you, we will consider updating these principles over time to reflect policy changes, technological maturity, and market innovations, as necessary."

ONC will establish a monitoring program to ensure the governance goals are being addressed.

Also this week, there were several debates about optimizing EHRs. When used correctly, EHRs produce more accurate documentation leading to more complete coding, and ultimately, more accurate reimbursement claims, according to Sue Bowman, senior director of coding policy and compliance of the American Health Information Management Association (AHIMA). Bowman presented during a listening session hosted by Centers for Medicare & Medicaid Services (CMS) and the ONC.

Bowman called for more research on the causes of higher levels of coding and reimbursement. “The extent to which EHRs have led to improper reimbursement is unclear,” Bowman said. “EHRs produce more complete and accurate documentation, and this could be leading medical providers to seek reimbursement for services they have always been providing, but weren’t properly documenting before. Higher levels of reimbursement do not necessarily equate to fraud.”

She also called for a code of ethics for both EHR vendors and users to design and use the system correctly and a national set of coding guidelines from CMS.

Meanwhile, Peter Basch, MD, medical director of ambulatory EHR and health IT policy for MedStar Health in Washington, D.C., shared his thoughts on using the EHR as well as getting face time with patients. Studies continue to be released that decry the time physicians spend on computers rather than with patients, he wrote. "These studies do our field a disservice because they don’t focus on the many ways EHRs have helped physicians do better for their patients."

EHRs need to improve and be made more usable and useful toward the overall mission of making care better, safer and more value-laden. How we optimize them within the evolving healthcare ecosystem will ultimately determine their value. Our shared goal should be to make the time “in front of the screen” of the highest value for doctor and patient; and not to consider screen time as something to avoid.

Are clinicians at your organization finding ways to balance screen time with face time? Please share your thoughts.

Beth Walsh

Clinical Innovation + Technology editor