Electronic Health Records

Adoption & Implementation News

Is the ONC taking a new approach to health IT certification?

By Kyle Murphy, PhD

The Office of National Coordinator for Health Information Technology (ONC) has the responsibility of overseeing the certification of EHR and other health IT systems and services. And it appears to be getting more serious about certification.

The Department of Health & Human Services (HHS) is currently looking to fill a full-time position in the ONC’s Office of Certification. Here are the duties listed on the HHS job post:

Supervises three or more Federal employees responsible for performing a variety of program/project management function associated with the management and oversight of all Office of Certification. Leads staff accomplishment of assigned tasks, make certain assignments are completed, performs required administrative and human resource management functions relative to staff supervised.

Works across the public and private sectors to foster a standards-based data architecture that maximizes interoperable health data by providing actionable, integrated data. Fosters definition and documentation of the national data architecture by working with national processes in gathering requirements, identifying appropriate standards and fostering implementation level guidance and conformance testing. Facilitates and documents agreements on appropriate health data and its usage, resolving conflicts among organizations, and ensuring standards are properly integrated and implemented.

According to the evaluation criteria, the figure is to be an authority on health IT certification by providing “advice and guidance” in this area while supervising and leading a “diverse work group.”

Certification is crucial to the EHR Incentive Programs in which eligible professionals and hospitals are required to use certified EHR technology in order to demonstrate meaningful use successfully.

The certification program, moreover, has come under criticism for its requirements. In a recent post on Life as a Healthcare CIO, John Halamka, MD, MS, has listed the need to reform the ONC’s certification program as one of his bits of advice for the new National Coordinator, Karen DeSalvo, MPH, MSc, who recently assumed her post. In fact, it is the first piece of advice he has offered in the post where he has provided two examples of where the current approach falls short

Here’s the first:

One of the most negative aspects of 2014 certification is the concept of “certification only”. No actual clinical use or attestation is required but software must be engineered to incorporate standards/processes which are not yet mature. An example is the “transmit” portion of the view/download/transmit patient/family engagement requirements. At present there is no place for a patient to “transmit”, yet vendors are required to implement complex functionality that no one will use.

Here’s the other:

Another example is the use of QRDA I and QRDA III for quality reporting. CMS cannot yet receive such files but EHRs must send them in order to be certified.

As Halamka notes, the end result of the ONC’s current certification program is a delay in EHR vendors being able to make products available meeting the most recent 2014 Edition Certification Criteria. “Certification should focus on rigorous interoperability testing, using mature standards, in practical use cases, supported by the evidence and experience,” he argues.

Perhaps the addition of a certification expert would go a long ways toward reducing the burden on EHR developers and in turn the problems providers face when working to meet the demands of health IT initiatives and mandates.





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