EHR developers have signed a code of conduct. Will it mean anything for doctors and patients?

A group of more than 40 electronic health records (EHR) developers made headlines last week when they announced a new "EHR Developer Code of Conduct" that outlines plans to enhance patient safety, data portability, system interoperability and security.

As is par for the course with these types of announcements, the Code of Conduct was accompanied by a big media event and glowing press release, proclaiming just how "transformative" this new development is.

The 9-page code is a "reflection of our industry's ongoing commitment to collaborate as trusted partners with all stakeholders," said Mickey McGlynn, chair of the Electronic Health Record Association (EHRA), the group behind the pledge. The code is "an important milestone in the maturation of the healthcare information technology industry," said Siemens CEO John Glaser, an early supporter of the pledge. It's simply "the right way to treat our customers," said Farzad Mostashari, MD, chief of the Office of the National Coordinator for Health IT.

But not everyone in the health IT industry was so impressed.

"It's telling about the business practices of our industry that this is a new development," said Dave Chase, CEO of Avado, a patient relationship management software provider. "Why this wouldn't be a standard practice is rather shocking."

Brian Ahier, president of health information exchange company Gorge Health Connect, suggested that EHR developers may have had other motivations for announcing the code besides treating customers right, given widespread reports about growing physician and government dissatisfaction with existing EHR technology.

"To some degree, there probably is some sense of 'We need to do something to sort of calm down the regulatory bodies and the provider community as far as their complaints,'" Ahier said.

Ahier was critical of some of the code's patient safety pledges, calling them "too vague." For example, the EHR developers promise to participate with at least one patient safety organization in reporting, reviewing and analyzing "health IT-related patient safety events." But the "nature, extent and timing" of the companies' participation depends on a host of factors, including the outcome of "current industry and policy discussions," regulatory changes, the availability of "appropriate recognized organizations," and the development of "standardized definitions of safety events."

"That leaves an awful lot of wiggle room," Ahier said. For example, exactly what "policy discussions" are the developers referring to? Won't policy discussions around health IT be perpetually ongoing, so who's to say when or if those discussions will produce a definitive "outcome?"

What's more, the EHR vendors have issued the code with a set of conditions that don't exactly promote transparency or inspire much confidence that the companies are even fully standing behind the code. The EHRA won't levy any charges or fees against a company that says it'll abide by the code but fails to, Modern Healthcare reported. Further, despite the fact that the EHRA released the code, that alone doesn't even mean that any of its individual members endorse it.

Nor will the EHRA keep a running tally of companies that have promised to take up the pledge - making it much more difficult for patients and physicians to ascertain the extent to which the code is (or isn't) having any impact. (Companies that adopt the pledge will be able to display a logo the EHRA has developed for the code.)

It seems, then, that the developers are seeking out the positive publicity associated with pledging to adhere to a code of conduct, while at the same time keeping that code at arm's length and avoiding full accountability around whether they actually do adhere to it.

"I don't put much stock in press releases," Chase said. "It's only 'news' when one can actually do what is stated."

Nonetheless, Chase acknowledged that the code represents a "step in the right direction" for doctors and patients - if and when developers adopt it. As Ahier said, "How could you not agree with its principles?"

Michael Barr, MD, a senior vice president with the American College of Physicians, embraced the code after some initial skepticism, praising the effort around it as "significant" and its intent as "genuine."

"I can go back to our members and point to [the code's] principles that are very responsive to the issues physicians would like addressed as they try to select, implement, optimize, and potentially change EHR solutions," he wrote on the American EHR blog.

So while it may be too early to say whether the EHR Developer Code of Conduct will result in anything besides good public relations for the industry, EHR vendors have given doctors and patients several reasons to be both optimistic and pessimistic about the code's effects in the future.

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