The American Medical Association is calling for an overhaul of a federal program to test and certify electronic health-record systems for suitability in the EHR incentive-payment program. Its request has been joined by 34 other medical specialty societies and healthcare professional organizations.
“We believe there is an urgent need to change the current certification program to better align end-to-end testing to focus on EHR usability, interoperability and safety,” the group said. “Physician informaticists and vendors have reported to us that MU (meaningful use) certification has become the priority in health information technology design at the expense of meeting physician customers' needs, patient safety and product innovation.”
A 9-page letter to the head of the Office of the National Coordinator for Health Information Technology (PDF) complained of “documented challenges and (a) growing frustration with the way EHRs are performing.” Such problems are inadequately addressed by the federal EHR testing and certification program led by the ONC, the AMA and its colleagues contend.
An ONC spokesman said the agency is reviewing the Jan. 21 letter.
The AMA-led group said many physicians find EHRs cumbersome and ill-suited to their workflows, an oft-stated criticism. As a result, EHRs slow physicians down, the group said. In addition, many EHR systems don't connect well with other systems and some create patient safety issues.
The ONC's testing procedures for EHRs should move from its current “unit-based” testing for discrete functions to a broader testing regime, the letter said.
Unit testing “does little to assure a product's performance once deployed in a clinical environment,” the group wrote. Instead, the AMA and the others said EHRs should be rigorously tested “against a multitude of clinical scenarios that represent the variety of workflows seen in acute and ambulatory care settings.” As such, the AMA also is asking that the ONC “decouple EHR certification” from the meaningful-use program.
The AMA and its letter cosigners also recommended that the ONC more fully embrace and require vendors to demonstrate “user-centered design” principles in their software development processes.
The association also criticized the ONC's heavy reliance in its certification program on the Consolidated-Clinical Document Architecture (C-CDA), a set of interoperability standards and implementation guides for clinical messaging built by standards-development organization Health Level Seven, (HL7).
ONC testing rules require vendors to use message formats conforming to C-CDA to send patient-care summaries between provider organizations. But that architecture allows too much variation in how a message is created, the AMA group said, and relying on it has “led to poor interoperability” and “placed patients at risk,” the organizations said.
The letter writers said ONC should work with HL7, to develop better user guides for C-CDA and reduce variation in how the standard can be implemented.
Members of the AMA coalition include medical specialty societies such as the American College of Physicians and the American Academy of Family Physicians, and several professional associations, such as the Medical Group Management Association and the College of Healthcare Information Management Executives.
Since 2011, when the federal government began making EHR incentive payments under a program created by the American Recovery and Reinvestment Act, more than 443,000 healthcare providers, including more than 351,000 physicians, have received $26.4 billion for buying and using EHRs in conformance with a set of “meaningful use” criteria developed by the CMS.
To qualify for use in the program, however, EHRs must first be tested and certified by their developers against a second set of criteria, developed by the ONC, for functionality. A main goal of the testing program is to ensure physicians have EHRs with all the capabilities they need to meet CMS's meaningful-use targets.
The ONC's testing and certification regimen has run into multiple snags in the past two years, delaying vendor delivery of tested and certified EHR systems to their provider customers. The delays have had a snowballing effect on providers, hampering some from meeting their meaningful-use targets.
The problems have drawn congressional attention. They also prompted ONC to scrap one set of testing criteria and, along with the CMS, provide both vendors and providers some relief from meaningful-use compliance deadlines and attendant Medicare penalties for non-compliance.
Last month, however, AMA President-elect Dr. Steven Stack said the organization was appalled that large numbers of physicians still might incur reductions to their Medicare reimbursements this year because they failed to meet EHR payment program timelines.
Follow Joseph Conn on Twitter: @MHJConn