HIMSS Annual Meeting 2016

LAS VEGAS – Doctors are dreading what some have started to call EHR "pajama time.”

“That’s the hour or two that physicians are spending – every night after their kids go to bed – finishing up their documentation, clearing out their in-box,” according to Dr. Christine Sinsky, vice president of professional satisfaction at the American Medical Association.

At a session held in conjunction with the annual meeting of the Healthcare Information and Management Systems Society, Dr. Sinsky spoke about how electronic health records have not lived up to their promise of helping streamline patient care and instead have added hours and headaches to most physicians’ days.

Leah-Anne Thompson/Thinkstock

Data on the impact of EHR systems on physicians’ workflows and satisfaction is beginning to accumulate, she said. University of Wisconsin researchers studying the impact of EHR systems on physicians’ workflow and lives looked at how often and when doctors were accessing their patients’ medical records, she said. What they found was that so many doctors don’t have enough time in their days to finish their documentation, so they spend their evenings and weekends finishing up. Their preliminary findings were presented in 2015 at a primary care research meeting.

Dr. Sinsky said the researchers see “a bump” of time spent on Saturday nights.

“I call that ‘date night’. That Saturday night belongs to Epic, Cerner, or McKesson,” she said sarcastically. “Well, I don’t want my doctor on her electronic health record on a Saturday night. I want my doctor having fun on Saturday night, because I want her to love her job.”

That same study “found that primary care physicians were spending 38 hours a month after hours doing data entry work,” in other words “working a full extra week every month doing documentation after hours, between 7 p.m. and 7 a.m.,” said Dr. Sinky, who is also an internist in Dubuque, Iowa.

Here are 10 ways EHRs contribute to more work, Dr. Sinsky said:

1. Too many clicks. “It takes 33 clicks to order and record a flu shot. And in the emergency room, it takes 4,000 clicks to get through the day for a 10-hour shift,” Dr. Sinsky said. “Studies have shown that physicians are spending 44% of their day doing data entry work, [but] 28% of the day with their patient.”

In her own EHR, she said, “it took 21 clicks, eight scrolls, and five screens just to compose the billing invoice, and within that EHR, the responsibility, which used to be a clerical responsibility, has transferred many things to the physician. All of those clicks, all those screens, and all those minutes add up.”

2. Note bloat. With her current EHR, Dr. Sinksy said, “I have six pages of notes for an upper respiratory infection.” This is not efficient. She offered another example: “I had a patient recently who I sent to a local university,” Dr. Sinsky said. “I got back an enormous note, about 12 pages long. But I still didn’t know, at the end of it. Did she have cancer, or not?”

3. Poor workflow. Today’s EHRs have a workflow that doesn’t match how clinicians work, she said. “Right now, many clinicians are encountering these very rigid workflows that don’t meet the patient’s need and don’t meet the provider’s need.” For example, “in some EHRs, the physician can’t look at any clinical data while dictating the note. This means that the physician has to rely on memory or print lab results, x-ray reports, medication lists, etc., in order to reference these data points in their clinic note.”

4. A lack of focus on the patient. Most EHRs lack a place for a photo of the patient and his or her family, and a place for the patient’s story, a deficiency that detracts from the value of the encounter.

5. No support for team care. Often, both a physician and a nurse or medical assistant need to add documentation to the EHR. Yet many systems are set up such that each party must log in, then log out, before another can contribute. “The nurse has to sign in and sign out; the doctor has to sign in and sign out. That’s about a 2-minute process, so it’s completely unworkable,” Dr. Sinsky said.

6. Distracted hikes to the printer. While most health care settings have installed the computer in the exam rooms, few have also installed a printer. “The doctor types up the exit summary, hits print, runs around the corner, down the hall, around the corner to the one printer, picks up the visit summary, goes back down the corner down the hall. Meanwhile, they’ve broken their bond with the patient and been interrupted several times on that journey.”

7. Single-use workstations. Doctors who can sit side by side with their nurses and talk about the patient as they’re working on the EHR can save 30 minutes per day. But most office practice setups don’t accommodate that interaction.

8. Small monitors. Being able to see a large display of information rather than a tiny swatch can save 20 minutes of physician time a day, Dr. Sinsky said.

9. A long sign-in process. Streamlining the way a doctor signs into a computer, perhaps with the use of technologies like the tap of one’s badge, “can save 14 minutes of physician time a day,” Dr. Sinsky said.

