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August 21, 2015 12:00 AM

Feds pushing EHR vendors toward modular software

Joseph Conn
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    A proposed regulation issued in March by the key federal healthcare information technology policy agency will affect how providers meet and attest for completion of their meaningful-use objectives under the federal electronic health record incentive payment.

    The 431-page proposed rule by the Office of the National Coordinator for Health Information Technology seeks to change how EHR developers test and certify their software, a requirement if it is to be used by hospitals, office-based physicians and other eligible professionals seeking federal EHR incentive payments.

    In the proposed rule, the ONC said it plans to require EHR vendors to improve the interoperability of their systems by specifying they use a Common Clinical Data Set, handle behavioral health data by embracing Data Segmentation for Privacy standards and functionality and drop the popular “complete EHR” testing and certification definition in favor of an all-modular testing and certification scheme.

    EHR developer Cerner Corp., of Kansas City, got a jump on that change in 2014.

    In the past, Cerner marketed its products as both complete and modular EHRs. But for 2014, it moved away from bundling and testing its software as a “complete” EHR in favor of testing its software as individual modules.

    “We made the switch to modular certification because some Cerner clients don't use our entire catalog (of products),” John Travis, vice president of regulatory and compliance strategy for Cerner. Those customers “needed to be able to reference other vendor-certified products and the ONC's possession policy requires license for everything that is included in a certified product.”

    Thus, Cerner was the king of the “modular” EHR market last year among hospitals that used its software in an inpatient setting to meet Stage 2 criteria, according to a mashup of program databases kept by the CMS and the ONC.

    Cerner had the No. 1 position in the rankings of vendors of modular EHR software used in a hospital inpatient setting, with 429 of its hospital clients achieving Stage 2 meaningful use that way.

    No. 2 was Epic Systems, Verona, Wis., with 334 hospitals using some parts of its EHR. No. 3 Meditech, Westwood, Mass., followed with 236 hospitals; then came No. 4 Sunquest Information Systems, Tucson, Ariz., 115; No. 5 HCA Information & Technology Services Inc., Nashville, 105; No. 6 MEDHOST, Franklin, Tenn., 101; No. 7 McKesson, 96.

    Cerner all but disappeared from the data for vendors of “complete” EHRs used by hospitals in an inpatient setting for Stage 2. Only six hospitals were Stage 2 meaningful users with complete Cerner inpatient software, tying it for 10th in that group.

    Since the federal EHR incentive payment program was launched in 2010, hospitals have used two pathways to seek reimbursements for their health information technology purchases.

    One of them was to buy and use a complete EHR that has all of the functions providers need to enable them to meet the program's meaningful-use requirements.

    The other pathway was to build a complete EHR out of components or “modular” parts developed by one or more vendors, often called a “best of breed” strategy.

    Since 2010, the ONC, through rule-making, has set the criteria for EHR testing and certification for both complete and modular EHRs. The government pays providers that become meaningful users the same money for using either approach and has shelled out more than $18.6 billion in EHR incentive payments to hospitals.

    Both routes remain popular among hospital IT leaders as well, with the complete EHR pathway being taken a bit more often last year among Stage 2 achievers for inpatient care.

    In 2014, there were 1,196 hospitals that used products from 117 vendors in the modular approach in the inpatient setting to meet Stage 2 objectives, according to program data.

    In comparison, that same year there were 1,638 hospitals that used complete EHRs from 16 vendors in inpatient setting to meet Stage 2.

    Correction, Aug. 24, 2015

    This article has been updated to correct a miscalculation of the rankings.

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