Patient-Centered Care

New HHS Effort Underway to Mitigate Clinician Burden Issues

The department’s move to reduce the administrative burden of health IT is an important step toward tapping technology to create true operational efficiencies in healthcare, says HIMSS’ senior director for federal and state affairs.

Jeff Coughlin

Jeff Coughlin is the senior director for federal and state affairs at the Healthcare Information and Management Systems Society. In this role, Jeff leads HIMSS’ efforts to build stronger relationships with federal agencies and facilitates the building of a nationwide network of advocates for state-based initiatives that impact all aspects of health IT.

On Nov. 28, 2018, the U.S. Department of Health and Human Services released a draft document focused on presenting ideas and collecting feedback on the challenges facing the community related to clinician burden. In its “Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs,” HHS devised a series of recommendations that government policies and the broader community can undertake to better position clinicians to effectively care for their patients and ensure an appropriate work-life balance.

The reality of extensive burdens placed on physicians, nurses and other clinical staff is not new, but it has become a hot-button topic over the past several years as concerns of a clinician administrative overload — with time subtracted from patient interaction — has grown.

Much of the work that healthcare practitioners face today is unnecessarily burdensome. Some of these burdens can be attributed to health information technology issues, while others are related to clinical workflow.

The report’s primary aims for minimizing burden are to reduce the effort and time it takes for healthcare providers to record information in electronic health records while delivering care and adhering to overall regulatory reporting requirements, as well as to improve the functionality and intuitiveness of EHRs.

HHS outlines draft strategies focused on clinical documentation, the usability of health IT, EHR reporting and public health reporting. As part of these strategies, HHS has put forward the idea of reducing the regulatory burden around documentation requirements for patient visits by leveraging data already present in the EHR to reduce redocumentation in the clinical note. In addition, HHS is promoting improved usability through better alignment of EHRs with clinical workflow, as well as through improved decision-making and documentation tools. Moreover, the report seeks to address program reporting and participation burdens by simplifying regulatory program requirements and incentivizing new approaches that are both easier and provide better value to clinicians.

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With the Innovative Use of Tech, Operational Efficiencies Can Emerge

A key aspect of reducing this burden, according to the report, will be incentivizing the innovative use of health IT and interoperability in order to make it easier for other providers or federal agencies to pull data directly. This includes improving everything from end-user engagement and training to optimizing authentication practices for health IT tools.

HIMSS has been keenly focused on addressing clinician burden issues for the past year. We authored a letter (with the Association of Medical Directors of Information Systems) to HHS in June 2018 where we expressed interest in eliminating the unnecessary actions that occur in the course of clinical practice so clinicians could focus their time on actions that make sense, such as caring for patients and delivering better outcomes.

We firmly believe that technology is part of any solution to address reducing clinician burden and should be recognized as such when developing public policy initiatives. EHRs and other health technologies are designed not just to serve as documentation records, but to improve care and ultimately improve health, as well as help streamline the extra layer of unnecessary efforts that regulatory requirements often demand.

In addition, layering digital infrastructures without streamlining existing healthcare delivery processes has often resulted in a digitization of the same inefficient processes. As our healthcare system continues to shift from volume-based to value-based care delivery and toward a “learning health system,” we believe that operational efficiencies — the opposite of burden — can evolve. We believe it’s possible to build a system that uses health information and technology to drive to that future state, where patients receive higher-quality, safer and more efficient care, and clinicians can focus on better outcomes.

In the meantime, we urge you to take this opportunity to provide feedback on HHS’ draft strategy document — HHS will accept your input until Jan. 28, 2019.