In a really thoughtful post on HISTalk, Dewey Howell MD, PhD, Founder, CEO Design Clinicals, Inc. wrote a n article called “The Real Problem with CCHIT Certification.” In it, Dr. Howell basically makes the case against CCHIT, because it doesn’t take into account all of the various specialized EHR which only need to do a few things really well. His example was an EMR for “ambulatory, inpatient, and emergency settings.”
These arguments remind me when near the beginning of the CCHIT certification process it included such things as growth charts. Sure, growth charts are essential to a pediatric EMR, but not so much so for other EMR companies. Luckily, the vetting process did remove this criteria and what CCHIT ended up with was much better than what they started to create. Unfortunately, it’s still an onerous process for a specialized EHR to be CCHIT certified.
Dr. Howell also provides this really interesting insight:
Another deficiency of the current certification process is the lack of requirement for certification of results or outcomes. How do we certify and validate that the system actually delivers the outcomes that we are trying to achieve? The current process encourages vendors to throw a button or screen into their application that produces a specific action or display. But, there is no accountability to the patient and quality of care delivered with the tool. It encourages technology for technology’s sake, presuming that outcomes will be “better” just because a product is certified, instead of really validating results. Maybe this is a much tougher nut to crack, but it is considerably more important than things like, “The system shall provide the ability to allow users to search for order sets by name.”
I like how he described the need to measure results or outcomes. We’ve often mentioned on this blog CCHIT’s biggest problem is actually measuring usability, but results and outcomes are another way to look at the challenge of certification.
As an application developer/designer working on a major EMR for every year that CCHIT certification has been offered, I personally feel that many EMRs are simply insufficient to meet the needs of doctors.
Every practice is different, specialty or not. I personally feel that the onus is still on the end user to select an EMR that will work for them. Get a demo from the vendor and make them show you how THEIR software fits YOUR needs. But for all those questions you didn’t know you had to ask, the CCHIT certification provides answers.
In my opinion, someone who is REALLY concerned that CCHIT certification isn’t enough should go to the CCHIT website could pull down their test scripts, read them over, and then take them to their vendor’s demo. Use it as a resource to focus your thinking, and figure out what is important to you.
AlleyGator,
The real problem is that Doctors aren’t informed enough to know what CCHIT certification really means. There’s just not very good education being given to doctors about what CCHIT certification does and doesn’t do. So, people start assuming things and you know what happens when people start assuming.
I really like your idea of using CCHIT criteria and test scripts as a starting point for “self-certifying” the EHR you demo during your selection process.
I’ll have to download them and see how that might work. It will be interesting to see if this is a reasonable suggestion for most doctors to do.
I’m definitely on board with clinics taking more responsibility during the selection process. Hopefully we can continue to provide better tools to help them make better selections as well.
Thanks for your comments. You’ve definitely given me some ideas about things to try.
The CCHIT test scripts for ambulatory criteria are all about functionality, not about how nicely the software handles it. As an example…
Step 1.05:
Mother has remarried;
and address has
changed.
Update last name and address.
Step 1.06:
Show how system
maintains historical
information for prior
names and addresses.
Step 1.21:
Using a template,
record vital signs at
today’s visit:
• BP 90/55
• Height 40”
• Weight 40 lbs
• Temperature 98.6
(F)
• Pulse 80
• Respiratory rate 20
Not all of the features offered by CCHIT are interesting, and having designed them I can assure you that some are entirely forgettable. But if you read through the test scripts you’ll get an idea of what workflows an EMR should help you accomplish.
After you decide what you need, you talk to the Vendor and determine whether the software is just scraping by, or whether they made the features sexy.
AlleyGator,
I’m going to have to take a look in more detail at these things. I wonder if I can help sort out what is “unforgettable” and what are useful to consider during selection.
I also love your description of EHR vendors that just got by on an important feature and those that made that feature sexy. I like it so much, that a future post will be titled something like that.