10. Underuse of medical and nursing students. Practices are beginning to hire premed and prenursing students as assistants who shadow the physician with each patient. While the physician is “giving undivided attention to the patient, the practice partner is cuing up the orders, doing the billing invoice ,and recording much of the encounter.” At the University of California, Los Angeles, researchers found that the use of these assistants saves 3 hours of physician time each day (JAMA Intern Med. 2014;174[7]:1190-3).

LAS VEGAS – Doctors are dreading what some have started to call EHR "pajama time.”

“That’s the hour or two that physicians are spending – every night after their kids go to bed – finishing up their documentation, clearing out their in-box,” according to Dr. Christine Sinsky, vice president of professional satisfaction at the American Medical Association.

At a session held in conjunction with the annual meeting of the Healthcare Information and Management Systems Society, Dr. Sinsky spoke about how electronic health records have not lived up to their promise of helping streamline patient care and instead have added hours and headaches to most physicians’ days.

Leah-Anne Thompson/Thinkstock

Data on the impact of EHR systems on physicians’ workflows and satisfaction is beginning to accumulate, she said. University of Wisconsin researchers studying the impact of EHR systems on physicians’ workflow and lives looked at how often and when doctors were accessing their patients’ medical records, she said. What they found was that so many doctors don’t have enough time in their days to finish their documentation, so they spend their evenings and weekends finishing up. Their preliminary findings were presented in 2015 at a primary care research meeting.

Dr. Sinsky said the researchers see “a bump” of time spent on Saturday nights.

“I call that ‘date night’. That Saturday night belongs to Epic, Cerner, or McKesson,” she said sarcastically. “Well, I don’t want my doctor on her electronic health record on a Saturday night. I want my doctor having fun on Saturday night, because I want her to love her job.”

That same study “found that primary care physicians were spending 38 hours a month after hours doing data entry work,” in other words “working a full extra week every month doing documentation after hours, between 7 p.m. and 7 a.m.,” said Dr. Sinky, who is also an internist in Dubuque, Iowa.

Here are 10 ways EHRs contribute to more work, Dr. Sinsky said:

1. Too many clicks. “It takes 33 clicks to order and record a flu shot. And in the emergency room, it takes 4,000 clicks to get through the day for a 10-hour shift,” Dr. Sinsky said. “Studies have shown that physicians are spending 44% of their day doing data entry work, [but] 28% of the day with their patient.”

In her own EHR, she said, “it took 21 clicks, eight scrolls, and five screens just to compose the billing invoice, and within that EHR, the responsibility, which used to be a clerical responsibility, has transferred many things to the physician. All of those clicks, all those screens, and all those minutes add up.”

2. Note bloat. With her current EHR, Dr. Sinksy said, “I have six pages of notes for an upper respiratory infection.” This is not efficient. She offered another example: “I had a patient recently who I sent to a local university,” Dr. Sinsky said. “I got back an enormous note, about 12 pages long. But I still didn’t know, at the end of it. Did she have cancer, or not?”

3. Poor workflow. Today’s EHRs have a workflow that doesn’t match how clinicians work, she said. “Right now, many clinicians are encountering these very rigid workflows that don’t meet the patient’s need and don’t meet the provider’s need.” For example, “in some EHRs, the physician can’t look at any clinical data while dictating the note. This means that the physician has to rely on memory or print lab results, x-ray reports, medication lists, etc., in order to reference these data points in their clinic note.”

4. A lack of focus on the patient. Most EHRs lack a place for a photo of the patient and his or her family, and a place for the patient’s story, a deficiency that detracts from the value of the encounter.

5. No support for team care. Often, both a physician and a nurse or medical assistant need to add documentation to the EHR. Yet many systems are set up such that each party must log in, then log out, before another can contribute. “The nurse has to sign in and sign out; the doctor has to sign in and sign out. That’s about a 2-minute process, so it’s completely unworkable,” Dr. Sinsky said.

6. Distracted hikes to the printer. While most health care settings have installed the computer in the exam rooms, few have also installed a printer. “The doctor types up the exit summary, hits print, runs around the corner, down the hall, around the corner to the one printer, picks up the visit summary, goes back down the corner down the hall. Meanwhile, they’ve broken their bond with the patient and been interrupted several times on that journey.”

7. Single-use workstations. Doctors who can sit side by side with their nurses and talk about the patient as they’re working on the EHR can save 30 minutes per day. But most office practice setups don’t accommodate that interaction.

8. Small monitors. Being able to see a large display of information rather than a tiny swatch can save 20 minutes of physician time a day, Dr. Sinsky said.

9. A long sign-in process. Streamlining the way a doctor signs into a computer, perhaps with the use of technologies like the tap of one’s badge, “can save 14 minutes of physician time a day,” Dr. Sinsky said.

