Friday, January 29, 2010

Don McDaniel: Why certify EHRs?

I was recently at the eHealth Initiative’s annual meeting in Washington, DC. eHealth Initiative is the organization focused on building bridges in healthcare by and between all of the disparate information systems in healthcare — in short, they are promoting the development of a truly interoperable information ecosystem in healthcare.

The promise of this concept is significant to many stakeholders in healthcare for many reasons, not the least of which is the significant benefit that might be offered to patients that won’t be victimized by the various and sundry errors prevalent in our dysfunctional domestic healthcare system. It’s been well chronicled that tens of thousands of patients per year are harmed or even killed as a result of something as innocuous as an adverse drug reaction.

Anyway, at lunch I struck up a conversation with an especially bright CIO from an integrated delivery system in Eastern North Carolina. We were discussing the recent pronouncements of CMS and ONC on the topic of meaningful use and I mentioned certification of vendors. He quickly replied that there’s no reason to certify vendors of electronic health records because the market will take care of that. I was simultaneously impressed and upset that I didn’t suggest the very same thoughts; I am, after all the free enterprise guy!
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My new acquaintance was right. Meaningful use is a process/outcome achievement scheme. Providers will not be incentivized to simply implement electronic health records, but rather to achieve a (nirvana-like) “state of meaningful use” – which will require appropriate data collection, fidelity to certain clinical treatment protocols, monitoring of patient status and intervention when necessary, and finally, reporting that one has mastered all of the above.

If someone is stupid enough to buy an appliance that doesn’t support their achievement of these goals, shame on them. Is their protection really worth all the money that will be spent — and passed onto purchasers in the form of higher prices — to achieve and maintain certification status? As with every market transaction – caveat emptor – buyers need to educated and ask the right questions.

For instance, I can’t imagine advising one of my clients to purchase clinical decision support technology from a vendor that won’t guarantee that their product will be completely meaningful use-compatible. But do we need a regulator to ensure our protection?

Then again maybe if we were all much better, more demanding consumers of healthcare services, we wouldn’t need the government to carrot and stick our way through meaningful use!

1 comment:

  1. Certification acts as a pseudo-Consumer's Reports for doctors- it gives us at least a baseline idea of legitimacy of the product. We have no idea if the claims are true that the program is "HIPAA secure" or e-prescribing-ready or able to be properly backed up and restored. I wouldn't buy a car that claims "safe in crashes" without seeing the official crash test ratings- why would I buy an EMR without crash ratings? Toyota has taught us that we can't trust manufacturers to disclose all the flaws.