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Florida-based AdventHealth plans to replace its Cerner electronic health record (EHR) system with rival Epic’s.

One of the largest faith-based health systems in the country, AdventHealth operates 50 hospital campuses across a dozen states. The health system employs more than 80,000 people who serve more than 5 million patients annually and reports nearly $20 billion in annual revenue.

The health system first signed a deal with Cerner in 2002 when it was known as Adventist Health System.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

AdventHealth will¬†begin the transition in March and will eventually roll Epic’s EHR out to 1,200 care sites. The work is expected to be completed in about three years, the health system said.

In a press release issued Tuesday, AdventHealth said it plans to install a single, integrated Epic EHR and revenue cycle management system across all of its acute care, physician practice, ambulatory, urgent care, home health and hospice facilities.

Epic’s Community Connect program will also allow AdventHealth to extend its EHR system to affiliated providers as part of the integrated platform, according to AdventHealth.

‚ÄúOur journey to become a consumer-focused clinical company requires a fully connected network throughout our entire enterprise,‚ÄĚ Terry Shaw, president and CEO for AdventHealth, said in a statement. ‚ÄúConnecting our network with a robust, integrated health record platform will give our caregivers access to the clinical information they need at the point of care and ultimately advance our consumer promises through a more seamless experience for those we serve.‚ÄĚ

In an emailed statement, Cerner confirmed the changeover. “AdventHealth has made the business decision to transition over the next few years management of its EHR and revenue cycle management system to another supplier. The shift is expected to take up to five years and Cerner is committed to working closely with AdventHealth to continue delivering superior health care technology solutions throughout the transition,” the company said.

Anonymous Reddit posters predicted the change months ago, saying that the health system was frustrated with integration issues with Cerner’s ambulatory solution and revenue cycle functionalities. HIStalk first reported the Reddit posts regarding Cerner and AdventHealth.

One Reddit user¬†said¬†AdventHealth staff felt the health system¬†was on the “back burner” since Cerner signed massive projects with the departments of Defense and Veterans Affairs.

It’s unclear what the loss of a big EHR client will mean for health IT company Cerner’s annual revenue or earnings.

The company continues efforts to turn its financial picture around and improve its operating performance.

Almost a year ago, activist investor Starboard Value stepped in, and Cerner reached a settlement with the hedge fund to add new directors to its board and buy back more of its shares. Cerner also agreed to take steps to improve operations and committed to hitting certain operating targets.

The new agreement between Cerner and Starboard Value, which has a 1.2% stake in the company,¬†was seen as welcome news by many financial analysts as a plan to increase the company’s profitability.

Cerner’s full-year 2019 bookings were¬†down 11% compared to¬†2018 bookings, from¬†$6.72¬†billion to $5.99 billion. Company executives said during their full-year and fourth-quarter earnings call that the¬†decline in bookings was primarily driven by the company being more selective in the types of contracts it pursues, which led to fewer large, long-term outsourcing contracts.

Congressional Democrats said they felt blindsided¬†by the Department of Veterans Affairs’ (VA’s) decision this week to push¬†off its go-live date for a new $16 billion medical records system.

The House Veterans’ Affairs Subcommittee on Technology Modernization plans to hold a hearing in the next few weeks to scrutinize the VA’s decision to delay the platform’s rollout,¬†Susie Lee, D-Nevada,¬†chairwoman of the subcommittee, announced.

The VA had planned to flip the switch on the new electronic health record (EHR) at its first site‚ÄĒMann-Grandstaff VA Medical Center in Spokane, Washington‚ÄĒon March 28. But the VA announced this week it’s delaying plans to commence end-user training, which may impact ‚Äúgoing live‚ÄĚ with its EHR¬†in March in Washington.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

“After rigorous testing of our new EHR, the department will need more time to complete the system build and ensure clinicians and other users are properly trained on it,”¬†VA spokesperson Christina Mandreucci told FierceHealthcare in an emailed statement.

“We believe we are 75-80% complete in this regard and will be announcing a revised ‘go-live’¬†schedule in the coming weeks,” she said.

