ONC shares thinking behind Certified EHR 2015 Edition rule

The Certified EHR 2015 Edition final rule is part of a wider effort to achieve better care, smarter spending and healthier people, said Elise Sweeney Anthony, senior policy analyst at the Office of the National Coordinator for Health IT, speaking about the rule at the November Health IT Policy Committee.

The rule builds on the foundation established by the 2011 and 2014 editions and addresses stakeholder feedback by reducing the burden on providers. “We took a real close look at the key pieces that would move interoperability and patient engagement forward,” Anthony said.

They wanted to make sure the criteria are beneficial to the behavioral health requirements the Centers for Medicare & Medicaid Services (CMS) are putting forward in Meaningful Use Stage 3, which includes support for other care settings in the larger continuum of care. “We thought about how behavioral health professionals can communicate with hospitals or primary care providers," said Anthony. "What does that look like and what opportunities do we have for that to happen?”

They also wanted to create a more accessible program supportive of diverse health IT systems, including but not limited to EHR technology. That’s one reason there is no complete EHR criterion in the 2015 edition or in future editions. Going to an entirely modular program means providers can work more closely with their developer to tailor their systems.

The program is agnostic, said Anthony, and not designed to only support any particular setting. “We want to be a resource across health IT. Almost like a buffet, we provide a variety of different certification criteria. We encourage providers to work with developers to determine what best suits their particular practice.”

Transparency is key to updates, she said. They thought about what type of information would be helpful to providers in the position of being purchasers and how they could improve the conversation between developer and provider. The rules ensure that health IT developers conspicuously disclose their products' capabilities in plain language on the website, in all marketing materials, communication statements, and other assertions related to certified health IT. Disclosures could include limitations. “The goal was to make more information about the technology available to the provider.”

Developers will be required to provide a hyperlink for all disclosures which will be published via ONC’s Certified Health IT Product List (CHPL). “We’re hoping that makes the information more accessible and allows more information to become available. Transparency attestation in the rule requires developers to say whether they will provide the required information upon request.”

They’re also converting the CHPL to an open data file to make more information readily available and parsable. Authorized certification bodies (ACBs) are required to report on an expanded set of information about health IT products for increased product transparency. “We’re doing things ourselves and asking things of developers” to improve transparency, Anthony said.

Surveillance of health IT is another key update, she said, and the rule includes new requirements for in-the-field surveillance to determine how well a product works once it’s implemented. ONC wants more understanding of the effectiveness of a product. There are two types of surveillance--reactive (complaints) and randomized. Surveillance will be mandatory and nonconformity information will be made available on the CHPL.