Physician EHR Experience Needs HELP, Senate Committee Says

Wed, Jun 24, 2015 --

EMR/EHR, ICD-10

U.S. Capitol dome

According to Republican Senator Bill Cassidy, an MD from Louisiana, just 11% of eligible physicians have successfully attested to the federal government’s Meaningful Use Stage 2 for electronic health record use, despite compliance penalties kicking in this year. Many doctors would rather take a financial penalty  than comply, Cassidy said. Interoperability problems between EHRs from different vendors add to the concerns, including those caused by business practices that intentionally block information flow. Senator Sheldon Whitehouse, Democrat of Rhode Island, said, “Since we aren’t going back to paper records, we need to focus on moving forward,” with the goal of improving EHRs and identifying best practices for using EHRs as care management tools.

The Senate HELP Committee’s June 16 hearing, chaired by Cassidy and Whitehouse, focused on ways to improve physician experience with health IT. Cassidy said that meaningful use was onerous not only on older physicians less comfortable with computers, but also on residents and new practitioners. He said that this was reflected by the statistics showing poor physician compliance with Meaningful Use 2 requirements.

Cassidy said that as a physician, he would rather spend his time communicating with patients than entering data in an EHR. “Time is better spent looking into a patient’s eyes to make sure that she comprehends that even though she has cancer, there is hope, as opposed to clicking on a computer screen,” he said. Current EHR design forces clinicians to focus on documenting information required by someone far removed from the exam room, Cassidy said.

The Committee heard testimony from chief medical information officer Boyd Washington, MD, of Franciscan Missionaries of Our Lady Health System in Louisiana; Timothy Pletcher, DHA, executive director of Michigan Health Information Network Shared Services; and Meryl Moss, COO of Coastal Medical, Rhode Island.

EMRs Under OIG Fire for Fraud Capability

In March, the HHS Office of the Inspector General (OIG) noted that electronic health record (EHR) systems can be vulnerable to fraud when clinicians copy and paste notes from within the EHR. Misused copy and paste functionality can harm reimbursement programs but even worse, the inaccurate data caused by copy and paste puts patients at risk, the agency said, calling for CMS to develop guidance on the correct usage of EHRs’ copy-paste features. The OIG also asked the U.S. Department of Health and Human Services (HHS) to create safeguards to protect against electronically enabled healthcare fraud and require visible audit logs on all EHRs.

Information Blocking by EHRs on ONC’s Radar

Congress and the Office of the National Coordinator (ONC) for health IT recently investigated the practice of information blocking, where some EHRs may actually be built to block information exchange, with vendors charging high fees to build interfaces to allow record sharing among other EHRs. Other types of information blocking occur when hospital systems make it hard to send patient records to their competitor systems, or when practices are blocked from moving to a different EHR because data migration is too expensive.

House Introduces Third Bill to Stall ICD-10

One June 4, Representative Gary Palmer (R-AL-6) introduced the third ICD-10-related House bill in two months. Palmer’s bill, H.R. 2652, Protecting Patients and Physicians Against Coding Act of 2015, would create a two-year grace period where ICD-10 claims to Medicare and Medicaid would not be denied due to coding errors. According to Palmer, his bill prohibits penalizing physicians for coding errors, mistakes, and “malfunctions of the system” during the two-year grace period, helping small and rural physicians who have not had time or resources to transition to ICD-10.

According to AHIMA, H.R. 2652 had 32 co-sponsors as of June 8 and was referred to the House committees on Energy and Commerce and Ways and Means. AHIMA believes a grace period is unnecessary because May 2015’s CMS end-to-end testing showed only two percent of claims being rejected due to ICD-10 coding errors, which is lower than the 3 percent of claims currently rejected by CMS after annual ICD-9-CM code updates.

In May, Rep. Diane Black (R-TN-6) introduced H.R. 2247, the ICD-TEN Act, which would create an 18-month “implementation period” for ICD-10 after the system is fully functioning, which would be later than the implementation date of October 1, 2015. Earlier this year, Rep. Ted Poe (R-TX-2) introduced H.R. 2126, the Cutting Costly Codes Act of 2015, which would prohibit HHS from replacing ICD-9 with ICD-10 entirely. The bill was referred to the Committee on Energy and Commerce and the Committee on Ways and Means.

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About 

Susan taught health information and healthcare documentation at the community college level for more than 20 years. She has a special love for medical language and terminology. She is passionate about ensuring accurate patient healthcare documentation through education. She has a master's degree in healthcare administration, is a certified healthcare documentation specialist, and serves as immediate past president for the Association for Healthcare Documentation Integrity (AHDI).

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