10. Underuse of medical and nursing students. Practices are beginning to hire premed and prenursing students as assistants who shadow the physician with each patient. While the physician is “giving undivided attention to the patient, the practice partner is cuing up the orders, doing the billing invoice ,and recording much of the encounter.” At the University of California, Los Angeles, researchers found that the use of these assistants saves 3 hours of physician time each day (JAMA Intern Med. 2014;174[7]:1190-3).

LAS VEGAS – Doctors are dreading what some have started to call EHR "pajama time.”

“That’s the hour or two that physicians are spending – every night after their kids go to bed – finishing up their documentation, clearing out their in-box,” according to Dr. Christine Sinsky, vice president of professional satisfaction at the American Medical Association.

At a session held in conjunction with the annual meeting of the Healthcare Information and Management Systems Society, Dr. Sinsky spoke about how electronic health records have not lived up to their promise of helping streamline patient care and instead have added hours and headaches to most physicians’ days.

Leah-Anne Thompson/Thinkstock

Data on the impact of EHR systems on physicians’ workflows and satisfaction is beginning to accumulate, she said. University of Wisconsin researchers studying the impact of EHR systems on physicians’ workflow and lives looked at how often and when doctors were accessing their patients’ medical records, she said. What they found was that so many doctors don’t have enough time in their days to finish their documentation, so they spend their evenings and weekends finishing up. Their preliminary findings were presented in 2015 at a primary care research meeting.

Dr. Sinsky said the researchers see “a bump” of time spent on Saturday nights.

“I call that ‘date night’. That Saturday night belongs to Epic, Cerner, or McKesson,” she said sarcastically. “Well, I don’t want my doctor on her electronic health record on a Saturday night. I want my doctor having fun on Saturday night, because I want her to love her job.”

That same study “found that primary care physicians were spending 38 hours a month after hours doing data entry work,” in other words “working a full extra week every month doing documentation after hours, between 7 p.m. and 7 a.m.,” said Dr. Sinky, who is also an internist in Dubuque, Iowa.

Here are 10 ways EHRs contribute to more work, Dr. Sinsky said:

1. Too many clicks. “It takes 33 clicks to order and record a flu shot. And in the emergency room, it takes 4,000 clicks to get through the day for a 10-hour shift,” Dr. Sinsky said. “Studies have shown that physicians are spending 44% of their day doing data entry work, [but] 28% of the day with their patient.”

In her own EHR, she said, “it took 21 clicks, eight scrolls, and five screens just to compose the billing invoice, and within that EHR, the responsibility, which used to be a clerical responsibility, has transferred many things to the physician. All of those clicks, all those screens, and all those minutes add up.”

2. Note bloat. With her current EHR, Dr. Sinksy said, “I have six pages of notes for an upper respiratory infection.” This is not efficient. She offered another example: “I had a patient recently who I sent to a local university,” Dr. Sinsky said. “I got back an enormous note, about 12 pages long. But I still didn’t know, at the end of it. Did she have cancer, or not?”

3. Poor workflow. Today’s EHRs have a workflow that doesn’t match how clinicians work, she said. “Right now, many clinicians are encountering these very rigid workflows that don’t meet the patient’s need and don’t meet the provider’s need.” For example, “in some EHRs, the physician can’t look at any clinical data while dictating the note. This means that the physician has to rely on memory or print lab results, x-ray reports, medication lists, etc., in order to reference these data points in their clinic note.”

4. A lack of focus on the patient. Most EHRs lack a place for a photo of the patient and his or her family, and a place for the patient’s story, a deficiency that detracts from the value of the encounter.

5. No support for team care. Often, both a physician and a nurse or medical assistant need to add documentation to the EHR. Yet many systems are set up such that each party must log in, then log out, before another can contribute. “The nurse has to sign in and sign out; the doctor has to sign in and sign out. That’s about a 2-minute process, so it’s completely unworkable,” Dr. Sinsky said.

6. Distracted hikes to the printer. While most health care settings have installed the computer in the exam rooms, few have also installed a printer. “The doctor types up the exit summary, hits print, runs around the corner, down the hall, around the corner to the one printer, picks up the visit summary, goes back down the corner down the hall. Meanwhile, they’ve broken their bond with the patient and been interrupted several times on that journey.”

7. Single-use workstations. Doctors who can sit side by side with their nurses and talk about the patient as they’re working on the EHR can save 30 minutes per day. But most office practice setups don’t accommodate that interaction.

8. Small monitors. Being able to see a large display of information rather than a tiny swatch can save 20 minutes of physician time a day, Dr. Sinsky said.

