Everyone who works in health care knows electronic health records (EHRs), originally designed to streamline patient records and improve patient care, have dramatically increased the amount of time providers spend mired in paperless “paperwork.” It’s an industry-wide concern leading to increased burnout and job dissatisfaction. Recent surveys of ACEP membership revealed that no matter your age, years of experience, or clinical setting, EHR frustration and overall “administrative burden” is your number-one pain point.

It’s a complicated issue affected by many different entities and regulations, so our advocacy team is working in multiple channels to push for positive progress. The following is an overview of our efforts, and the table provides more information about our stance on each aspect and how the outcomes could affect your daily practice.

1. Appropriate Use Criteria (AUC) Program: Created in legislation in 2014, the AUC program will eventually require physicians ordering advanced imaging for Medicare beneficiaries to first consult AUC through approved clinical decision support mechanisms in order for the furnishing provider to be able to receive payment. We’ve fought hard to get all emergency physicians exempted from the AUC program requirements, and we recently achieved a significant victory that saves you unnecessary administrative hassle. While the requirement does not start until 2020, we have heard hospitals are already forcing emergency physicians to consult AUC before ordering advance imaging. We’re hearing these AUC tools are burdensome and not user-friendly, plus often do not apply to cases typically seen in the emergency department. See Table 1 for details.
2. Promoting Interoperability Category of the Merit-based Incentive Payment System (MIPS): The Promoting Interoperability (PI) category of MIPS replaced the Meaningful Use program. We are advocating for all emergency physicians to be exempt from the PI category of MIPS. For the most part, emergency physicians were exempt from Meaningful Use requirements. Most emergency physicians are contracted by hospitals and have little say over the hospital’s EHR. In the PI category of MIPS, there is again an exemption for clinicians who are deemed “hospital-based.” However, current Centers for Medicare & Medicaid Services (CMS) regulations are causing some emergency physicians to lose that exemption.
3. EHRs and Data Sharing: CMS and the Office of the National Coordinator for Health Information Technology (ONC) recently proposed policies that would dramatically alter how personal health information is exchanged and used. We are working hard to ensure any policies CMS and ONC actually finalize do not increase administrative burden on emergency physicians.
4. EHR Burden: ONC recently released a draft strategy on how to reduce provider burden while improving EHR usability and information exchange. ACEP submitted comments on this draft strategy and is continuing to work with ONC and other federal agencies on ways to reduce burden around the use of EHRs.

The Timeline

Here’s an overview of our federal advocacy timeline related to these EHR issues so you can see where we started, what’s happening now, and where we are heading next.