Several commentaries published in this forum in the past few weeks have shown a consensus among readers that Certification Commission for Healthcare Information Technology certification of an electronic health record can lead to the negative consequence of attracting a prospective EHR purchaser into the frustrating experience of purchasing and implementing a difficult-to-use EHR because ease-of-use is not evaluated in the certification process.
Given physicians' trepidation in purchasing EHRs in the current marketplace due to the bad reputation that EHRs have for being difficult to use, the last thing our industry needs is to have a certification process that does not address one of the most important issues facing physician adoptionnamely, ease-of-use.
However, one must ask whether a third-party, private enterprise such as CCHIT is best qualified to identify which products are easy-to-use. After all, if a prospective buyer wants to know if a system is easy-to-use, wouldnt it be better to get that information from another similar user rather than a third-party enterprise doing its best to make a theoretical judgment regarding ease-of-use?
To this end, earlier this year we submitted the following recommendation to the Office of the National Coordinator for Health Information Technology, and hope that CCHIT or any other certification body that is ultimately selected by the National Institute of Standards and Technologyas stipulated in the stimulus billwould take this recommendation under consideration: Establish a well-regulated Web site that allows physicians who have purchased EHRs to rate and evaluate the EHR and its implementation and support on an ongoing basis.
The recommended Web site will allow the best products to rise to the top of the list and prospective buyers will learn from real-world experience which products are easy-to-use in real life scenarios.
Note that the recommendation includes the term well-regulated to imply that only providers using an EHR are permitted to evaluate that EHR and that no fee is incurred nor monetary reward offered by or to vendors and/or providers for a provider to evaluate an EHR. After all, the information on the site would be useless if vendors could pay their way to the top.
There are two additional benefits from the recommended Web site. The first is that if an EHR vendor does not provide good, consistent support to its clients then its support ratings will suffer. Thus, EHR vendors are permanently on the hook to provide good service. Secondly, with a well-designed Web site there will be no question as to the fairness of the system, which as we have read, unfortunately has not been the case with CCHIT.
There are many popular rating-system models in use today that can be emulated when developing the recommended Web site. From Angies List to seller ratings on eBay, an online method of viewing buyers recommendations of sellers products has proven to be an effective tool to empower prospective purchasers. We believe it is a tool that will lead to much more rapid growth in physician adoption of EHRs than a third-party ease-of-use certification score.
A. Cyril Spiro, M.D.Founding partner and general managerM.D. Web SolutionsTampa, Fla. To submit a letter to the Modern Physician Reader Blog, click here. Please include your name, title, company and hometown. Modern Physician reserves the right to edit all submissions.