EHR interoperability should be ONC’s priority, vendors say

Electronic health record (EHR) vendors and other healthcare IT stakeholders contested and criticized new certification rules proposed by the Office of the National Coordinator for Health Information Technology (ONC) for 2015 in a Health IT Policy Committee hearing on May 7.

The ONC aims to create EHR standards separate from the Centers for Medicare and Medicaid Services (CMS) meaningful use (MU) standards, even establishing certification standards for non-MU EHRs. Other significant parts of the new rule would make 2015 certification voluntary for vendors and providers in meeting CMS incentive programs. In addition, the ONC wants to publish new certification criteria more frequently, every 12 to 18 months, to better respond to stakeholder feedback. The final rule will be published in summer 2014.

By relaxing the standards for EHRs, vendors and providers can work toward 2015 at their own terms and pace, Karen DeSalvo, MD, national coordinator for ONC, said in a statement about the rules in February.

The EHR certification process forces vendors to focus on meeting MU standards, rather than meeting provider needs, said Mickey McGlynn, chair of the EHR Association and senior director of strategy and operations at Siemens Healthcare.

“The certification criteria for the meaningful use objectives, the reports that measure these objectives, and the clinical quality measures, are not consistently aligned with each other and sometimes not aligned with clinical practice,” McGlynn said during the hearing. “We are concerned that, as the provider community comes to use the software, there will be dissatisfaction that will reflect negatively on EHR developers, when in fact we are doing what is required for certification.”

Though the Certification Commission for Health Information Technology is discontinuing its accreditation programs for EHRs this year, Alisa Ray, the certification commission’s executive director, acknowledged that EHR compliance is perceived as a bureaucratic function and not as an asset to providers. “Our own experience suggests that it requires broad input and collaboration from the health IT community, in an atmosphere of transparency and reliability, to successfully design certification programs that will demonstrably improve the effectiveness and satisfaction associated with of use of EHRs, thus removing one of the major barriers to widespread adoption,” Ray said.

Sasha TerMaat, director of certification and regulatory programs for EHR vendor Epic, said that interoperability is more important than certification guidelines. “I receive questions as to whether certification simplifies the process of selecting and purchasing an EHR. There is a minor improvement in the process of selection and purchasing, but it is not proportionate to the effort expended on certification. For every $1000 spent on certification, $1 of savings in the selection process might be achieved,” TerMaat said during testimony.

Sarah Corley, MD, FACP, chief medical officer for NextGen Healthcare, said that the EHR certification process should have a forward-looking map so that vendors can anticipate requirements.

“There should be evidence of the utility of any given certification requirement. It is important to remove requirements for automatic numerator and denominator calculations for measures that require additional documentation that is not necessary for the provision of care. These measures should be attested to,” Corley said during testimony.

Jitin Asnaani, director of technology standards and policy at athenahealth, says that instead of pushing back deadlines and making compliance voluntary, the ONC needs to make interoperability a priority.

“What the national health care delivery system really needs is a true mandate for robust interoperability,” Asnaani said in a blog posting. “Where is the ability for providers to click a button and migrate all their data – clinical, quality, population health, patient communication – wherever they wish, without being held hostage by a poorly performing EHR? All of these critical pieces are superficially explored, if at all, in the proposed rule, but could prove so instrumental to the transformation of health care over the next few years.”