Lee said during a hearing on VA’s data privacy policies Wednesday¬†that the VA needs to be “forthright about its progress, identify concerns, and notify Congress about any challenges.”

“I‚Äôve long said that getting it right is far more important than hitting a date on a calendar. If there needs to be a delay¬†to get the system to a place where veterans’ lives are¬†not at risk and VA staff are ready to use it, that‚Äôs the right thing to do,” she said.

She added, “However, I‚Äôm concerned that as we have moved closer to the go-live date, we were told repeatedly there were no show-stoppers in implementation, that¬†testing was going great, and that things were on track.”

Politico reported that the committee’s¬†staff said the VA had not mentioned the possibility of delay in recent meetings. When the department informed¬†Lee of the decision, VA officials employed inconsistent explanations, committee staff told Politico.

Lee acknowledged that software development and testing conditions can change rapidly, but the committee¬†requires “transparency and for the VA to be accountable for its actions.”¬†

She also noted that President Donald Trump’s proposed budget would “speed up” the EHR project rollout.

The VA signed a $10 billion deal with Cerner in May 2018 to move from the VA’s customized VistA platform to an off-the-shelf EHR to align the country’s largest health system with the Department of Defense, which has already started integrating Cerner’s MHS Genesis system.

For the VA, the Cerner EHR will replace the approximately 130 operational instances of VistA currently in use across the department. While the initial EHR contract signed with Cerner was for $10 billion, the VA has pushed the estimated 10-year cost for implementing the system past $16 billion.

The VA’s delay comes a week after a key VA EHR project leader, former VA Deputy Secretary James¬†Byrne, was¬†abruptly dismissed. In his five months at the agency, Byrne¬†was a key leader¬†updating members of Congress on the progress and challenges of the implementation.

Lawmakers on both sides of the aisle want more answers on why the department pushed off its go-live date for the multibillion dollar medical records system.

Rep. Jim Banks, R-Indiana, ranking member of the committee, said during the hearing that he supported VA Secretary Robert Wilkie’s decision to delay the EHR launch but was disappointed that no VA officials in charge of the EHR project attended Wednesday’s hearing, as lawmakers had requested.

Rep. Phil Roe, M.D., R-Tennessee, the ranking member of the House Committee on Veterans‚Äô Affairs and a member of the subcommittee, said VA’s decision to delay the project highlighted the need for lawmakers to ramp up¬†oversight of the project.

Sen.¬†Jon Tester, the ranking member of the Senate Veterans‚Äô Affairs Committee, said in a statement that, ‚ÄúVA must establish stable leadership to provide sufficient accountability and robust oversight of this process.‚ÄĚ

Mark Takano, D-California, chairman of the House Veterans’ Affairs Subcommittee on Technology Modernization, said he supported VA leadership taking¬†the time they¬†need¬†to get the $16 billion dollar implementation right, but leaders need¬†to be transparent with Congress.

During Wednesday’s hearing,¬†Paul Cunningham, the VA’s deputy assistant secretary and chief information security officer, testified that he was made aware of the EHR project delay on Tuesday.

The delay was more a “tactical decision” than a result of a lack of resources, he said, while acknowledging that the project was “outside his purview.”

WASHINGTON, D.C.‚ÄĒFederal health IT leader¬†Donald Rucker, M.D., said an¬†upcoming interoperability rule will include “solid” privacy protections for patients as they share their medical data.¬†

Speaking at Health Datapalooza on Tuesday, Rucker‚ÄĒwho is the head of the Office of the National Coordinator for Health IT (ONC)‚ÄĒacknowledged that privacy in a digital world is a challenging issue. But he reiterated his perspective that patients should be able to easily access and share medical data.

“It is our human right as patients to have access to our data,” he said.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

Rucker was pushing back on health IT vendor Epic’s lobbying efforts against the proposed rules, including an email Epic CEO Judy Faulkner sent to customers encouraging¬†them to sign an opposition letter. The letter cited¬†risks to patient privacy and intellectual property if the rules are finalized now.

According to reporting from CNBC’s Chrissy Farr, about 60 health systems signed the letter.

