The challenge to improve the functionality and ease of appropriate use of electronic health records (EHR) and health information technology (IT) was recently outlined in a draft document by the Department of Health and Human Services (HHS).¹

In submitted comments on the draft, the Association for Professionals in Infection Control and Epidemiology (APIC) outlined some of the challenges IPs face in dealing with EHRs and IT.

“Because all EHRs do not ‘talk’ to each other, relevant information may be contained in scanned records from another care setting,” APIC stated.

“A method of organizing scanned documents would facilitate the review of such information. Having a standardized format across all care settings would enable seamless communication of information despite the need for sharing information through scanned documents.”

Regarding public health reporting, APIC commented that “consideration should be given to improving the electronic transfer of reportable communicable disease and emerging infectious pathogen data from all care settings to the local and state health department.”

By way of example, APIC cited “bidirectional” web-based data exchange systems or registries³, which can pick up clusters in a timely manner, triggering use of infection control measures.

“Additionally, Ray and colleagues⁴ found that the use of discharge data coupled with information in the registry accurately predicted which hospitals patients with an outbreak strain⁵ of New Delhi metallo-beta-lactamase producing Escherichia coli would visit,” APIC reported.

“Strategies to support public health reporting should address communicable diseases and emerging infectious pathogens,” the association commented.

The association recommended that public health departments have automated access to reports of communicable diseases and emerging infections, working with healthcare sites to control transmission.

“Our members will benefit from interoperable health information, which, in turn, will allow them to create a safer healthcare system,” APIC said.

Regarding the proposed rule’s recommendation to “leverage data already present in the EHR to reduce redocumentation in the clinical note,” APIC submitted the following comment:

“The unique ability to ‘copy and paste,’ which was not possible with a paper health record, can save time when healthcare providers recognize the importance of ensuring the information is correct and/or still applies before moving it forward.”

The caveat is that allowing unlimited copy and paste changes could lead to “the unintended consequence of incorrect information being perpetuated. One wrong piece of information becomes the ‘truth’ when there are no checks,” APIC commented.

That means it will be critical to make sure “that review and verification processes are hardwired into the ‘copy and paste’ functionality. It may be determined that certain data should not be included in copy and paste capabilities.” Moreover, “auto-populating” accurate data on, for example, prescribed antibiotics and lab results would ensure the transfer of vital information during transitions of care.

“As with most quality improvement initiatives in healthcare, a multi-stakeholder approach is needed to reduce the unintended consequences, optimize the functionality, and ensure the needs of all are met,” APIC concluded.

The public comment period on the HHS draft closed on Jan. 28, 2019.

REFERENCES

1. HHS. National Coordinator for Health Information Technology. Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs. Draft for Public Comment. November 2018. Available at:
   https://bit.ly/2Q25CNa.
2. APIC. RE: Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs. Jan 28, 2019. Available at:
   https://bit.ly/2CV39un.
3. Trick WR, Lin MY, Cheng-Leidig R, et al. Electronic Public Health Registry of Extensively Drug-Resistant Organisms, Illinois, USA. Emerg Infect Dis 2015;21(10):1725-1732.
4. Ray MJ, Trick WR, Lin MY, et al. Utilizing SaTScan and the Space-time Permutation Scan Statistic to Detect Spatial and Temporal Clustering Based on Disease Registry Information. Abstract (5246). Council of State and Territorial Epidemiologists Annual Conference, Boston, 2015.
5. Ray MJ, Lin, MY, Tang AS, et al. Regional Spread of an Outbreak of Carbapenem-Resistant Enterobacteriaceae Through an Ego Network of Healthcare Facilities. Clin Infect Dis 2018;67(3):407–410.