Doctors have begun to express concern regarding meaningful use criteria for electronic health record certification. The American Medical Association is leading a group of 35 medical societies in an attempt to officially separate EHR certification from the EHR Incentive Programs. The coalition has also made recommendations for the certification of EHR technology outside of meaningful use certification in a letter to National Coordinator Karen DeSalvo.
Worried doctors aim to shift focus of EHR certification
The group is mainly concerned with how EHR certification ends up impacting patient safety. In its letter to the National Coordinator for Health Information Technology, the coalition asks that the ONC addresses this issue.
"We believe there is an urgent need to change the current certification program to better align end-to-end testing to focus on EHR usability, interoperability, and safety," said the coalition's letter to the ONC.
The effects of EHR certification on patient safety is one of the few important concerns on the list that the medical societies are asking the office to address. According to the coalition, meaningful use requirements for EHR certification are having negative effects on patient safety. The group also brings to light its concern with the adequacy of testing procedures and standards by questioning the ONC's oversight of authorized testing. The group of worried doctors has found that the priority of health IT remains simply to achieve EHR certification for meaningful use, even if it conflicts with patient safety and physician EHR use.
The alliance also pointed out that making sure patient safety is effective is a responsibility that is shared between both physicians and vendors. The EHR system should have the proper safety measures regardless of its stage of development. There are plenty of quality EHR vendors that do work to make patient safety a priority and offer systems that are equipped to handle these safety measures throughout the entire implementation process, highlighting the importance of choosing a reputable vendor.
In fact, in the coalition's letter to the ONC, it pointed out that many physician informaticists and vendors have complained that meaningful use certification has dominated the priorities and requirements involved in health IT design. Product innovation and customers' needs have begun to suffer as a result.
The full list of recommendations
The official list of the coalition's suggestions, of which it highlighted in its letter, touched on six different topics. The first suggestion is to reconsider alternative software testing methods to improve interoperability and security features. The others include establishing greater transparency and uniformity on user-centered design testing and process results, to incorporate exception handling into EHR certification, to develop C-CDA guidance to support exchange, to seek further stakeholder feedback and to increase education on EHR implementation.
The need to improve security of patient information
It is clear that among the main concerns on the coalition's list of recommendations, the lack of necessary security measures in some EHR systems to ensure that patient information is safe and private is one of the most essential. The current meaningful use program takes away from these important factors.
Perhaps the top priority on the list, however, was the separation of EHR certification from meaningful use. The decoupling of the two was sited in the letter as being critical. However, the societies pointed out that even with a successful separation, without drastic alterations to the current program, the process involved in EHR certification is likely to remain the same.
"Only a widespread overhaul with continuous input from all key stakeholders will ensure that [certified electronic health record technology] can support the growing and changing needs of physicians and their patients," the societies wrote.
The coalition stressed the importance that these recommendations are taken seriously and that these features change as stage 3 meaningful use inches closer and the development of the Health IT Safety Center becomes more likely.
The societies also recommended that EHR functionality is tested and made a higher priority over the meaningful use standards. This can be done using the exception handling and scenario-based testing that exemplifies the workflows that are common in ambulatory and acute care settings, according to the letter.
A standard backed by the ONC referred to as the variability in C-CDA construction accounts for a lot of the ineffective interoperability. The standard did not have the necessary testing or approval from standards groups, which the coalition called to attention in its recommendations and concerns.
Later in the letter, the societies define what they believe makes a system effective in terms of interoperability.
"Although there has been an increase in the exchange of patient information, the act of two computers sending and receiving data does not constitute functional interoperability – the ability for information to be exchanged, incorporated, and presented to a physician in a contextual and meaningful manner," the coalition wrote in the letter.
Therefore, it is essential that practices are investing in an EHR system with the proper safety features and one that has been tested and approved.