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ONC Head Blumenthal Says Certified EHR Not Good Enough

Posted on April 1, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

John over at Chilmark Research has a really good find on his blog. He quotes the new head of ONC, David Blumenthal, from an article in the New England Journal of Medicine (NEJM) where Blumenthal talks about the certified EHR requirement in the HITECH act. Here’s the quote:

ONCHIT currently contracts with a private organization, the Certification Commission for Health Information Technology, to certify EHRs as having the basic capabilities the federal government believes they need. But many certified EHRs are neither user-friendly nor designed to meet HITECH’s ambitious goal of improving quality and efficiency in the health care system. Tightening the certification process is a critical early challenge for ONCHIT.

I find it really interesting how two people can take the same quote different directions. Chilmark Research gives a nice little rant about how you can’t certify usability, quality and efficiency in an EHR. I agree with him on most points and I definitely agree that the market is much better at these three items than some government certification body.

However, I don’t feel like this was what Blumenthal meant in the above quote. I don’t think Blumenthal was trying to say that the certification would need to certify user-friendly, quality and efficient EHR software. Instead, I see the above quote meaning that the current CCHIT certification isn’t good enough, because it has certified a bunch of unusable EHR (a topic we’ve talked about many times before). Sounds to me that Blumenthal is making a case for why the government shouldn’t use the CCHIT certification. At least not in its current form. Essentially Blumenthal is saying that CCHIT isn’t good enough to meet the goals of HITECH.

This seems like a ray of hope for myself and others who think that selecting CCHIT certification as the certified EHR requirement of the HITECH act is the worst decision the government could make. Albeit still just a ray.

What Blumenthal means about “tightening the certification process” is up for debate. He could mean something like what John from Chilmark research describes. Basically some convoluted method of measuring usability, quality and efficiency of an EHR system. Or it could mean that the certification process will need to be tightened so that unneeded requirements are removed and it gets cut down to what will help an EHR achieve the ambitious goals of the HITECH act.

Of course, in the end the certified EHR criteria will probably land somewhere in between. However, this quote did give me some hope that Blumenthal realizes the impact that it will have on EHR adoption if many of the currently unusable certified EHR gain wide adoption thanks to the $18 billion in EHR stimulus money.

I do think John from Chilmark Research does make a nice conclusion to his post:

Suggesting that we tighten the certification process is heading in the wrong direction. Instead, we need to actually relax the certification process to encourage innovation in the HIT market allowing developers to create solutions that will truly provide value to their users while concurrently meeting the broader objectives of delivering better care and better outcomes. Creating light certification criteria and focusing more on what outcomes we wish to see occur as a result of broad HIT adoption is where Blumenthal and his staff need to focus their energies.

Obama and Congressional Leaders Can’t Overlook EMR Failure Rates

Posted on January 29, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

“If it’s [EMR investment and implementation] too hasty, you can create so many bad experiences that people say…’My data’s a mess and my patients are angry,'” Mr. Glaser said in a recent Wall Street Journal article on the possible wasted investment in EMR. 

The scary thing is that John Glaser, chief information officer for Partners Healthcare, is probably right.  I know that President Barack Obama wants to “wield technology’s wonders to raise health care’s quality and lower its costs.”  I want to do that too.  In fact, I think we’d all like for that to happen.  Unfortunately, I think we have to seriously ask ourselves if the current electronic medical records offerings can raise health care’s quality and lower its costs.

I think there are two points that have been proven time and time again in implementing an electronic medical record in a doctor’s office.

Point 1: A Well Implemented EMR Yields Great Results – Hundreds (possibly thousands) of doctors can attest to how happy they are using an EMR.  My personal finding is that the key to a successful EMR implementation is deeply related to how well a clinical practice is run before implementing an EMR.  In fact, I believe an EMR will exacerbate any problems a clinic may have been experiencing pre-EMR.  However, many clinics have shown that when done right there are tremendous benefits associated with an EMR.

Point 2: A Poorly Implemented EMR Causes More Harm Than Good – Blame it on the software.  Blame it on the clinic.  Blame it on the technology.  Blame it on the health care culture.  It’s probably a mixture of all of these things that has caused so many EMR implementations to fail.  Regardless of the reason, all of these failed EMR implementations have shown the damage that can be done to a practice that fails in their implementation.  Unhappy patients.  Unhappy and frustrated doctors.  Thousands of hours evaluating, learning, training, testing and implementing down the drain.

It’s no wonder that the New England Journal of Medicine found that only 4% of U.S. physicians were using a “fully functional” electronic health record system.  The huge failure rate among physicians has created a fear in doctors that’s difficult to overcome.  Sadly I think it might take a generation for doctors to overcome this bias.

The reality is that implementation of an EMR CAN increase health care’s quality and lower its costs.  The problem is that most clinics haven’t yielded these promised benefits and most are living with failed EMR implementations.  The huge numbers of failed implementations can not be ignored.  Ignoring this will lead to even more failed implementations which could set the movement to digitizing patient records back years.

It’s not enough to poor money onto something without looking at and solving the reasons why so many people have failed in their implementation of electronic medical records.

I don’t want to give the impression that I’m not for investment in EMR and health care IT.  I think that help is needed and could be beneficial to the future of health care in the US.  I also really believe that EMR does open up a whole world of opportunities that we couldn’t consider without broad adoption of electronic medical records.  However, I don’t think enough attention is being paid to understanding what factors are important to implementing an EMR successfully.  By understanding these facets of implementation we can invest in electronic medical records that are actually being used and effective.  Otherwise, we’re just lining the pockets of the EMR vendors without any benefits to health care or doctors.