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AHIMA Warns About Burden on Rural Hospitals from HHS EHR Proposals

AHIMA is warning that a number of recommendations in an HHS draft report could increase burdens on rural and/or smaller healthcare facilities.

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Source: Thinkstock

By Fred Donovan

- The American Health Information Management Association (AHIMA) is warning that a number of recommendations in HHS’s draft report Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs could actually increase burdens on rural and/or smaller healthcare facilities.

In its draft strategy, HHS laid out a series of recommendations designed to reduce administrative and regulatory burdens that can make health IT infrastructure, such as EHR, cumbersome to use. 

“Addressing the challenge of health IT burden and making EHRs useful for patients and providers, as the solutions in this draft report aim to do, will help pave the way for value-based transformation,” said HHS Secretary Alex Azar in releasing the draft strategy, a joint effort by ONC and CMS.

In its comments on the draft strategy, AHIMA agreed with most of the agencies’ recommendations and the draft strategy’s overall approach to reducing burdens.

“This document was very thoughtful in its approach to address the current clinician burden with respect to EHRs,” said AHIMA Federal Relations Senior Director Lauren Riplinger.

“HHS included much stakeholder input in the drafting of this report. There were a number of roundtable discussions and interactions HHS had with the clinician community to find out what are the major pain points for physicians in terms of documentation burden,” Riplinger told HITInfrastructure.com.

“In general, the draft report is a great start. It did a really great job of identifying the things that the agencies like ONC and CMS are currently working on and how the healthcare sector can integrate into this broader strategy,” she added.

At the same time, AHIMA disagreed with several of the draft report’s recommendations.

HHS recommended that patient data in scanned reports be extracted and indexed for better retrieval. AHIMA cautioned that technologies and processes to extract and index data “can be costly, require additional staff resources, and may be difficult for small and/or rural practices and facilities to implement. Additionally, our members have noted that existing technologies may be limited in their ability to extract and index handwritten documentation from scanned reports.”

Riplinger said that extracting data from scanned reports can be an “arduous process” but it could with the broader use of artificial intelligence and natural language processing. “As we look at the current state, this is a challenge and costly to implement particularly when we are still in this paper-electronic hybrid world,” she observed.

In addition, the draft report stated: “It is absolutely critical that health care institutions ensure that all end users receive initial and ongoing EHR training, with easily accessible and ongoing technical support, along with systems to promote competency.” The association had concerns about this proposal because smaller and rural practices might not have the resources needed to provide ongoing training.

Also, AHIMA had issues with the report’s recommendation that healthcare organizations use audit logs to develop insight into workflow and usage patterns. “These insights can help identify areas of difficulty and end users that might benefit from additional training and support,” the draft report noted.

“The ease of use of audit logs can vary by EHR vendor and can often be difficult to use, often requiring extensive resources, including manpower, to process and synthesize the information,” AHIMA said in its comments.

Riplinger said that many of AHIMA members use audit logs on a regular basis. “Depending on the vendor, it can be challenging to extract data and make it usable. Particularly when you have a rural or smaller facility that may not be able to adopt software technology that is as comprehensive as a larger institution, that can be a challenge for that facility.”

“The biggest question now is what is the timeline for these recommendations. Once it receives and reviews the comments, HHS needs to answer the questions what will this strategy look like and when will the recommendations be implemented,” she said.


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