Skip to main content
Subscribe
  • Sign Up Free
  • Login
  • Subscribe
  • News
    • Current News
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Digital Health
    • Transformation
    • ESG
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Opinion
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
  • Events & Awards
    • Awards
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top Innovators
    • Diversity in Healthcare
      • - Luminaries
      • - Top 25 Diversity Leaders
      • - Leaders to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Digital Health Transformation Summit
    • ESG: The Implementation Imperative Summit
    • Leadership Symposium
    • Social Determinants of Health Symposium
    • Women Leaders in Healthcare Conference
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Diversity Leaders Gala
    • Top 25 Women Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Hospital at Home
    • - Workplace of the Future
    • - Digital Health
    • - Future of Staffing
    • - Hospital of the Future (Fall)
  • Multimedia
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
  • Data Center
    • Data Center Home
    • Hospital Financials
    • Staffing & Compensation
    • Quality & Safety
    • Mergers & Acquisitions
    • Data Archive
    • Resource Guide: By the Numbers
    • Surveys
    • Data Points
  • Newsletters
  • MORE+
    • Contact Us
    • Advertise
    • Media Kit
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Government
March 25, 2015 01:00 AM

ONC stepping up efforts to ensure EHRs perform as advertised

Darius Tahir
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print

    The Office of the National Coordinator for Health Information Technology's new certification rule, released Friday, may signal a new direction for the agency: ensuring that electronic health-record systems perform as advertised.

    The ONC is proposing a two-pronged approach to achieve that goal. It will increase EHR transparency for providers and will encourage certifying bodies to raise their minimum EHR certification standards.

    “This will, at least, create another level of accountability,” said Cletis Earle, the chief information officer of St. Luke's Cornwall Hospital, Newburgh, N.Y., of the effort to promote greater accountability for EHR systems being marketed to providers and practices.

    “We're all challenged by lack of functionality to hit these (meaningful-use) measures,” he said. “It's because these systems are not truly ready.”

    The problem is a common one. Providers and practices purchase a "complete" EHR, certified as complying with the meaningful-use program—only to find that they have to pay extra to achieve the program's goals.

    The certification program was supposed to give a client assurance that what's being purchased can perform the tasks required by the meaningful-use program. The process is conducted by certifying bodies, which inspect records in a controlled environment—a lab—and then with checks to see if it works in the field.

    But some buyers say the certified records do not perform as promised, and action is needed to ensure they do. Earle and St. Luke's Cornwall Hospital provide one example.

    When the second stage of the meaningful-use incentive program rolled out, Earle's hospital was using Meditech Magic, version 5.66. According to the government's EHR list, the program is certified for the “view, download and transmit” function, which allows patients to access their data and transport it elsewhere.

    Earle said, however, that the software didn't actually have that capability. So he was forced to either buy a module from Meditech or a third party, or to build one.

    Earle chose the former, which meant costs of “tens of thousands of dollars.” Meditech did not respond to a request for comment.

    “It's time and time again, that I'm going back to my vendors, and saying, 'Look, these are the regulatory requirements, and you're not necessarily making sure we fit those initiatives,' ” he said.

    Charles Christian, the CIO of St. Francis Hospital in Columbus, Ga., said he'd had similar experiences with his hospital's EHR and direct messaging using the C-CDA standard, which allows hospitals to exchange patient data. His vendor attempted to sell the capability as an extra, despite the EHR purporting to be “complete.”

    “After expressing my disappointment that they would use this as a revenue opportunity, I was successful in getting the services turned on without additional costs,” he said.

    Dr. Farzad Mostashari, the former head of ONC, and current CEO of startup Aledade, said that such problems likely spurred the agency to act. “I don't think that every vendor did this, or every certification requirement was treated this way. But enough vendors are doing it in enough certification criteria, that I think it has caused ONC to push harder.”

    To win certification, the agency now proposes, developers need to disclose more information about the use of their system, including more on the expected method of implementing EHRs and about how much it would cost to make the record perform as certified.

