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EHR Use Cases, Not Certification, Should Drive EHR Selection

Healthcare industry insiders are hinting that successful EHR use cases should carry more weight than EHR certification.


Source: Thinkstock

By Kate Monica

- EHR certification is useful in signaling when certain technology meets industry standards in a test environment. In particular, 2015 edition ONC health IT certification informs providers when a certain technology can be used to earn payments under federal incentive programs such as the EHR Incentive Program and the Quality Payment Program.

However, the recent $155-million lawsuit to settle EHR certification allegations against eClinicalWorks has raised questions about the significance of EHR testing versus performance in the real world.

Providers relying on word of mouth and health IT certifications when making EHR purchasing decisions now have less assurance these stamps of approval mean much.

While the certification process itself has strict and specific criteria, the possibility that vendors could illegally obtain certification by hiding certain inefficiencies or inadequacies of its technology from the certification body raises concerns.

“As a customer of any vendor, do I have any responsibility or liability to verify certifications; can or should we simply accept that the vendor has attested to? Is it even possible to verify?” said Spaulding Rehabilitation Network at Partners Healthcare CIO John Campbell. “What would be considered reasonable efforts to verify?”

According to Vice President of Interoperability at Epic Peter DeVault, certifications should play a negligible role in provider’s EHR purchasing decisions.

“The best advice for a provider buying health IT is not just to rely on the certification and on responses to the RFP the vendor provides, but to do site visits and reference calls,” he said at the Value-Based Care Summit earlier this month. “You have to see it in action.”

Sequoia Project CEO Mariann Yeager whose organization involves Carequality, eHealth Exchange, and other health IT interoperability initiatives agreed.

“If you want assurance the system is capable of sharing information, you would have a high degree of assurance if that system and technology was widely deployed in a multi-vendor network initiative like Carequality,” Yeager said. “It’s not just that a system out of the box is capable of interoperating — where is the evidence that it is already? That requires a higher bar of testing for not just the movement and the transport, but also the content and the payload.”

Demonstrated benefits and a positive reputation among users, according to Yeager, are the best indicators of successful, efficient technology that stacks up to industry standards and expectations.

“It’s about taking that technology and making it real in a real environment — seeing the proof,” Yeager said. “Look where there’s a high degree of connectivity and production exchange in existence and a high utilization, and you’re going to see some winners.”

Similarly, Beth Israel Deaconess Medical Center CIO John Halamka, MD, said in a recent blog post that providers should focus on one thing when making EHR purchasing decisions: outcomes.

Health IT certification and prescriptive health IT policy, Halamka said, will soon be abandoned in favor of an outcomes-based approach to EHR purchasing decisions and quality assessments of these technologies.

Outcomes-based EHR assessments are more in line with value-based purchasing. Rather than judging the efficiency of a technology based on its level of certification or raw stats, providers should instead find out if a technology typically leads to improved outcomes at hospitals and physician practices.

“Rather than counting the number of Direct messages sent, giving organizations the flexibility to each data using the most locally appropriate technology but then holding them accountable for a result of that data exchange, i.e. reduced readmissions, reduced redundant testing, reduced errors seems to be well aligned with a move to value-based purchasing,” he wrote.

While EHR certification — and health IT certification in general — can be helpful in determining which technologies are approved for use in earning federal incentive payments, it is an imperfect and surface-level gauge of efficiency.

With the transition into value-based care underway, providers should similarly take an outcomes-based approach to EHR purchases. 



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