Essential Electronic Health Record Reforms for This Decade

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Enhancing patientcare by improving electronichealthrecords: Plan outlines three 'essential' steps uva JAMA_current

In early 2020, the American College of Medical Informatics explored this issue. Soon thereafter, the American Medical Informatics Association, with seed funding from the National Library of Medicine, formed a group under the moniker of 25 × 5 to reduce clinician documentation burden by three-quarters during the next 5 years.

Although it is difficult to separate payment models and other administrative requirements from clinical documentation, this is essential because they are currently associated with many of the frustrations that clinicians and patients face. All prior approval or authorization practices should be reviewed to determine whether they can move to an audit approach post hoc or be removed. If they are still required in some circumstances, streamlined methods must be developed.

Including patient-entered data and removing administrative tasks from the clinician’s work will only mitigate the currently diseased EHR. The clinical note should be prospective in focus . All hard stops during the ordering process in hopes of added patient safety should be examined critically, so they may be either minimized or eliminated. Clinicians functioning as billers will need to “unlearn” unnecessary patterns of documentation, with less documentation being the norm rather than more.

 

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