CMIO Summit: 'Buyer-beware market' for EHRs
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In addition, the Office of the National Coordinator for Health IT’s (ONC) new program has provided two new reasons for certification: proof that an EHR can do the things that the government wants it to do, and to enable eligible providers and hospitals to get EHR incentive money.
“The idea is not to assure the product will do all things that are desired for patient care, instead, the idea is to stimulate innovation,” said Bell. As a result, the program is considered a major success because more than 700 certified health IT products are now on the ONC website. “The idea was to get a lot of new products started. This is a very different reason for certification than what we began doing several years ago,” she said.
However, just because CCHIT or another ONC-Authorized Testing and Certification Body (ONC-ATCB) doesn’t test and certify for a particular ability, that doesn’t mean the EHRs don’t have it. “It’s just up to [the provider] to make sure the vendors have it,” said Bell.
Innovation might be the name of the game now, but “for EHRs to be used in meaningful way, they would have to have all of their functionalities integrated. That’s not the case,” she warned. “You can buy an EHR right now where the e-prescribing does not integrate with the CDS [clinical decision support] module. Given the fact that CDS is mostly about e-prescribing, this is a problem. In a hospital environment, you’re taking care of all of this yourself. In a vendor environment, it’s up to you to make sure there’s integration, or it’s up to you to spend the money to build the interfaces yourself.”
“If you don’t have integration, you won’t get good workflow support,” Bell added.
CCHIT does have criteria that assess and guarantee a focus on workflow, “but on the ONC side of the house, you’re not going to see an emphasis on workflow. You’re not going to see a lot of emphasis on a lot of other functionalities as well,” because that isn't the focus of ONC-ATCB product certification, she said.
Backup is another feature that’s not part of the ONC certification processes, she said. “One would assume that any system you’re purchasing would have appropriate backup, [but] there is no backup [requirement] in the ONC certification process. You have to ask and make sure that your vendor has it.”
When it comes to usability testing and rating, “we know there’s definition: [A] system works as it should for those who want to use it for a specific purpose.” Because patient safety issues are tied to usability, “I recommend that providers work with an EHR vendor that has a commitment to usability, and make sure the vendor has a group or a department to address usability issues,” Bell advised.
“There may be a lot of new products on the [Certified Health IT Products List], but they’re not checked for real-world usage and verification. A lot of them are vaporware right now. It’s a buyer-beware market out there,” Bell asserted.