Physician organizations have been screaming for financial assistance from payers and the government to purchase healthcare information technology.
The government, in the form of David Brailer, M.D., the national healthcare IT coordinator, has been saying the feds will be willing to help, but they won't buy a pig in a poke. If the government is going to put money into electronic health records, or EHR, systems, he has said, it will insist on knowing there is something on a physician's computer more effective in improving the quality of care than an Excel spreadsheet.
Brailer called for a private-sector entity to certify electronic health records systems. A group of IT industry leaders gathered earlier this month to attempt to reach a consensus on a certification program (Modern Healthcare, July 12, 2004, p. 8)
Today, Brailer got three healthcare organizations to step up to the plate.
The American Health Information Management Association, the Healthcare Information and Management Systems Society and the National Alliance for Health Information Technology, all based in Chicago, announced they have set up a joint venture for the certification of ambulatory EHRs.
Steve Lieber, president and chief executive officer of HIMSS, said the three groups will hold a series of open forums to ask vendors, users and payers what they would like to see in a certification criteria, which they hope to have in place by April 2005.
Lieber said a draft standard for EHR contents approved in May by the standards setting organization Health Level 7 and a list of EHR attributes HIMSS produced last year could serve as "foundation documents" for the work ahead.
In addition, Lieber said, the group would try to establish a validation process to ensure physicians who say they have the systems in place could actually use them. Validation could be as simple as a sworn statement by a physician at the practice that the EHR is up and running or might include the transmission of a data packet to test system interoperability, he said. Either way, the validation testing will be kept simple and unobtrusive, Lieber said.
"We're not going to create a joint commission for physicians offices," Lieber said, referring to the Joint Commission on Accreditation of Healthcare Organizations.
Several physician leaders praised the effort.
"We believe that voluntary, private-sector certification of these systems will let physicians and other healthcare professionals select and implement these products with greater speed and confidence, and ensure that information can be securely exchanged as the nation's health information infrastructure develops," said veteran informaticist and HIMSS Medical Director Mark Leavitt, M.D.
Earlier this week, the 115,000-member American College of Physicians issued proposed legislation that would include federal grants and loan guarantees for healthcare information technology for office-based physicians, noting more than half of practicing physicians work in groups of six doctors or less.
Meanwhile, the 93,700-member American Academy of Family Physicians has several initiatives that promote IT usage among its members, and its strategic plan calls for family practitioners to use IT to wrestle away from disease management services offered by insurance companies and outside vendors.
Leaders from both physician groups hailed the certification announcement.
"The American College of Physicians strongly endorses the need for an independent process to certify electronic medical records," said its executive vice president, John Tooker, M.D.,
"Physicians in smaller practices are looking for a trusted certifier of HIT products and services to help them make more rational choices in this crowded marketplace," said the AAFP's David Kibbe, M.D. Kibbe heads the Center for Health Information Technology, which promotes IT usage among AAFP members.
One possible concern about the certification effort is the dual role of HIMSS as a co-accreditor and a trade organization that survives on the dues of its members.
Lieber said, given HIMSS' historic orientation toward hospital-based IT systems and vendors, he expects quite a few EHR vendors whose products will be reviewed by the consortium to not be HIMSS members.
"This is something we're going to be sensitive about because we've established a reputation as being vendor-neutral," Lieber said. "It's really key for this to be not only perceived as, but to actually be, a fair and open process."
Charles Koo, founder and chief technical officer of iMedica, a developer of electronic medical-records software, said he sees positives and potential pitfalls to the certification process.
"I don't think iMedica has any problem with passing," he said. "It will level the playing field a little bit by eliminating some of the less adequate solutions."
And, Koo said, "It may help shorten the sales cycle. You will have fewer choices, but you will have everyone at a certain level."
One consideration from the physician's perspective is the limited utility of a certification if it doesn't take into consideration the medical specialty of the buyer, since systems must be configured by specialty.
"An internal medicine doctor tends to be visit-based, encounter-based," Koo said. "But then, when you're talking to an OB doctor, an OB doctor treats a pregnancy as a total episode. They have totally different application requirements. It's almost like a project plan.
"So the question is, how much value do you get by certification if you sell it to a different specialty," Koo said.
Bottom line, Koo said, the success or failure of the certification effort will ride on who makes the final decisions in each system, and there better be some physicians on the panel or decisionmakers "could drag the industry in the wrong direction."
"Depending on whom they choose, they could be good or they could be bad," he said. "The high-level goal is fine, but when you choose the judges, everyone coming in has a special interest in mind, depending on where they came from. It requires someone who has absolute clarity of what needs to be done. If you get lucky and get the right set of people, it could be done very efficiently. Until you see these people, it will be a guessing game.
"Assembling the right people who will be fair, that is the challenge."