    The other prong of the agency's proposal is to increase surveillance requirements. Currently, certifying bodies inspect EHRs in the field. The agency believes higher minimum requirements will stimulate more thorough surveillance. The intent is for the certifying bodies to investigate whether the records are performing in the field as they do in the lab.

    That will be accomplished through two methods: “reactive” surveillance, in which a certifying body responds to complaints and critiques made by customers in the field; and “randomized” surveillance, in which a body spends time proactively inspecting EHRs used by clinicians.

    In the latter instance, the agency proposes, a given certifying body would have to randomly select 10% of its certified products per year to inspect for compliance.

    Fortifying the inspection requirements is critical, Mostashari said, because of the way certification has worked to date. Vendors, he said, “develop the functionality in order to pass the test.”

    “They don't bother re-working the whole product, to make that function or feature a core part of their production environment, of how that product is intended to be used,” he said.

    Earle worries that the auditors testing the systems might not be up to the job, saying they need to have clinical experience to understand why a certain functionality might fail.

    Others are concerned about the potential consequences of a failed test. As a part of the proposed rule, the ONC is considering how to go about “decertification”—stripping an EHR's certification. The problem with decertification is the potential for collateral damage, Christian and Mostashari warned.

    Decertifying a product means it cannot be used to attest for meaningful use—which affects all of the providers and hospitals using that product. They might have to switch systems or hope the product can somehow regain certification.

    “There has to be a lot of thought given to the process, to the due process, and how to minimize the potential impact to the innocent bystanders,” Mostashari said.

    So far, the agency has decertified two products made by small vendor EHRMagic; no one had tried to use them for the incentive program.

    Others are convinced that transparency-and-surveillance tactics won't be effective, or are going after the wrong targets.

    "Price transparency might not reduce ongoing fees, which can be substantial revenue for health IT vendors—about 15% to 20% of the upfront costs, said Saurabh Singh, an analyst for Morgan Stanley. “Usually there are just a handful of vendors who are credible when someone is looking to replace their legacy EHR.”

    “Price is not the main factor in a decision,” he said.

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    abortion-pill-misoprostol-legal
    Abortion pill case advances to appeals court, on course to Supreme Court
    young doctor medical resident
    Federal physician recruitment program at risk
    Most Popular
    1
    More healthcare organizations at risk of credit default, Moody's says
    2
    Centene fills out senior executive team with new president, COO
    3
    SCAN, CareOregon plan to merge into the HealthRight Group
    4
    Blue Cross Blue Shield of Michigan unveils big push that lets physicians take on risk, reap rewards
    5
    Bright Health weighs reverse stock split as delisting looms
    Sponsored Content
    Modern Healthcare Alert: Sign up for this breaking news email to be kept in the loop as urgent healthcare business news unfolds.
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2023. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Digital Health
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • ESG
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Opinion
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Events & Awards
      • Awards
        • Nominate/Eligibility
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Excellence in Governance
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top Innovators
        • Diversity in Healthcare
          • - Luminaries
          • - Top 25 Diversity Leaders
          • - Leaders to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Conferences
        • Digital Health Transformation Summit
        • ESG: The Implementation Imperative Summit
        • Leadership Symposium
        • Social Determinants of Health Symposium
        • Women Leaders in Healthcare Conference
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Diversity Leaders Gala
        • Top 25 Women Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Hospital at Home
        • - Workplace of the Future
        • - Digital Health
        • - Future of Staffing
        • - Hospital of the Future (Fall)
      • Webinars
    • Multimedia
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • Data Center
      • Data Center Home
      • Hospital Financials
      • Staffing & Compensation
      • Quality & Safety
      • Mergers & Acquisitions
      • Data Archive
      • Resource Guide: By the Numbers
      • Surveys
      • Data Points
    • Newsletters
    • MORE+
      • Contact Us
      • Advertise
      • Media Kit
      • Jobs
      • People on the Move
      • Reprints & Licensing