9. A long sign-in process. Streamlining the way a doctor signs into a computer, perhaps with the use of technologies like the tap of one’s badge, “can save 14 minutes of physician time a day,” Dr. Sinsky said.

10. Underuse of medical and nursing students. Practices are beginning to hire premed and prenursing students as assistants who shadow the physician with each patient. While the physician is “giving undivided attention to the patient, the practice partner is cuing up the orders, doing the billing invoice ,and recording much of the encounter.” At the University of California, Los Angeles, researchers found that the use of these assistants saves 3 hours of physician time each day (JAMA Intern Med. 2014;174[7]:1190-3).

LAS VEGAS – Federal officials have spent months listening to doctors’ complaints about their frustrating EHRs and are responding with a core group of changes to simplify and standardize health IT.

“We’ve made a great start, but we’re still at a stage where technology often hurts rather than helps physicians to provide better care,” Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services, said March 1 at the annual meeting of the Health Information and Management Systems Society.

©thinkstockphotos.com

He provided some examples of complaints he hears from doctors: “Ordering aspirin takes eight clicks on the computer; to order full-strength aspirin, 16,” he said as the audience laughed.

And, “the systems don’t talk to each other. It’s actually the opposite. I can’t even access the hospital because of a firewall, and I can’t even get into the EMR at the hospital to look at patient records.”

And, “I can’t track my patients’ referrals,” or “I sent them to the hospital and I don’t know what happened.”

Mr. Slavitt said that he has 700 complaints from doctors just like those. “But the good news is that they’re not describing problems that we don’t know how to solve.”

And, he said, solving them is exactly what the CMS and a host of other agencies within the Health and Human Services department are trying to do with a raft of new proposed rules and announcements designed to more easily connect patients and providers with health care information necessary to provide better care.

Mr. Slavitt’s view of the EHR situation was echoed by Dr. Karen DeSalvo, national coordinator for Health Information Technology, who said that her husband is a practicing physician with real time frustrations.

“That’s my dinner conversation,” she said. “He’s a very clinically busy emergency medicine doc, and he wants the system to enable his workflow, and just like many physicians, it’s the same common refrain.”

Part of the solution is a proposed rule announced March 1 that would allow the Office of the National Coordinator for Heath Information Technology (ONC) to directly review certified health IT systems “and take action necessary including requiring the correction of nonconformities found in health IT … and suspending and terminating certifications.”

The proposed rule would:

• Enable ONC to directly review certified health IT products, including certified EHRs, and address circumstances such as potential risks to public health and safety. This would complement the existing responsibilities of ONC-Authorized Certification Bodies.

• Give ONC direct oversight of health IT testing bodies.

• Publish information on the performance of certified EHRs and other certified health IT products so that users can easily understand both the positive and negative aspects of each product.

Also on March 1, ONC announced $625,000 worth of challenge awards to encourage the development of mobile apps that patients and physicians can use to manage health information. The challenge will encourage the use of open, standardized application programming interfaces and one federal programming language standard (the Health Level 7 – Fast Healthcare Interoperability Resources or FHIR).

More expected rule making will come in several months to roll out expectations under MACRA, the Medicare Access & CHIP Reauthorization Act of 2015, including the Merit-Based Incentive Payment System (MIPS) and more alternative payment models such as accountable care organizations and bundled payment plans.

Under MIPS, Mr. Slavitt said, Congress is asking to measure quality, resource use, use of technology and practice improvement.

In addition, Mr. Slavitt said the CMS intends to roll out EHR requirements for long-term care facilities and behavioral health care providers. And, he said, “significant, significant effort and rules are underway” to improve quality and access for patients under the Medicaid program.

“I need physicians who are committed and who feel that part of their role is to take care of people who need care the most, who have lower socioeconomic status and who are more difficult to treat.”

LAS VEGAS – Federal officials have spent months listening to doctors’ complaints about their frustrating EHRs and are responding with a core group of changes to simplify and standardize health IT.

“We’ve made a great start, but we’re still at a stage where technology often hurts rather than helps physicians to provide better care,” Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services, said March 1 at the annual meeting of the Health Information and Management Systems Society.

©thinkstockphotos.com

He provided some examples of complaints he hears from doctors: “Ordering aspirin takes eight clicks on the computer; to order full-strength aspirin, 16,” he said as the audience laughed.

And, “the systems don’t talk to each other. It’s actually the opposite. I can’t even access the hospital because of a firewall, and I can’t even get into the EMR at the hospital to look at patient records.”

And, “I can’t track my patients’ referrals,” or “I sent them to the hospital and I don’t know what happened.”