“Most of their customers did not sign on to that letter,” Rucker¬†said. “If you parse out the big academic medical centers, only three¬†out of 100 AMCs signed on.”

He also called out hospitals that signed the opposition letter due to their claims about data privacy concerns but then disregard patient privacy when filing lawsuits for unpaid medical bills.

“One of the signers of the letter is known for taking thousands of patients to court. If you take someone to court,¬†that information becomes public discovery. Their medical care is now public. It’s part of the court record,” he said.¬†“Looking at protecting privacy, we need to walk the walk here as we look at who is saying what and letter-writing campaigns.”

Almost a year ago, ONC issued a proposed interoperability and information-blocking rule that defines the demands on healthcare providers and electronic health record (EHR) vendors for data sharing. The rule also outlines exceptions to the prohibition against information blocking and provides standardized criteria for application programming interface (API) development. 

Department of Health and Human Services (HHS) leaders have not offered a timeline for when the rule will be published, but many have speculated it will be released during the Healthcare Information and Management Systems Society conference in March.

While Epic and many hospitals have come out against the interoperability rules, many technology vendors, including Apple and Microsoft, along with health plans and consumer advocacy groups have urged HHS to move forward with publishing the rule.

Four healthcare leaders recently penned an op-ed in Health Affairs calling for ONC to publish the rule immediately. Omada Health’s Lucia Savage and University of California, San Francisco’s Aaron Neinstein, Julie Adler-Milstein and Mark Savage said the ONC rule will not make the current consumer privacy protections worse.

“All health care stakeholders who are concerned about that issue should raise it with Congress and state legislatures, which have authority to act, rather than request to delay the ONC‚Äôs rule, delaying critical improvements to interoperability, access, innovation, and ending information blocking,” the authors wrote.

APIs are the technology used to link IT systems, such as EHRs, with apps and will help bring healthcare into the modern app economy, according to Rucker.

ONC’s vision is for patients to choose what apps to use, he¬†said

“We’ve often looked at interoperability in a narrow view, which is just as a replacement for moving the patient‚Äôs chart.¬†Modern computing and APIs offer a vastly richer and more empowering global computing environment. Well-built APIs can do almost anything that your creativity allows,” he said.

Before Rucker took the stage at Health Datapalooza, HHS Secretary Alex Azar also addressed the upcoming interoperability rules and the Trump administration’s commitment to putting “patients in charge of their data” and¬†called out industry stakeholders who are “defending the status quo.” They are protecting a health records system that is “segmented and Balkanized,” he said.¬†

“We have a serious problem‚ÄĒand scare tactics are not going to stop the reforms we need,” Azar said.

Health technology company Seqster is focused on helping patients bring all their health information into one place.

The San Diego-based company, which launched in 2016, announced Thursday it secured backing from Japanese pharmaceutical giant Takeda Pharmaceutical. 

The companies did not disclose the funding amount.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

The funds will be used to accelerate the adoption of the company’s interoperability technology for enhancing clinical trials, patient engagement and outcomes, the company said.

“Seqster‚Äôs technology is a very unique platform that addresses interoperability on not only a nationwide scale but also globally. Interoperability is one of the biggest barriers to applying precision medicine to clinical trials and patient engagement,” Bruce Meadows, head of investments at Takeda Digital Ventures, said in a statement.

Seqster’s platform retrieves, parses and harmonizes multidimensional data sets to help accelerate¬†the entire drug development process and provides clinical trial participants a¬†platform to share their data with investigators in¬†real time creating a longitudinal health record, according to the company.

Before the Takeda investment, the company raised at least $4 million in seed funding.

The company’s name, Seqster (pronounced seekster), comes from the idea that everyone is “seeking”¬†health data, company CEO and co-founder Ardy Arianpour told FierceHealthcare during Health Datapalooza this week.

Arianpour said he was motivated to launch the startup as a result of his mother’s experience as a cancer patient and the challenge of aggregating health data from multiple providers and hospitals.

