Informaticians Propose ‘Essential EHR Reforms for This Decade’

May 22, 2023
Writing in JAMA, Don E. Detmer, M.D., M.A., and Andrew Gettinger, M.D., propose reinventing the ‘clinical note,’ to directly address expected or desired results from each visit
  • Removing all administrative and regulatory documentation obligations for care providers during their “clinical time” with patients, except for matters pertaining directly to the reason for the patient’s visit. This would effectively separate care provision from payment and billing, cutting through red tape. For example, Detmer and Gettinger suggest streamlining all insurance approval and authorization practices to eliminate, as much as possible, the need to get “pre-approval” from insurers for treatments. 
  • Adding the ability for patients to enter information in their electronic health record, making them more active participants in their care.
  • Reinventing the “clinical note,” one of the most common records providers create, to better support patient care. These notes, Detmer and Gettinger say, should directly address expected or desired results from each visit and could include timelines, when possible.

  “A major move in these directions will allow far greater creativity and innovation between clinicians and patients to transcend the traditional boundaries of what constitutes care,” the authors say. “The focus of care can broaden to consider all the social determinants of health [the external factors that affect outcomes] that may be relevant to a particular patient.”

In addition to those proposals, Detmer and Gettinger argue that the most urgently needed change is the least likely to be implemented. They say there is a desperate need for “unique personal safety identifiers” that would let hospitals, employers, health plans, insurance companies and other healthcare organizations streamline operations by jointly identifying individual patients. That idea was originally mandated in 1996’s Health Insurance Portability and Accountability Act (HIPAA) but has not been implemented at the national level because of concerns about patient privacy and other issues. The lack of such consistent identifiers, Detmer and Gettinger maintain, “presents a continuing threat to privacy, safety, cost reduction and administrative errors.”

The authors say that that enacting some of the changes they suggest could make a big difference for both clinicians and patients.

“Although addressing shortcomings in EHRs will not cure all that ails our current healthcare system, implementing these recommendations should positively affect patients and clinicians and move us toward the original vision of a patient-centered, technology-enhanced healthcare ecosystem that is designed to significantly improve outcomes at a lower cost, with more satisfied patients and clinicians,” the authors conclude. 

Sponsored Recommendations

Clinical Evaluation: An AI Assistant for Primary Care

The AAFP's clinical evaluation offers a detailed analysis of how an innovative AI solution can help relieve physicians' administrative burden and aid them in improving health ...

From Chaos to Clarity: How AI Is Making Sense of Clinical Documentation

From Chaos to Clarity dives deep into how AI Is making sense of disorganized patient data and turning it into evidence-based diagnosis suggestions that physicians can trust, leading...

Bridging the Health Plan/Provider Gap: Data-Driven Collaboration for a Value-Based Future

Download the findings report to understand the current perspective of provider and health plan leaders’ shift to value-based care—with a focus on the gaps holding them back and...

Exploring the future of healthcare with Advanced Practice Providers

Discover how Advanced Practice Providers are transforming healthcare: boosting efficiency, cutting wait times and enhancing patient care through strategic integration and digital...