Mr. Slavitt said that he has 700 complaints from doctors just like those. “But the good news is that they’re not describing problems that we don’t know how to solve.”

And, he said, solving them is exactly what the CMS and a host of other agencies within the Health and Human Services department are trying to do with a raft of new proposed rules and announcements designed to more easily connect patients and providers with health care information necessary to provide better care.

Mr. Slavitt’s view of the EHR situation was echoed by Dr. Karen DeSalvo, national coordinator for Health Information Technology, who said that her husband is a practicing physician with real time frustrations.

“That’s my dinner conversation,” she said. “He’s a very clinically busy emergency medicine doc, and he wants the system to enable his workflow, and just like many physicians, it’s the same common refrain.”

Part of the solution is a proposed rule announced March 1 that would allow the Office of the National Coordinator for Heath Information Technology (ONC) to directly review certified health IT systems “and take action necessary including requiring the correction of nonconformities found in health IT … and suspending and terminating certifications.”

The proposed rule would:

• Enable ONC to directly review certified health IT products, including certified EHRs, and address circumstances such as potential risks to public health and safety. This would complement the existing responsibilities of ONC-Authorized Certification Bodies.

• Give ONC direct oversight of health IT testing bodies.

• Publish information on the performance of certified EHRs and other certified health IT products so that users can easily understand both the positive and negative aspects of each product.

Also on March 1, ONC announced $625,000 worth of challenge awards to encourage the development of mobile apps that patients and physicians can use to manage health information. The challenge will encourage the use of open, standardized application programming interfaces and one federal programming language standard (the Health Level 7 – Fast Healthcare Interoperability Resources or FHIR).

More expected rule making will come in several months to roll out expectations under MACRA, the Medicare Access & CHIP Reauthorization Act of 2015, including the Merit-Based Incentive Payment System (MIPS) and more alternative payment models such as accountable care organizations and bundled payment plans.

Under MIPS, Mr. Slavitt said, Congress is asking to measure quality, resource use, use of technology and practice improvement.

In addition, Mr. Slavitt said the CMS intends to roll out EHR requirements for long-term care facilities and behavioral health care providers. And, he said, “significant, significant effort and rules are underway” to improve quality and access for patients under the Medicaid program.

“I need physicians who are committed and who feel that part of their role is to take care of people who need care the most, who have lower socioeconomic status and who are more difficult to treat.”

LAS VEGAS – Federal officials have spent months listening to doctors’ complaints about their frustrating EHRs and are responding with a core group of changes to simplify and standardize health IT.

“We’ve made a great start, but we’re still at a stage where technology often hurts rather than helps physicians to provide better care,” Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services, said March 1 at the annual meeting of the Health Information and Management Systems Society.

©thinkstockphotos.com

He provided some examples of complaints he hears from doctors: “Ordering aspirin takes eight clicks on the computer; to order full-strength aspirin, 16,” he said as the audience laughed.

And, “the systems don’t talk to each other. It’s actually the opposite. I can’t even access the hospital because of a firewall, and I can’t even get into the EMR at the hospital to look at patient records.”

And, “I can’t track my patients’ referrals,” or “I sent them to the hospital and I don’t know what happened.”

Mr. Slavitt said that he has 700 complaints from doctors just like those. “But the good news is that they’re not describing problems that we don’t know how to solve.”

And, he said, solving them is exactly what the CMS and a host of other agencies within the Health and Human Services department are trying to do with a raft of new proposed rules and announcements designed to more easily connect patients and providers with health care information necessary to provide better care.

Mr. Slavitt’s view of the EHR situation was echoed by Dr. Karen DeSalvo, national coordinator for Health Information Technology, who said that her husband is a practicing physician with real time frustrations.

“That’s my dinner conversation,” she said. “He’s a very clinically busy emergency medicine doc, and he wants the system to enable his workflow, and just like many physicians, it’s the same common refrain.”

Part of the solution is a proposed rule announced March 1 that would allow the Office of the National Coordinator for Heath Information Technology (ONC) to directly review certified health IT systems “and take action necessary including requiring the correction of nonconformities found in health IT … and suspending and terminating certifications.”

The proposed rule would:

• Enable ONC to directly review certified health IT products, including certified EHRs, and address circumstances such as potential risks to public health and safety. This would complement the existing responsibilities of ONC-Authorized Certification Bodies.

• Give ONC direct oversight of health IT testing bodies.

• Publish information on the performance of certified EHRs and other certified health IT products so that users can easily understand both the positive and negative aspects of each product.