As a health technology entrepreneur, Arianpour has a background in genomics and big data. Prior to starting Seqster, he helped bring next-generation DNA sequencing to the clinic as chief strategy officer of Pathway Genomics as well as senior vice president of Ambry Genetics, which Konica acquired for $1 billion in 2017.

Seqster aims to provide¬†“person-centric interoperability,”¬†he said.

“When I started on this journey I didn’t know what interoperability was,” he said. “Recently a¬†former executive from a large EHR¬†vendor¬†came to us and said:¬†‘You cracked interoperability.”

The platform is designed to pull together episodic clinical electronic health record (EHR)¬†data, baseline genetic DNA results and continuous fitness/wearable device data all in one place. The company’s technology standardizes¬†and harmonizes¬†different data sources on the back end and then organizes and visualizes those health data in an easily accessible format.

Arianpour compares¬†the platform to the personal finance management platform Mint.com, which was designed to be a platform that brought all of an individual’s financial information together to a single place.

Seqster is not a consumer-facing platform, but licenses it to enterprise customers such as providers and payers. The platform currently connects users to more than 3,600 healthcare providers and over 150,000 hospitals and clinics nationwide.

Other companies taking a stab at aggregating patient records include Picnic Health, which collects and digitizes health records, and PatientBank, which offers online medical record sharing. Apple also launched its Health Records feature that is now supported by hundreds of hospitals, medical clinics and specialty practices.

One distinction from Apple Health Records is that Seqster is platform-agnostic, the company says. It also enables families to aggregate health data to form a multigenerational health record, an idea that has raised privacy concerns. 

In January, the company added new interoperability features it says will help its customers more easily share longitudinal health information across various sources. Seqster improved its connectivity to providers by adopting the Fast Healthcare Interoperability Resources (FHIR) standard through the FHIR application programming interface, the company said.

The company says the new platform can help healthcare providers and health plans come into compliance with upcoming federal interoperability regulations to be released by the Office of the National Coordinator for Health IT and the Centers for Medicare & Medicaid Services.

As we wait for final rules that will enable consumers to freely access their health data, electronic health record (EHR) giant Epic is saying breaking down the silos where this information lives will create a privacy hazard for patients.

While privacy concerns over health data sharing are always legitimate, they can’t stem the tide of the inevitable: Patients and consumers are demanding access to their data, and new proposed government rules supporting a consumer-directed, seamless flow of medical information will likely go into effect as soon as this month.

When they do, it will accelerate the race among technology companies to offer consumers the end-to-end healthcare experience and outcomes we’ve all been missing. At the same time, they will force the government to move quickly to establish a new privacy framework that will replace HIPAA’s limited reach and work to benefit all stakeholders.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

We could be in for a wild ride. But when the dust settles, we will have what we should have had all along: a healthcare system where consumers sit at the center and are empowered by ownership of their own health data.

A snapshot of health IT’s bumpy history

In 2004, the Office of the National Coordinator for Health IT released a framework for strategic action, the decade of health information technology: delivering consumer-centric and information-rich care (PDF).

I worked for David Brailer at the time, who was appointed by President George W. Bush to be the country‚Äôs first information ‚Äúczar‚ÄĚ for healthcare. Dr. Brailer is still an advocate for information-sharing, recently calling on healthcare CEOs to lean into, not away from, the opportunity to engage the patient in a more meaningful way. If healthcare CEOs fall short, tech companies will fill the void (more on that later).¬†

We envisioned a system where important health data would follow the individual by building interoperability into EHRs from the start‚ÄĒa vision that tragically has yet to be realized.¬†

ELATED:¬†Epic’s Judy Faulkner: ONC data blocking rule undermines privacy, intellectual property protections

We imagined health data would function as a powerful currency for consumers, but to date, this valuable asset has stayed in the hands of EHR companies who keep it under lock and key. 

Consumers will soon hold this currency in their hands for the first time. If they seek to understand and apply their health data like they have with their genetic information‚ÄĒconsider the explosion of tech companies like 23andMe and others‚ÄĒwe‚Äôll see dramatic shifts in the health tech landscape.

