AMIA's 2020 report focuses on regulations, documentation and patients

A year in the making, the American Medical Informatics Association (AMIA) released its EHR 2020 report that details recommendations to accelerate the development of EHRs over the next five years and better support patient-centric care.

The association established its EHR 2020 Task Force last year, headed up by Thomas Payne, MD, medical director of IT services at University of Washington Medicine in Seattle.

The report outlines the following five broad focus areas policymakers and health IT developers should use to help EHRs foster better patient care by 2020:

1. Increasing and simplifying clinical documentation speed;
2. Refocusing government regulations;
3. Increasing EHR certification transparency;
4. Spurring innovation; and
5. Supporting person-centered care delivery.

Within those five categories, the task force offered the following 10 recommendations:

1. Decrease the data entry burden for clinicians;
2. Separate data entry from data reporting;
3. Enable EHRs to assist with research and systemic learning at the point of care during typical practice for the purposes of care delivery and billing;
4. Focus regulations on simplifying and clarifying EHR certification procedures, advancing interoperability and data exchange, and reducing the need to re-enter data and prioritize patient outcome metrics;
5. Alter reimbursement regulations to "support novel changes and innovation in EHR systems";
6. Increase flexibility and transparency in the EHR certification process to help improve patient safety and EHR usability;
7. Ensure providers, vendors and health care organizations are "fully transparent about unintended consequences and new safety risks introduced by health information technology systems" and share "best practices for mitigating these risks;"
8. Have EHR vendors use application programming interfaces and follow open data standards;
9. Integrate EHRs into all health care settings, including long-term care and behavioral care; and
10. Design EHR interfaces to be more intuitive.

"The problems we face today in EHR use are complex, and solutions will not be simple or quick," the task force wrote. "Solving these problems will require regulatory stability, the development of an acceptable threshold 'barrier to entry' into the EHR marketplace and a supportive national policy.”

Payne discussed the report at AMIA’s iHealth 2015 Conference in Boston on May 29 and shared his thoughts with Clinical Innovation + Technology.

Documentation is a big topic in the report because “physicians carry the largest burden which impairs their ability to do what they do best,” Payne said. As a result, the use of shortcuts has harmed the product of this documentation. “The most important result, other than loss of time, is that we’ve lost the story which is so key to understanding how we can help someone. That’s something no template or checklist can ever convey.”

The task force focused “on the most important changes that we think we can achieve in the next five years. We did not intend to map out a 30-year strategy.”

The public is very interested in this topic, which is good, he said, because problems won’t be solved without them. “Every week there are new articles, books, radio segments and more on something to do with this topic.”

The report reflects the idea that healthcare is a “team sport in that everybody who is part of the team needs to be able to contribute their information into the EMR, said AMIA President and CEO Douglas Fridsma, PhD. The systems need to foster that input from a range of clinicians as well as empower patients to also be considered part of the care team.

Some of the recommendations look at refocusing regulations, Fridsma said. “This is a challenging area” because of the need for urgency to adjust regulations that don’t provide much value to the patient.

AMIA also wants to see greater transparency about how EHR systems are tested and safety problems. “Understanding across the industry adds better trust in the system.”

Another challenge in planning for the future, Fridsma noted, is that “the kinds of system we have in place are unlikely to be what we have installed in five years. For us to be effective, we have to foster innovation. We need to create ways to build toward the next generation of EHRs.” That includes workforce training and developing a stable set of building blocks to connect different systems.  

Fridsma said he is optimistic about the future because before rapid HER adoption five or six years ago, “we probably wouldn’t even be having this conversation. The fact that we are talking about how to improve EHRs and interoperability means we’ve made progress.”

Read the complete report.