I’ve wanted to post about this for a few days and just haven’t had time. One of my favorite HIT bloggers, Will Weider, wrote a really interesting post about CCHIT. Yes, I kept reading even after he said, “I love CCHIT.”
Will’s main point is that just because one vendor doesn’t meet the CCHIT certification, doesn’t mean a combination of vendors couldn’t create a system that was equal or better than a CCHIT Certified EHR. A fine point that I’m sure CCHIT will never find a solution for.
However, this paragraph from Will really described my feelings well:
The problem is that vendor functionality does not determine how well an EHR is implemented. I could have a vendor that provided my organization the richest functionality one could imagine, and still implement it in a way that totally sucks.
I think will could have replaced “vendor functionality” with “CCHIT Certification” and had a quote like this:
The problem is that [CCHIT Certification] does not determine how well an EHR is implemented. I could have a [CCHIT Certified EHR] that provided my organization the richest functionality one could imagine, and still implement it in a way that totally sucks.
So, what’s the purpose of using CCHIT Certification?
I can easily think of a long laundry list of problems that CCHIT Certification causes. What I can’t understand is how CCHIT Certification does any good at encouraging implementation of good EHR programs. Maybe someone can help me out in the comments.
If the public wants an EHR that will produce better patient outcomes, then CCHIT should evolve to ISO level certifications. That way EHR’s will be tools in the greater processes to accomplish those outcomes. Computer systems will never replace human in healthcare so ignoring the care provider is ignoring half the equation.
Jeremy,
I need to become more familiar with the ISO level certifications. Do you have any proven research on ISO level certification producing better outcomes? Or is it almost all theoretical right now?
I don’t think that ISO would necessarily be pertinent. The larger point that I was trying to make was that the certification of an EMR needs to depend proven improved patient outcomes and not feature/function adoption. That means two things. First, a new product that has never been installed or put into production could not be certified. Second, It would force healthcare providers to continually update their processes. Doctors and nurses cannot continue to use 30 year old processes and combine them with the newest technology and blindly hope that patients will benefit.
Jeremy, don’t you think that not allowing new companies in can stifle innovation? Some of the newer EHR companies are just as good and often better than some of the big name EHR companies. I’m still wrestling with how you might certify an EHR company to improve adoption and outcomes. I know that CCHIT isn’t doing this right now. I do think some sort of focus on patient outcomes will be the better solution than a feature/function based certification. It’s just a much harder nut to crack.
To speak to both points:
First, you can use insurance reimbursement as an example. If a facility start doing sleep studies, it is not certified to do them. That takes six months, therefore, the facility does not get reimbursed for those studies on those patients. However, once it has achieved certification, it we be reimbursed retroactively for past studies. This can be done for hospitals or companies with new products. There is no other way to evaluate a new process or outcomes until they actually happen.
Second point, it will be harder to evaluate outcomes. You have to analyze certain objective numbers on an ongoing basis. Rates such as adverse drug occurrences or hospital acquired infections or days to final bill are all numbers that can used. These numbers will show how physicians and hospital staff use EMR/EHR’s to provide better care.
Jeremy,
I like thinking about the comparison you offer for offering back reimbursement if the objectives are achieved. Sure adds some complication, but is something to consider. However, it still doesn’t solve the need for a better certification which focuses less on features on more on results.
Your second point seems like it could be an interesting start to a discussion for hospital EHR. What about the solo doctor’s office EHR? That would need to be a quite different outcome measurement for reimbursement I would think.
For the physician, the test for the EHR is interoperability. The EHR needs to hook into or provide e-perscriptions, send orders, and recieve results. Also, hooking into a RHIO, would be ok, but a doctor is going to be more interested in exportability. If you have an EHR, it needs to be easy to allow other doc’s to get a copy in order to consult or cover for him if one of his patients are in the hospital. From a process point of view, there are much fewer numbers to track. I would like to have the certifying body use a physician satisfaction and use survey to be a part of certification.
That’s interesting that you say that Jeremy, because from what I’ve seen much of what you mention is a burden to most doctors. The exception is the results. That is definitely a strong benefit for the doctor. Especially for chronic patients where you can graph results over time. Very cool stuff.
However, the e-prescriptions can often be more heartache to the doctor. A great great service for patients, but not necessarily for the doctor. RHIO is the same. Great for patients and ok for doctors.
I think a physician satisfaction survey by an independent party would be a really interesting survey. If designed correctly, it could tell a lot about an EHR company. The challenge would be to try and understand who is actually responsible for the satisfaction/dissatisfaction. The survey instrument used would need to try and evaluate if it was the EHR vendors fault, the IT support person’s fault, the clinic’s fault, etc. That’s something I don’t expect any government survey could measure well.
I’ve worked with the outcomes data on several large studies of radiation therapy, and I do not believe that “ISO” level certification is going to solve ANYTHING. I have had more clients complain they don’t know how many patients they treated yesterday — they are too busy getting THAT number to even understand how WELL they were treated yet — and if you’re talking about an office setting with more than one doctor (or corporations), the situation is more compounded.
Most of the times I’ve worked with doctors (and there have been years of work there), they don’t like these systems AT ALL — it’s faster to make a phone call than to mess around with a computer that may or may not do what you want it to.
If your comment pertains to physician practice EMR’s then the survey would for the doc’s to fill out not the patients. What you can’t do is a certification on “features”. I understand that anecdotal evidence is weighted against technology. I have also worked with doctors that were resistant, but after they were exposed to it, they found it very helpful. It may be faster to dial the phone, but you aren’t guaranteed that the person on the other end will be able to help you.
This whole discussion assumes that focusing on the software vendors is the right approach to achieve widespread, “quality” EMR adoption. I would contend that it is not at all. The focus should be on the practice to be “certified” or more accurately “compliant” with the standards required to achieve the additional reimbursement. Whether a single software vendor or a group of software vendors help a practice “comply” is (or should be) irrelevant. ISO would be largely overkill here and would be costly. If a practice is billing using “enhanced codes” for additional reimbursement, then we already have an OIG mechanism in plan to manage and monitor that. We don’t need a functional checklist handed to software vendors. If we do that, we need to look at the hardware vendors next…then the cleaning companies, then the electricians, and all the vendors that serve the practice. Ultimately, it is more efficient to focus our efforts at point where they matter most…at the physician/practice level.