Also on March 1, ONC announced $625,000 worth of challenge awards to encourage the development of mobile apps that patients and physicians can use to manage health information. The challenge will encourage the use of open, standardized application programming interfaces and one federal programming language standard (the Health Level 7 – Fast Healthcare Interoperability Resources or FHIR).

More expected rule making will come in several months to roll out expectations under MACRA, the Medicare Access & CHIP Reauthorization Act of 2015, including the Merit-Based Incentive Payment System (MIPS) and more alternative payment models such as accountable care organizations and bundled payment plans.

Under MIPS, Mr. Slavitt said, Congress is asking to measure quality, resource use, use of technology and practice improvement.

In addition, Mr. Slavitt said the CMS intends to roll out EHR requirements for long-term care facilities and behavioral health care providers. And, he said, “significant, significant effort and rules are underway” to improve quality and access for patients under the Medicaid program.

“I need physicians who are committed and who feel that part of their role is to take care of people who need care the most, who have lower socioeconomic status and who are more difficult to treat.”

LAS VEGAS – Health care data interoperability should get a huge boost under a public-private effort announced Feb. 29 by U.S. Department of Health and Human Services Secretary Sylvia Burwell.

The nation’s top five health care systems and companies, which provide the electronic health record systems that cover more than 90% of U.S. hospital patients, have agreed to principles designed to improve patient access to health data and eliminate the practice of data blocking.

They also have agreed to adopt federally recognized, national interoperability standards, Ms. Burwell announced at the annual meeting of the Healthcare Information and Management Systems Society.

“Technology is not just one leg of our strategy to build a better health care system for our nation – it supports the entire effort,” Ms. Burwell said. “We are working to unlock health care data and information so that providers are better informed and patients and families can access their health care information, making them empowered, active participants in their own care.”

Courtesy HHS

In a show of support, medical specialty societies including the American Academy of Family Physicians, the American College of Physicians, the American Society of Clinical Oncology, and the American Medical Association also signed on to the commitment.

“We have made tremendous progress to bring health care into the 21st century,” Ms. Burwell said. “In 6 short years, we have tripled the adoption of electronic health records. Today, three-quarters of physicians are using them. And nearly every hospital uses EHRs, meaning that there is now a digital care footprint for almost everyone in this country.”

To unlock all those data and make them useful to health care providers and patients, the health IT companies and health care systems have agreed to the following steps:

• Implement application programming interface (API) technology so that smartphone and tablet apps can be created, facilitating patient use and transfer of their health care data.

• Work so providers can share patient health care data with patients and other providers whenever permitted by law, while not blocking such sharing either intentionally or unintentionally.

• Use the federally recognized Fast Healthcare Interoperability Resources (FHIR) data standard.

This commitment is a “major step forward” to help patients “not just in one episode, but over the long term,” explained Dr. Karen DeSalvo, National Coordinator for Health Information Technology. The agreement means the health care system is “on the threshold of a truly historic opportunity to transform quality of care,” she added.

Federal officials have a timeline for progress toward these goals by 2018, Dr. DeSalvo noted. But “the private sector wants to pull that forward and be leaders with us,” she said. “So, our expectation is that the calls and the commitments and the associated actions that these developers have declared will be seeing some changes by the fall.”

To highlight health information technology’s promise, Ms. Burwell shared a story about electronic health records’ use to find children affected by lead pollution in the water supplies of Flint, Mich.

Alerted to the problem by a friend, pediatrician Mona Hanna-Attisha of Hurley Medical Center in Flint tried to determine whether pipe corrosion might leach dangerous levels of lead into the water supply, Ms. Burwell said.

“She knew the danger lead posed and began what she called a ‘crusade’ to find out if it was affecting children,” Ms. Burwell explained. Dr. Hanna-Attisha mined Hurley’s medical records to “compare blood test results from more than 700 children in the area and map home addresses for geographic variations.

“She quickly discovered that the percentage of children in Flint with lead poisoning had doubled, and even tripled, in some neighborhoods,” Burwell said.

If those results had still been on paper, “it would have taken forever to get these results,” she said.

“Dr. Hanna-Attisha’s story shows us the power of putting health care data to work,” Ms. Burwell noted. “It allows us to see the connections in our communities and helps us put patients in the center of their care.”

Dr. David Classen, chief information officer of the patient safety organization Pascal Metrics and an author of a 2011 Institute of Medicine report on health IT and patient safety, applauded the announcement and the commitment from major EHR vendors and hospital systems have signed on.

“That was one of the things [the IOM expert panel] envisioned – a public-private partnership that would really help this. That’s close to optimal in my view.”

