ONC, CMS get an earful on EHRs

With help from Arthur Allen (@arthurallen202) and Darius Tahir (@dariustahir)

YOUR PRODUCT SUCKS: ONC and CMS officials got an earful during a daylong listening session at HHS on Thursday about reducing provider burden from health IT. Speaker after speaker said physicians and nurses are on the edge of nervous breakdown over the depressing hours they spend struggling with bad EHR workflows and government reporting requirements.

“Bloated notes. Inaccurate medication lists. Tremendous broken promise around interoperability, which never happened,” said a Maryland pulmonologist.

“I’ve had a chronic disease for 40 years,” said a patient advocate. “None of my excellent physicians ever caught a drug-drug interaction. The systems you are forced to use suck and don’t do what they’re supposed to be doing.”

“What are we collecting? How is it helping provide better care?” asked a primary care doctor.

“The only way out is Open APIs.”

‘’Meaningful use is really a four letter word.”

“The actual important information is buried in the overwhelming minutiae of data.”

“Too much reporting.”

“Too many hours, too many FTEs.”

“Too much.”

“I don’t think you can fix a caked that’s been ill-baked. The only solution is to throw it out.”

John Fleming, ONC deputy secretary for reform, boiled down the complaints into four priorities: streamlining documentation, getting EHR-based preapprovals for tests, referrals and medications; making quality reporting less laborious, and better PDMPs for controlled substances.

“Our work won’t be done until EHRs and other health IT tools are things that providers can’t imagine taking care of patients without, because they need them,” concluded Andy Gettinger, chief medical information officer at ONC. “I didn’t get that sense today. So we have work to do.”

THE QUEST TO REDUCE PHYSICIAN BURDEN: The listening session provided some insight for an investigation that CMS and ONC are conducting to make life easier for clinicians. A group of about 20 staffers, led by Gettinger and CMS Chief Medical Officer Kate Goodrich, are collecting complaints and suggestions from providers. HHS may consider regulation and sub-regulatory measures, Gettinger told Thursday’s listening session. The team has working groups dedicated to “documentation, administrative and reimbursement,” EHR reporting, user-centered design and non-federal payers. CMS has already started taking steps to alleviate physician burden, including ending a requirement that doctors re-document medical students’ notes in EHRs. In the future, it plans to simplify document exchange among providers and between providers and payers. As CMS’ Melanie Combs-Dyer puts it, "[w]e want to get rid of the stupid stuff.” More for Pros here.

ENERGY AND COMMERCE COMMITTEE HEARING COULD ADDRESS TELEMEDICINE BILLS: A House Energy and Commerce Committee hearing next Wednesday is slated to touch on a package of legislation drafted to address the opioid abuse crisis. The committee is unveiling multiple bills to allow easier prescription of controlled substances — which could be used to treat addiction — via telemedicine. That package should be complete by May, according to sources familiar with the process. Two of the measures, authored by a bipartisan group including Buddy Carter (R-Ga.), Cheri Bustos (D-Ill.), Doris Matsui (D-Calif.) and Gregg Harper (R-Miss.), focus on easing the Drug Enforcement Administration obstacles to writing prescriptions via telemedicine. Currently prescriptions of controlled substances through telemedicine are restricted by the Ryan Haight Act. More for Pros here.

eHealth Tweets of the day: Leo Beletsky @LeoBeletsky: Important reminder that ppl in US are increasingly medicated w serious psychoactive substances. It’s not just opioids, it’s also benzos, amphetamines, etc. Use of these substances has skyrocketed since 2000. Focusing just on opioids doesn’t make sense in context of broader trends

@KeithNHumphreys Benzodiazepine-involved deaths are up 800% -- shape of curve very similar to opioids...many deaths involve both drugs.

Lisa Pettigrew @lisapettigrew: Bring on #PrecisionMedicine (the drug we all take multiple times a day that needs to be personalized most is food)

Forbes Health @forbeshealth: A new study pitted low-carb and low-fat diets against each other. It was a draw https://www.forbes.com/sites/larryhusten/2018/02/20/low-carb-and-low-fat-diets-battle-to-a-draw … by @cardiobrief

IT’S FRIDAY at Morning eHealth, where your author is deciding whether to see “The Shape of Water” or “I, Tonya” this weekend. Cast your vote for the fish-person or 90’s nostalgia and send news tips to [email protected]. Or Tweet them to @arthurallen202, @dariustahir, @ravindranize, @POLITICOPro, @Morning_eHealth.

CMS PUSHES BACK ATTESTATION DEADLINE: Medicare-eligible hospitals now have until March 16 to submit data related to meaningful use and the electronic quality measures program, CMS announced Thursday. The agency directed hospitals to use the QualityNet Secure Portal (QNet). The story for Pros here.

...in other CMS news, the agency posts specs for 2018 qualified clinical data registry: The agency posted measure specificationsfor a QCDR — an entity that collects medical data to improve patient care quality. The new specifications allow users to group measures by speciality and topic to establish which actually apply to them, according to CMS. They can also be used as a reference tool for vendors who want to develop their own QCDR measures, according to the agency.

ONC APPROVES NCQA TESTING LAB: The National Committee for Quality Assurance’s testing lab is now approved to perform health IT testing through ONC’s certification program. Its testing lab focuses in part on the electronic clinical quality measures to be reported to CMS. Fee-for-service models have led to an “increasing reliance on performance measurement,” NCQA’s CIO Rick Moore said in a statement.

REPORT: SENATE BACKS VA CHOICE REFORM MEASURE: Lawmakers have tinkered with VA Choice legislation to add a provision that would require VA centers to meet minimum standards to be considered preferred facilities, Modern Healthcare reports. According to the report, the current language states that if VA facilities don’t make the grade, the patient could instead look to a community provider. Earlier legislation passed the Senate VA Committee by a 14-1 vote in December, with opposition from Kansas Sen. Jerry Moran. Supported by VA Secretary David Shulkin — now under fire over an IG report about his summer travels--it didn’t include the requirement for VA facilities.

…. Two veterans groups, however, denied the report, saying the bill wasn’t done yet. “There have been no discussions since the Senate went on recess, and with the recent failed coup, the original Senate version will be the language that moves, or nothing will move at all,” said Louis Celli of the American Legion. His and many other Vets groups fear any language in the Choice bill — which will provide billions to support veterans’ care outside the VA--that could undercut the future of VA installations.

TEFCA COMMENTS STILL POURING IN: Stakeholders are still sharing their thoughts on the Trusted Exchange Framework Common Agreement draft published in early January. Two of note: The Health Record Banking Alliance argues that the draft, which aims to establish an agreement between health information networks so they can seamlessly exchange patient information “would not be consistent with the Cures Act” and therefore “would not survive judicial review in the United States Court of Appeals, which would further delay progress toward an effective health information infrastructure.” Instead, ONC needs a “single standard mechanism for EHRs to use for purposes of exchanging medical records nationwide.”

…. Mark LaRow, CEO of Verato, describes as unrealistic TEFCA’s provision that qualified health information networks should “collectively manage patient identity and record location information for hundreds of millions of patients” to create a nationwide record locator service. “The reason we don’t have this capability today is NOT because we don’t have HIEs and IHE/FHIR protocols. It’s because our current patient matching technology is not good enough,” he writes.

WHAT WE’RE CLICKING ON:

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—The case against precision diets

—Why we should be worried about benzodiazepines too