Opposition Mounts to the Government EHR Certification Process with AMA Letter

The AMA and some 35 other physician professional societies have sent a letter to the ONC requesting changes to the EHR certification process (see: Docs to ONC: Change the EHR certification process). Here's a link to the letter and below is an excerpt from the article discussing it: An American Medical Association-led coalition of 35 medical ...

The AMA and some 35 other physician professional societies have sent a letter to the ONC requesting changes to the EHR certification process (see: Docs to ONC: Change the EHR certification process). Here's a link to the letter and below is an excerpt from the article discussing it:

An American Medical Association-led coalition of 35 medical societies, stressing "elevated concern" about the certification of electronic health record systems, has sent a letter to National Coordinator for Health IT Karen DeSalvo urging ONC to reevaluate its "current trajectory" and recommending changes to the certification process. The letter, dated Jan. 21, identifies a myriad of problems with the current EHR certification process, including: the lack of necessary security measures to protect patient information; the lack of oversight on the authorized testing and certification bodies; concern that test methods are no guarantee that the systems will perform as expected in production; and fear that the administration is "pushing too quickly" for use of certified EHRs beyond the Meaningful Use program.

Without going into too many details, Meaningful Use (MU) is a key element in the certification process and refers to the set of criteria used to assess the ability of the various electronic health record (EHR) products to achieve the following high-level goals (see: EHR Incentives & Certification)

  • Improve quality, safety, efficiency, and reduce health disparities
  • Engage patients and family
  • Improve care coordination, and population and public health
  • Maintain privacy and security of patient health information

This letter from a broad range of medical organizations is a frontal assault on the federal bureaucracy, the healthcare IT industry, and healthcare IT professional groups like HIMSS. This latter organization, in my opinion, is solidly in the pocket of industry. My notes on this topic go back eight years (see, for example: A Curious Aspect of the HIMSS Registration ProcessHIMSS Describes Itself as a "Trade Association" in a Press Release; Multiple Privileges Extended to Hospital CIOs at HIMSSHIMSS Virtual Conference: Qualifying for a Reduced Fee)

This AMA letter has been the subject of discussion on the Association for Pathology Informatics (API) list server. A comment about MU was posted by Peter Gershkovich, M.D., who is Associate Director, Pathology Informatics at Yale University School of Medicine. It was so relevant to this discussion that I offer is below:

...Meaningful Use,...in my opinion..., ...restricts access to EHR market for smaller companies and shifts focus of development from “what makes sense for the end user” to “what makes sense for the committee”. It complicates modular approaches to systems implementation. Hospitals are incentivized to purchase all-in-one solutions with their inherent limitations: overblown costs, restrictive workflows, stalled innovation, lack of flexibility essential for clinical research, and inability to quickly replace poorly designed blocks or the entire systems. Epic scale of such systems may lead to failures of epic proportions.

He's right, of course. Like most governmental regulatory activity, the certification and MU requirements create an environment highly favorable to the largest EHR companies that have large business units to attend to regulatory affairs. In so doing, the process reduces competition. We are left with mega-EHRs that often provide inadequate functionality from the physician perspective and can lead to mega-system failures (see: What's Really Wrong with EHRs: Beginning a Deep DiveOn the Future of EHRs: A Continuing Deep Dive). There is a revolution brewing in terms of physician opposition to the deployment of EHRs, bolstered by the flawed government certification program. The AMA letter is simply another milestone in the declaration of the discontent of physician EHR users.

Source: labsoftnews.typepad.com