But “the devil’s in the details,” said Dr. Classen, associate professor of medicine at the University of Utah. “When it comes to sharing safety information, it’s not just removal of the gag clauses, it’s also the confidentiality clauses, and the intellectual property protections. Those things too can inhibit sharing of safety information. The challenge here is that [EHR vendors] worry that if they’re so interoperable, they convert their proprietary technology into something that could virtually be open source...and everyone can look at it. Those are legitimate concerns.”

Another concern is agreeing on a common alphabet. “Without that, this is not going to work,” he said. “All these vendor products grew up in silos, without standards imposed on them. So naturally, they’re going to have a Tower of Babel, which means most of them aren’t going to be speaking the same language.”

LAS VEGAS – Health care data interoperability should get a huge boost under a public-private effort announced Feb. 29 by U.S. Department of Health and Human Services Secretary Sylvia Burwell.

The nation’s top five health care systems and companies, which provide the electronic health record systems that cover more than 90% of U.S. hospital patients, have agreed to principles designed to improve patient access to health data and eliminate the practice of data blocking.

They also have agreed to adopt federally recognized, national interoperability standards, Ms. Burwell announced at the annual meeting of the Healthcare Information and Management Systems Society.

“Technology is not just one leg of our strategy to build a better health care system for our nation – it supports the entire effort,” Ms. Burwell said. “We are working to unlock health care data and information so that providers are better informed and patients and families can access their health care information, making them empowered, active participants in their own care.”

Courtesy HHS

In a show of support, medical specialty societies including the American Academy of Family Physicians, the American College of Physicians, the American Society of Clinical Oncology, and the American Medical Association also signed on to the commitment.

“We have made tremendous progress to bring health care into the 21st century,” Ms. Burwell said. “In 6 short years, we have tripled the adoption of electronic health records. Today, three-quarters of physicians are using them. And nearly every hospital uses EHRs, meaning that there is now a digital care footprint for almost everyone in this country.”

To unlock all those data and make them useful to health care providers and patients, the health IT companies and health care systems have agreed to the following steps:

• Implement application programming interface (API) technology so that smartphone and tablet apps can be created, facilitating patient use and transfer of their health care data.

• Work so providers can share patient health care data with patients and other providers whenever permitted by law, while not blocking such sharing either intentionally or unintentionally.

• Use the federally recognized Fast Healthcare Interoperability Resources (FHIR) data standard.

This commitment is a “major step forward” to help patients “not just in one episode, but over the long term,” explained Dr. Karen DeSalvo, National Coordinator for Health Information Technology. The agreement means the health care system is “on the threshold of a truly historic opportunity to transform quality of care,” she added.

Federal officials have a timeline for progress toward these goals by 2018, Dr. DeSalvo noted. But “the private sector wants to pull that forward and be leaders with us,” she said. “So, our expectation is that the calls and the commitments and the associated actions that these developers have declared will be seeing some changes by the fall.”

To highlight health information technology’s promise, Ms. Burwell shared a story about electronic health records’ use to find children affected by lead pollution in the water supplies of Flint, Mich.

Alerted to the problem by a friend, pediatrician Mona Hanna-Attisha of Hurley Medical Center in Flint tried to determine whether pipe corrosion might leach dangerous levels of lead into the water supply, Ms. Burwell said.

“She knew the danger lead posed and began what she called a ‘crusade’ to find out if it was affecting children,” Ms. Burwell explained. Dr. Hanna-Attisha mined Hurley’s medical records to “compare blood test results from more than 700 children in the area and map home addresses for geographic variations.

“She quickly discovered that the percentage of children in Flint with lead poisoning had doubled, and even tripled, in some neighborhoods,” Burwell said.

If those results had still been on paper, “it would have taken forever to get these results,” she said.

“Dr. Hanna-Attisha’s story shows us the power of putting health care data to work,” Ms. Burwell noted. “It allows us to see the connections in our communities and helps us put patients in the center of their care.”

Dr. David Classen, chief information officer of the patient safety organization Pascal Metrics and an author of a 2011 Institute of Medicine report on health IT and patient safety, applauded the announcement and the commitment from major EHR vendors and hospital systems have signed on.

“That was one of the things [the IOM expert panel] envisioned – a public-private partnership that would really help this. That’s close to optimal in my view.”

But “the devil’s in the details,” said Dr. Classen, associate professor of medicine at the University of Utah. “When it comes to sharing safety information, it’s not just removal of the gag clauses, it’s also the confidentiality clauses, and the intellectual property protections. Those things too can inhibit sharing of safety information. The challenge here is that [EHR vendors] worry that if they’re so interoperable, they convert their proprietary technology into something that could virtually be open source...and everyone can look at it. Those are legitimate concerns.”

