HIMSS EHR Association tackles TEFCA, opioid response, usability and safety

LAS VEGAS – Members of the HIMSS Electronic Health Record Association met at HIMSS18 on Thursday, and offered a briefing on some of the big issues its vendor members are focusing on this year so far.

Speaking on behalf of EHRA, several experts from leading EHR developers weighed in on their current efforts to gain clarity in the language of the draft Trusted Exchange Framework and Common Agreement, improve patient safety features, alleviate clinician burden and more.

The first topic of discussion for the EHR developer trade organization was TEFCA, which was published by the Office of the National Coordinator for Health IT in January, and which EHRA has said still needs "a lot more work."

Hans Buitendijk, director of interoperability strategy at Cerner and EHRA's standards and interoperability chair, said the draft framework called for "too many things at the same time" from software developers.

"We hope that ONC will have one or two more rounds, where we can look at the direction of what's going to happen," he said, noting that TEFCA puts a "substantial amount of capabilities on the table to be done in a very short period of time."

Specifically, he pointed to certain requirements that he hoped could be better harmonized, for instance, the U.S. Core Data for Interoperability and information blocking related rules, "we hope to see some relationship between those, that one could take advantage of the other," said Buitendijk.

For another, he mentioned questions around "how does everybody contribute to these networks and what can we do in this space."

There's "not much debate that patients need access to their data, easily," he said, "but as we get into other parties that participate in those networks, what kind of reciprocity is there for data exchange, or benefits that organizations get from that. We have to make sure that it creates a sustainable business model for everyone.

EHRA Chair Sasha TerMaat, director at Epic, noted that right now there are no current entities that meet TEFCA's definition of a Qualified Health Information Network.

"A lot of organizations are ruled out of being Qualified HINs by how they define it," she said. "And the requirements to be one, there's a lot of expensive aspects. So any network that would think about doing it is going to have to make big investments in infrastructure, in agreements with their participants, and so forth.

EHRA, she said, wonders whether it "has to be as expensive and as far out in the future as that model makes it seem, or are there changes we could suggest that would help it move faster. There's too much recreating the wheel. We've suggested a lot of changes to ONC in our feedback and would like to see them come out with a second round for comment. My goal would be to unite the networks that already exist today as the fastest way to interoperability."

In general, Buitendijk said the draft framework is "taking quite a big jump," and suggested ONC "take a more modular approach, a more step-wise approach – build on what we have and improve upon it, rather than take a substantial leap in a very short period of time."

Leveraging EHRs to fight opioid crisis

Allscripts VP of Policy and Government Affairs Leigh Burchell pointed out that EHRA had recently launched a task force to explore ways IT could further be brought to bear to help combat the opioid abuse in the U.S.

"We've gotten fantastic participation from pharmacists, health experts, doctors, technical experts, looking at it within the frame of health IT," she said.

EHRA is focused on several areas, said Burchell. First is policy, offering input for numerous bills in Congress and working with CMS and ONC to offer its members' technical expertise.

And also on physician burden, through a second workgroup called Clinician Impact, which is focused on what the response to the crisis is doing to physicians' workflow – given the demands of prescription drug monitoring programs and e-prescribing of controlled substances – and looking closer at clinical decision support to help present information that can help them make smart choices about pain management.

"We want to be sure that our systems respond to a way that doesn't create frustration," she said.

One of the biggest challenges the group has found is "significant inconsistency from state to state in how they're approaching it, said Burchell. There's been PDMP adoption in most states, for example, but they're "all doing it differently: a different technology framework, a different data set required to be exchanged, EPCS and PDMP that aren't even talking to each other."

A third workgroup, then, focuses on standards and technology, which homes in on where those disparate approaches are challenging EHRA members' clients and aims to help bring guidance on consistency and efficiency to policy-makers.

"We have 50 different flavors, we have 50 different types of code, and it's more costly. It doesn't make sense to anybody."

Burchell noted that a lot of the conversation these days is focused on responses to people who are already addicted: "what to do for treatment, how to stem mortality – all very valid."

But she said existing pre-analytics capabilities could help providers "look at the population health level to see patterns in the community, and look at individual patients. Three scripts in X amount of time is indicative of a danger to go forward. It's not already too late, it allows us to get in the path of this."

The urgency of the opioid epidemic represents a big opportunity, said Burchell. "This is clearly a very compelling use case. People are really, really passionate about this. It's sad that we got to this point, where there's a crisis, but I do think it sparks people in a way that they hadn't been previously motivated personally.

Easing clinician burden, improving patient safety

EHRA members also offered updates on the efforts to improve the user experience of their products and to bolster their ability to prevent medical errors.

On the topic of usability, EHRA Clinician Experience Chair Emily Richmond, senior director at Practice Fusion, said the trade group has been focused on a couple areas.

First, the Electronic Health Record Design Patterns for Patient Safety whitepaper, a collaborative efforts that tapped clinicians and experts in user-centered design and human factors to develop recommendations and guidelines for designing the parts of the EHR that most impact patient safety.

Second, EHRA's Persona Library offered insights into the the various EHR end-users in various health settings – their widely different goals, problems and backgrounds – to help member vendors design for them more empathetically.

"It is difficult to generalize how users interact with their software, because there are so many products that are represented, that are intentionally different – different settings, different specialties, different types of clinician users," she said.

"If you don't understand who your users are, if you hear, 'I have a complaint about X,' well, who is complaining about X? Maybe that's not an EHR problem, maybe it's a regulation problem where they feel compelled to overdocument and we're just the vehicle. It's important to understand who it is, and why the complaint is there."

Shari Medina, MD, regulatory affairs specialist at Harris Healthcare and EHRA's patient safety chair, meanwhile, said her workgroup has been most focused on a couple key provisions of the 21st Century Cures Act: the FDA guidance on clinical decision support, and the provisions around having health IT developers be covered by PSO Protections.