P.O. Box 409095
Chicago, IL 60640
Length: 7 minutes, 47 seconds
Interviewer: Joseph Conn, reporter, Modern Healthcare
Interviewee: Hugh Zettel, director of government and industry relations, GE Healthcare
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[0:00:29.0] Joseph Conn: This is Joseph Conn. Im a reporter and I write about healthcare information technology and privacy issues for Modern Healthcare magazine and its daily online newsletter, Health IT Strategist. With us today is Hugh Zettel. Hugh is the director of government and industry relations at GE Healthcare. Hugh also serves as vice chairman of the Electronic Health Record Vendors Association, an organization affiliated with the Chicago-based Healthcare Information and Management Systems Society, or HIMSS.
The topic today is an HHS policy to promote both physician adoptions of electronic health-record systems, and to promote healthcare IT systems that are quote-unquote interoperable. That is systems that can exchange information with each other, even if theyre not made by the same software developer. Hugh, why dont you set the table for our listeners?
[0:01:25.6] Hugh Zettel: If we look at EHR penetration rates of ambulatory or office-based physician practices, we know that those penetration rates are low. The government has recognized that and has sought ways to try to increase the adoption of electronic medical records, and really, as a part of the Medicare Modernization Act, where Congress required HHS to provide the creation of a safe harbor to applied electronic medical-records systems.
And so they recognized the need and created the ability for donating entities to donate electronic medical records if it met a couple of criteria. One is it had to either have electronic-prescribing capability, or be able to interface with existing capabilities a physician had. And it also had to be interoperable. In order to be interoperable, theres two ways to do that. The first is to meet the interoperability requirement thats set forth in the regulation. In addition you could be interoperable if you had an EHR system that was deemed to be interoperable, if it was certified by an outside agency that was recognized by the Department of Health and Human Services. And that entity is the Certification Commission for Healthcare IT, or CCHIT, as I know it.
Now, as part of its process, CCHIT also goes through roughly an annual cycle of providing continual new certification requirements, as new capabilities become recognized by the commission. As part of the deeming provision that is in the Stark anti-kickback regulations, if a donating entity provides an EMRthat if they use the deeming provisionit must be certified within the last 12 months at the time they make the donation. So what we have here, Joe, as youve highlighted in your article, is this challenge of certificationif you want to exercise the deeming provisionof kind of being in a 12-month rhythm for the certification process as a vendor.
[0:03:27.5] Joseph Conn: Hugh, what are the implications of this process, then, and these rules for vendors?
[0:03:32.4] Hugh Zettel: One is, in addition to the certification requirements, you also are developing products that have existing features and updates that your existing customers want. In typical product-development cycles, they vary. Theyre not necessarily lock step within a 12-month period. For those that want to conform to an annual cycle basically constrains their product development capabilities to that annual period.
For some vendors that is a difficult requirement, especially if youre ambulatory EMR is part, say, of an integrated EMR solution that may also serve the enterprise space. If you are a smaller vendor, sometimes being on annual rhythm can be a costly proposition.
[0:04:16.4] Joseph Conn: What are the implications for providers, both hospitals that might want to subsidize the systems and physicians who might want to receive a subsidized EHR?
[0:04:26.0] Hugh Zettel: Thats a great question. If you look at donating entities, in many cases their procurement is in purchasing large number of bulk licenses, if you will. And then they do the installations to the physician practices in their community when the physicians are ready. So you may be well beyond a 12-month period before those licenses expire.
For some of our customers a 12-month cycle time relates to them as well, in the sense that at the time you donate to the physician, it has to be certified within the last 12 months. For many of our customers, theyre faced with the proposition of having to support multiple versions of an electronic medical record, potentially by the same vendor. The prospect for them to have to support multiple versions of an electronical medical-records system has turned off some of them relative to looking at how they would provide donations using the certification deeming provision.
[0:05:24.4] Joseph Conn: What has the EHRVA done about this and whats the current status of that action that you guys have taken?
[0:05:32.1] Hugh Zettel: We first raised this concern to the Office of the National Coordinator, and when we met with them at the HIMSS annual conference in New Orleans this past spring. In addition, this topic was also brought up to CCHIT during their town hall sessions. As a result of our discussion with the Office of the National Coordinator and Dr. Robert Kolodner and his staff at HIMSS, we had a follow up discussion with Dr. Karen Bell. She noted to us that there were other stakeholders that have highlighted similar concerns that we have raised.
More recently we met with ONC staff in Washington. They mentioned that they are working on a process to try and resolve it. At the same time, we also highlighted the other concern that many of our vendors are facing, in a sense that it leaves many of our members that develop niche specialty systems on the sideline because many customers are just going through the deeming provision instead of using the interoperability criteria, since a lot of specialty systems arent being addressed by CCHIT until some time next year.
The Office of the National Coordinator was receptive to providing more clarity on the interoperability definition. We hope that they may act on providing some guidance on the definition so that can be used as a means of donating entities to look at EMRs that may not either meet the certification timing, or because they are niche products, say they dont have a viable business case to be certified, but want to be able to participate in the donation process.
[0:07:08.2] Joseph Conn: Thanks, Hugh, for that update. Well have to look to the East, I guess, as you said; see what kind of smoke is rising out of the ONC. This has been Modern Healthcare reporter Joseph Conn, speaking with Hugh Zettel, director of government and industry relations at GE Healthcare, and vice chairman of the HIMSS Electronic Health Records Association.
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