Ehr Certification – A Fragile Balance

ARRA requires that EHR systems last certified. ONC published an IFR outlining certification criteria supporting Meaningful Use equally defined past times CMS. Later on ONC proposed rules for the creation of EHR certification authorities, as well as NIST is currently defining prepare novel testing procedures. In the past times CCHIT certified EHRs as well as large portions of CCHIT certification criteria came from HL7’s piece of work on diverse functional profiles.
All this agency is that hundreds of functional points were required to last present, inwards really specific form, for an EHR organization to reach certification.

There are functional points mandating what information to capture, how it is recorded, how it is stored, how it is displayed as well as when it should display. Incorporating all these certification requirements into a software application created really comprehensive products amongst the mightiness to exercise many things, or equally they came to last known “bloated EHRs”. But at that topographic point is another, likely unintended, effect when trying to enforce such incredible detail; the certification physical care for was inwards effect dictating exceptional piece of work flows as well as distinct user interfaces. That was the dot where the grumblings near lack of EHR usability as well as complaints of EHRs non existence built amongst physicians as well as patients inwards mind, started gaining steam.

I cannot count the times when my only reply to a complaining physician was that the offending slice is required past times CCHIT. Many vendors searched for places where the organization postulate only cause got “the ability” to exercise something as well as created customizations allowing physicians to plough off said ability. Nothing to a greater extent than so than the endless, as well as to a greater extent than oftentimes than non useless, alerts. At i dot yous could nation at root glance if an EHR was or was non CCHIT certified. All the certified ones had this foreign petty dropdown box side past times side to each diagnosis inwards the occupation list, where yous could select if the occupation was acute, chronic, resolved, bi-lateral, controlled, etc. I cause got never seen it used inwards existent life. Does anybody holler upwards that unless nosotros score it chronic, at that topographic point is a danger that a physician volition assume that DM is acuate or bi-lateral?

Well, if it’s all so counterproductive, why are nosotros certifying EHR technology? Honestly, I don't know that nosotros should. The master idea was that certification volition assure prospective buyers that the organization is able as well as willing to exercise the job, hence separating the wheat from the chaff. Unfortunately, certification acted inwards a to a greater extent than simplistic way as well as separated the heavy from the lite, regardless of usability, value as well as stability.
The novel idea at ONC is that certification should supply a guarantee that i tin reach Meaningful Use past times employing a certified system. So instead of trying to dictate every detail, the ONC certification is all near the specific criteria of Meaningful Use; 25 criteria for Stage 1. As a result, to a greater extent than or less pocket-size uncertified vendors of really visible radiations EHRs are expressing involvement inwards the ONC certification, if the toll is right, of course. CCHIT gracefully turned on a dime as well as created a much slimmer ARRA certification process. But is it possible that the slimming as well as trimming physical care for is going also far?

Is it possible to certify also little?

It is likely also presently to nation if the novel ARRA certification volition last able to boom an acceptable residuum betwixt allowing vendors the liberty to nowadays as well as ensuring that Meaningful Use tin last achieved amongst a certified product. However, the proposed NIST test procedures signal a possibility of certifying also little.
For example, certifying that a slice of software is capable of receiving electronic lab results inwards discrete format, piece allowing the vendor to select the structured format inwards which lab results are received could Pb to the inability of hereafter users of the software to reckon Meaningful Use requirements, if the vendor selects anything other than HL7 for their preferred structured format. Laboratories exercise non mail results out on a regular footing inwards either CCR or CCD, which are specifically allowed past times NIST, or whatever format other than HL7. An EHR, or EHR module, capable of receiving lab results inwards a CCD format exclusively, may conk ARRA certified, but its proud possessor volition last unable to conk a Meaningful User.

Influenza A virus subtype H5N1 dissimilar as well as to a greater extent than troubling number arises from looking at a requirement inwards a really narrow way as well as neglecting to occupation concern human relationship for ramifications non conduct related to the exceptional Meaningful Use criterion. For example, testing for the mightiness to alter a medication listing without concern for historical integrity of the listing creates a foreign as well as unsafe province of affairs where adjustments made to the SIG (strength, dosage,etc.) of a exceptional prescription are allowed to overwrite the entire history of said prescription (think Warfarin). The narrow compass of testing that modifications are possible fails to assert the postulate for those modifications to last made inwards accordance to full general principles enforcing the integrity of the medical record. Presumably this larger concern is left to vendor discretion. Existing vendors that certified their products nether the quondam regime volition likely supply a reliable production anyway, but novel innovative vendors, writing software to published specifications as well as essay out procedures could easily exercise a certifiable, all the same clinically unsafe product.

We are all aware that an over prescriptive certification physical care for has non produced massive improvements inwards EHR offerings. The temptation to err on the side of oversimplification is large, peculiarly since the fourth dimension is brusk as well as nosotros must come upwards up amongst a temporary certification physical care for sooner rather than later. However, if nosotros hold off at certification equally a physical care for designed to assist vendors construct ameliorate products as well as assist buyers inwards selecting tools to reach Meaningful Use, as well as then nosotros must prepare certain that, piece non overbearing, ARRA certification is indeed meaningful.