EHR Certification is a Black Box

The EHR vendors have not been sharing HOW their products are being certified. Currently, it is a black box. This is VERY frustrating. Especially since hospitals and doctors are supposed to be using the EHRs as cerified. Often there are many ways for an EHR to accomplish a testing objective. The current certification just produces a check box and a pretty certificate.  How do we deploy and use the product in a certified way is a mystery. My EHR vendors have not been forthcoming with this informtation (slippery is a term that comes to mind).

During a HIMSS meeting with an ONC official, it became apparent to me that ONC now realizes this is a problem. There was a discussion that the vendors should provide screen shots for each step to share this with their customers. ONC can compel them to do this, but I would like to see the vendors do this on their own.

For me, this is one more reason to take the self certification route.

Replacing David Blumenthal

It appears everyone was surprised by the announcement from ONC HIT Coordinator Dr. David Blumenthal that he will be departing his government post to return to academic life. By all accounts he is a great guy and I wish him all the best.

[edit: One of our Clinical Informaticians pointed out that this has been rumored for some time and Blumenthal himself said his stay would be limited. So, in the sentence above when I say “everyone was surprised” – I guess I meant I was surprised]

I would suggest that when Dr. Blumenthal is replaced, the administration should appoint someone that has a more intimate knowledge of the reality of health care IT operations and what it really takes to achieve healthcare IT objectives. Another candidate from academia would not be the right choice. I would suggest someone with hands-on, in the trenches, implementation experience in a variety of healthcare provider settings is what is needed now.

Many of the current rules for EHR incentives just don’t make sense or lack necessary definition. There is too much focus on alphabet soup, and not enough on common sense. Just to be clear I support the implementation of standards, but they have to be relevant standards and they have to further the goals. Let me give you some examples of EHR incentive rules that seem to be rules, for rules sake:

  • Problem lists are great and needed. But the certification requirement that problem lists use ICD-9 or SNOMED coding is wrong-headed. There is a ton of time being spent mapping ICD-9 codes to problems for no true benefit. The mapping is highly subjective and the end result does not create something that is reliably shared between providers that are not sharing the same EHR implementation. This time could be better spent developing care plans and interventions that help patients get to goal reliably and less expensively.
  • I love the patient portal concept and the notion of giving patients access to their medication list, allergy list, problem list, etc. But, the certification requirement that one must do this using the emerging CCD or CDR formats is using the wrong tool for the job. These standards, once mature, should be great for sharing records between providers. However, this is useless to a patient and another place where we are spending time on something that is not getting us closer to the goal.
  • Why are the NIST specifications for quality reports written using SNOMED codes? Nobody has this information in their EHR coded in SNOMED. Now the burden is on each hospital and doctor to map these codes to ICD-9. A total waste of time.

I am hopeful that an ONC HIT Coordinator with more direct experience can:

  • write sensible rules, that are not ambiguous;
  • keep the scope of the objectives achievable in the set time frames; and
  • make sure all of the work required is work that gets us closer to the goals of more safe, effective and efficient care.

Since I am posting this on Super Bowl Sunday, I have to say: Go Pack Go. This is a big day here in Wisconsin.