Consumers are most likely to share their health information with companies that have proven they can offer a powerful, secure and user-friendly experience: companies like Amazon, Apple, Google and a host of established and emerging technology players.

We must now endeavor to build the necessary security and privacy frameworks that ensure the consumer will always be protected and in control of their personal health information.

Where to go from here

We’re entering a new era, one where healthcare providers, payers, solutions providers and technology companies will create a superior healthcare experience and deliver improved patient outcomes.

The days of medical information being walled off and guarded by EHR vendors are coming to an end.

We can expect three things to occur once the rules are finalized:

  • ¬†EHR companies will see their business models disrupted: As consumers control their health data, the silos created by EHR companies will gradually erode. This will change these companies‚Äô business models permanently. No longer the central gatekeepers of the country‚Äôs medical information, EHR companies will scramble to build new capabilities and services in a bid to remain important players in healthcare.
  • Technology companies that build trust will earn their moment in the sun: Consumers have shown a willingness to share sensitive information with technology companies in exchange for insights about their health. With new rules in place that turn loose volumes of health data, incumbent tech giants and newcomers will compete to create compelling new healthcare experiences and superior outcomes. Consumers will decide the winners by preferentially sharing their data with companies whose products and services are both transparent and secure.
  • New privacy laws must take shape: As tech companies compete to win the trust of consumers, the government will develop updated rules of the road for our new, consumer-centric health system. This effort is already underway thanks to multi-stakeholder groups like the CARIN Alliance and the work that the Robert Wood Johnson Foundation is doing with Manatt. We can expect these efforts to ramp up quickly.

HIPAA doesn’t cover many of the new digital products and services that can benefit consumers, but that doesn’t mean consumers and technology companies cannot hold this data. It means we need to modernize HIPAA.

When these trends come to pass, it will be the consumer‚ÄĒnewly empowered with their health data‚ÄĒwho will drive our country toward value-based care. Top-down decisions by healthcare providers, insurers and government agencies haven‚Äôt accomplished this vision‚ÄĒconsumers can and will.

As a consumer, a health tech entrepreneur, a mother and a former federal and state official, I am eager to bear witness as consumers take the driver’s seat, which was the intention all along.

Lori Evans Bernstein is a co-founder and the president and chief operating officer of HealthReveal. She was a senior advisor to the first National Coordinator for Health IT in the U.S. Department of Health and Human Services and served as deputy commissioner of the New York State Department of Health’s Office of Health IT Transformation.¬†

Executives are bullish on the potential of artificial intelligence to improve healthcare. But they say adoption is not happening quickly enough due to a lack of workforce training, high costs, and privacy risks, according to a survey by audit, tax, and advisory services firm KPMG.

KPMG’s survey of healthcare leaders¬†was part of a larger study of how executives across five industries view the future of AI in their sectors, and the steps they are taking to maximize its benefits and mitigate its challenges.

“The pace with which hospital systems have¬†adopted AI and automation programs has dramatically increased since 2017. Virtually all major healthcare providers are moving ahead with pilots or programs in these areas. The medical literature is showing support of AI‚Äôs power as a tool to help clinicians,” Melissa Edwards, managing director, digital enablement, KPMG, said in the report.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

An overwhelming majority of healthcare respondents (89%) think AI is already creating efficiencies in their systems, and 91% believe it is increasing patient access to care.

Many of the AI-related services and solutions being advanced in healthcare today are largely in the clinical, patient-facing space.

“Basic forms of automation are proving to be the ‚Äėgateway drug‚Äô to advanced forms of AI‚ÄĒsuch as scanning documents to determine the urgency of a referral. Applying AI to make earlier diagnoses of critical illnesses is a key area,” Edwards said.

  • Nine out of¬†10¬†healthcare executives are confident that AI will improve the patient experience with the greatest impacts being found on diagnostics, electronic records management and incorporating robotics into tasks.
     
  • More than two-thirds of healthcare stakeholders (68%) are confident AI will eventually be effective in diagnosing patient illnesses and conditions, and close to half (47%)¬†believe¬†that diagnostics will have a significant impact soon‚ÄĒwithin the next two years.
     
