Perhaps it's time to do away certification of electronic health records in favor of a "Meaningful Use" program that focuses on, oh, I don't know, using EHRs in a meaningful way in order to achieve the "triple aim" of more effective care, improved population health and lower costs.
The proposal last week from the U.S. Department of Health and Human Services to give healthcare providers an extra year before they have to upgrade their EHRs either shows that the 2014 certification standards were too stringent or the existing timeline was too tight.
According to data the Centers for Medicare and Medicaid Services presented at a Health IT Policy Committee meeting this month, just four — four — hospitals nationwide had attested to Stage 2 Meaningful Use as of May 1, and only 30 had attested to either Stage 1 or 2 since the beginning of the 2014 reporting year. Among "eligible providers" — physicians and certain other individuals — a mere 225 people had attested for 2014, and only 50 of those had reached Stage 2.
That's laughable. Or it least it would be if we weren't talking about an industry where the quality of service delivered can literally be a matter of life and death.
Part of the problem, as HHS acknowledged in the recent proposal, is that there simply hasn't been enough time since federal officials finalized rules in August 2012 for vendors to reprogram their EHRs to the 2014 standards, get their EHRs certified, install the upgraded technology and for hospitals and physician practices to make their own adjustments and demonstrate Meaningful Use for 90 consecutive days, as they are required. Now, if HHS sticks to its proposal, providers will be able to use EHRs certified to the previous, 2011 standards, but only for this year.
“Do we even need certification at this point?” was a question asked at a public hearing this month, according to Healthcare IT News. I say no. Just require vendors to make their technology interoperable so healthcare providers can exchange data easily but securely, with the triple aim in mind.
Certification dates to 2004, when several industry groups created the Certification Commission for Healthcare Information Technology (CCHIT), At the time, it was a self-regulatory move, as CCHIT developed a testing program that was intended to be, in the words of founding Chairman Dr. Mark Leavitt, a "Good Housekeeping seal" for EHRs to build customer confidence. CCHIT was controversial for its perceived high costs and cozy ties to large vendors, but it did help set a floor for EHR functionality that health IT needed at the time.
When the Health Information Technology for Economic and Clinical Health (HITECH) Act came along in 2009 as part of the stimulus legislation known as the American Recovery and Reinvestment Act, certification effectively became a commodity, as responsibility for setting EHR certification standards was shifted to the federal government.
CCHIT became one of the authorized certification and testing bodies, but after being consistently undercut on price by competitors, CCHIT in January announced that it was exiting the certification business. In a press release, CCHIT said the decision would "return it to its founding public mission of supporting the adoption of robust, interoperable health information technology."
If the organization that started testing and certification of EHRs in the first place believes the current program doesn't fully support adoption of interoperable health IT, doesn't that suggest that certification has run its course? It does to me.