Another concern is agreeing on a common alphabet. “Without that, this is not going to work,” he said. “All these vendor products grew up in silos, without standards imposed on them. So naturally, they’re going to have a Tower of Babel, which means most of them aren’t going to be speaking the same language.”

LAS VEGAS – Health care data interoperability should get a huge boost under a public-private effort announced Feb. 29 by U.S. Department of Health and Human Services Secretary Sylvia Burwell.

The nation’s top five health care systems and companies, which provide the electronic health record systems that cover more than 90% of U.S. hospital patients, have agreed to principles designed to improve patient access to health data and eliminate the practice of data blocking.

They also have agreed to adopt federally recognized, national interoperability standards, Ms. Burwell announced at the annual meeting of the Healthcare Information and Management Systems Society.

“Technology is not just one leg of our strategy to build a better health care system for our nation – it supports the entire effort,” Ms. Burwell said. “We are working to unlock health care data and information so that providers are better informed and patients and families can access their health care information, making them empowered, active participants in their own care.”

Courtesy HHS

In a show of support, medical specialty societies including the American Academy of Family Physicians, the American College of Physicians, the American Society of Clinical Oncology, and the American Medical Association also signed on to the commitment.

“We have made tremendous progress to bring health care into the 21st century,” Ms. Burwell said. “In 6 short years, we have tripled the adoption of electronic health records. Today, three-quarters of physicians are using them. And nearly every hospital uses EHRs, meaning that there is now a digital care footprint for almost everyone in this country.”

To unlock all those data and make them useful to health care providers and patients, the health IT companies and health care systems have agreed to the following steps:

• Implement application programming interface (API) technology so that smartphone and tablet apps can be created, facilitating patient use and transfer of their health care data.

• Work so providers can share patient health care data with patients and other providers whenever permitted by law, while not blocking such sharing either intentionally or unintentionally.

• Use the federally recognized Fast Healthcare Interoperability Resources (FHIR) data standard.

This commitment is a “major step forward” to help patients “not just in one episode, but over the long term,” explained Dr. Karen DeSalvo, National Coordinator for Health Information Technology. The agreement means the health care system is “on the threshold of a truly historic opportunity to transform quality of care,” she added.

Federal officials have a timeline for progress toward these goals by 2018, Dr. DeSalvo noted. But “the private sector wants to pull that forward and be leaders with us,” she said. “So, our expectation is that the calls and the commitments and the associated actions that these developers have declared will be seeing some changes by the fall.”

To highlight health information technology’s promise, Ms. Burwell shared a story about electronic health records’ use to find children affected by lead pollution in the water supplies of Flint, Mich.

Alerted to the problem by a friend, pediatrician Mona Hanna-Attisha of Hurley Medical Center in Flint tried to determine whether pipe corrosion might leach dangerous levels of lead into the water supply, Ms. Burwell said.

“She knew the danger lead posed and began what she called a ‘crusade’ to find out if it was affecting children,” Ms. Burwell explained. Dr. Hanna-Attisha mined Hurley’s medical records to “compare blood test results from more than 700 children in the area and map home addresses for geographic variations.

“She quickly discovered that the percentage of children in Flint with lead poisoning had doubled, and even tripled, in some neighborhoods,” Burwell said.

If those results had still been on paper, “it would have taken forever to get these results,” she said.

“Dr. Hanna-Attisha’s story shows us the power of putting health care data to work,” Ms. Burwell noted. “It allows us to see the connections in our communities and helps us put patients in the center of their care.”

Dr. David Classen, chief information officer of the patient safety organization Pascal Metrics and an author of a 2011 Institute of Medicine report on health IT and patient safety, applauded the announcement and the commitment from major EHR vendors and hospital systems have signed on.

“That was one of the things [the IOM expert panel] envisioned – a public-private partnership that would really help this. That’s close to optimal in my view.”

But “the devil’s in the details,” said Dr. Classen, associate professor of medicine at the University of Utah. “When it comes to sharing safety information, it’s not just removal of the gag clauses, it’s also the confidentiality clauses, and the intellectual property protections. Those things too can inhibit sharing of safety information. The challenge here is that [EHR vendors] worry that if they’re so interoperable, they convert their proprietary technology into something that could virtually be open source...and everyone can look at it. Those are legitimate concerns.”

Another concern is agreeing on a common alphabet. “Without that, this is not going to work,” he said. “All these vendor products grew up in silos, without standards imposed on them. So naturally, they’re going to have a Tower of Babel, which means most of them aren’t going to be speaking the same language.”