  • Healthcare executives also anticipate gains in process automation, with 40% seeing X-rays and CT scans being handled robotically.

Recent findings indicate that function may be close to reality. Google Health reported that an AI model developed and deployed by its DeepMind subsidiary was more effective in screening patients for breast cancer than human doctors using recent X-rays only, despite having access to patients’ previous records.

But the pace of progress is too slow, according to one-third of executives, citing barriers such as a lack of workforce talent and the high cost of implementing AI tools.

To date, only 44% of healthcare insiders say their employees are prepared for AI adoption, which is substantially lower than some of the other industries surveyed. Less than half of healthcare organizations (47%) offer AI training courses to employees.

Just 67% of healthcare insiders say their employees support AI adoption, the lowest ranking of any industry, according to KPMG.

Many healthcare institutions lack a breadth of individuals who ‚Äúspeak‚ÄĚ the language of AI, Edwards said.

“Comprehending the full range of AI technology, and how best to apply it in a healthcare setting, is a learned skill that grows out of pilots and tests. Building an AI-ready workforce requires a wholesale change in the approach to training and how to acquire talent. Having people who understand how AI can solve big, complex problems is critical,” she said.

Health systems have already made significant capital investments to meet electronic health records (EHR) requirements. To get AI off the ground requires even more of an investment, and, as a result, some health systems are slower to allocate full funding for AI.

More than half of executives (54%) believe that AI to date has actually increased rather than decreased the overall cost of healthcare. Decision-makers are struggling to determine where to place their AI best bets.

“The question is, ‚ÄėWhere do I put my AI efforts to get the greatest gain for the business?’ Trying to assess what ROI will look like is a very relevant point as they embark on their AI journey,” Edwards said.

Healthcare executives also are concerned that AI could threaten the security and privacy of patient data. Relatedly, 86% say their organizations are taking care to protect patient privacy as it implements AI.

As the industry waits for a landmark rule aimed at opening up access to patient data, Donald Rucker, M.D. said Wednesday that regulators are challenged with balancing data privacy and transparency.

The proposed interoperability rule will be coming out “relatively soon,” Rucker, who is head of the¬†Office of the National Coordinator for Health IT (ONC), said during a Health IT Advisory Committee meeting Wednesday.

Many have speculated that the rule will be released during the Healthcare Information and Management Systems Society conference in March.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

A year ago, ONC, which is part of the Department of Health and Human Services (HHS), proposed an interoperability and information-blocking rule that defines the demands on healthcare providers and electronic health record (EHR) vendors for data sharing. The rule also outlines exceptions to the prohibition against information blocking and provides standardized criteria for application programming interface (API) development. 

HHS officials say the rule, which promotes the use of application programming interfaces (APIs), will help bring healthcare into the modern app economy.

The proposed rule has created an industry rift‚ÄĒEHR vendor Epic, many health systems,¬†and some privacy groups have voiced¬†strong opposition to the rule. About 60 health systems signed an opposition¬†letter circulated by Epic CEO Judy Faulkner that was sent to Azar.¬†The letter cited¬†risks to patient privacy and intellectual property if the rules are finalized now.

Meanwhile, newer technology entrants to healthcare such as¬†Apple and Microsoft, some EHR companies like Cerner and consumer advocates are backing the rule. Google Health’s David Feinberg, M.D. has met with HHS officials about the rule, Politico reported.

Rucker was asked by members of the Health IT Advisory Committee about the status of the rule.

“There are complicated issues balancing the various interests of the American public to get a good deal in healthcare, to have transparency, to do this in a way that doesn‚Äôt prevent innovation and allows vendors to be able to build products in a practical way and draws the right balance on protecting privacy, yet addressing what is ultimately the biggest issue, which is simply the vast amount of healthcare costs that are out there and lack of patients having agency.”

As the lobbying battle over the rule goes on, Politico reported Tuesday that ONC’s rules gained a rare endorsement from a hospital system: the University of California, San Francisco. The “nation needs ONC’s proposed regulations,” the leaders of UCSF and its health system wrote to HHS Secretary Alex Azar, according to Politico.

All the lobbying efforts and public debates could have some positive results, Rucker said.

“Maybe it’s had the¬†unintended benefit of getting people to focus on¬†how this all will play out and¬†part of a broader dialogue about what we want to do with technology in our lives,” he said.

Federal regulators have listened to physicians’ complaints about health IT burdens and they¬†have¬†some solutions.

The Department of Health and Human Services (HHS) released Friday a final version of an overarching strategy to reduce clinician burden revolving around entering information into the electronic health records (EHRs), meeting regulatory requirements and improving EHR ease of use.

The new report (PDF), which includes 43 recommendations around clinical documentation and health IT usability, is a follow-up to a draft strategy released in November 2018.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

The overall goal is to improve patient care by enabling physicians to spend more time focused on them instead of their keyboards, HHS officials said.

“Physicians and other healthcare providers have long identified regulatory and administrative burdens as a key contributor to the many challenges they face. They also note these burdens weigh down the overall healthcare delivery system as well. Clinicians have pointed to an ever-increasing and poorly coordinated set of requirements they must meet to deliver and receive payment for patient care,”¬†senior officials with the Office of the National Coordinator for Health IT (ONC) wrote in a blog post Friday.

The clinical community frequently links the increased burden of meeting these requirements with the tasks and use of health IT, such as EHRs,¬†Andrew Gettinger,¬†chief clinical officer for ONC, and¬†Thomas Mason, ONC’s chief medical officer, wrote.

The report targets burdens tied to regulatory and administrative requirements that the federal government can directly impact through the rule-making process.

When looking at the steps HHS could take to mitigate EHR-related burden for healthcare providers, ONC and the Centers for Medicare & Medicaid Services (CMS) focused on strategies that are achievable within the near to medium term, roughly a three- to five-year window, according to the report.

And HHS is looking at strategies it can implement through existing or easily expanded authority.

EHR burdens have been a near-constant complaint from physicians that see the technology as an impediment to their relationship with patients. Numerous studies have documented the time suck of the technology.

The finalized strategy, required under the 21st Century Cures Act, reflects feedback from industry stakeholders and healthcare groups, including 200 comments submitted to the draft strategy, HHS said.

In several recommendations, the agency vowed to continue its work stripping down regulations and working with the industry to find solutions to growing problems. 

CMS already has taken some steps to reduce administrative burden such as changes to the more-than-two-decades-old E/M documentation and coding framework that clinicians use to bill Medicare for common office visits. 

HHS also wants to see health IT vendors doing more to improve technology usability. EHR vendors need to work with clinicians when designing systems or new features and should consult with experts in user-centered design during development, HHS officials said.

Specifically, EHR vendors should take the lead in developing health IT-specific user interface best practices and should collaborate to develop a shared repository of EHR usability practices.

This collaboration would help provide better consistency with user interface best practices while still enabling EHRs to compete with each other, HHS said in the report.

HHS also wants an EHR vendor’s user-centered design process to be highlighted on the ONC Certified Health IT Product List so potential EHR customers can see the efforts that went into the products they are considering acquiring.

“A shift from check-box interface elements to intelligent features that extract needed data from routine clinical workflows would provide a substantial reduction in usability-related clinician burdens,” HHS officials wrote in the report.

HHS’ recommendations represent the “best next steps” to address the growing problem of clinician burden related to their use of health IT and EHRs, ONC chief Donald Rucker, M.D., said in the report.

As part of its ongoing strategy, ONC plans to work to enable further automation in healthcare, with a focus on prior authorization and quality reporting.

“Through this HHS strategy, we look forward to advancing the premise of how to accurately model and support the clinical cognitive process in the EHR‚ÄĒa shift away from a strictly linear, logic-based model to a more sophisticated design that supports the complex pattern recognition inherent in the diagnostic and treatment process,” Rucker said in the report.

“We envision a time when clinicians will use the medical record not as an encounter-based document to support billing, but rather as a tool to fulfill its original intention: supporting the best possible care for the patient.”