I found a really nice interview of CCHIT Commissioner and Practice Partner CEO and President Andy Ury by HISTalk. There was some interesting information in the article. One thing that was a good comment was that Practice Partners seems like they finally figured out that EMR customer support would be their key to success. Doesn’t seem like rocket science if you’ve seen how many doctors talk. I think it has to do with the bonds created during medical school. Those long hours of studying really make students close to each other and so it continues after med school. I digress.
I also was very interested in what a CCHIT commissioner would say about the CCHIT certification process. HISTalk asked a very nice question:
Will CCHIT certification really increase EMR adoption by reducing customer risk?
I think it is a fair question. Here was CCHIT commissioner’s response:
I think certification is intended to increase EMR adoption, but reducing customer risk is just one of the ways it will achieve that. By ensuring baseline functionality, it does reduce customer risk. It also increases the chance that payors will provide incentives to physicians who use EMRs.
Certification wont be a differentiator if either everyone or no one obtains it. Will CCHIT consider releasing specific details instead of pass-or-fail results so that physicians can make their own decisions based on the needs of their practices?
The certification scripts are public. At this point, certification is 100% pass-fail, so Im not sure what there is to release. Certification is done using an anonymous jury, so theres no record to look at for most of the certification process. The bulk of it is a juried pass-fail test. Certainly certification and the criteria will evolve over time. While it provides a baseline for the market, theres plenty of room for product differentiation that certification doesnt cover.
Its still important for physicians to pick according to their needs. If theyre looking at five certified EMRs, theyll need to look at awards, medical society recommendations, VHA, demonstrations, etc. There are plenty of other ways to differentiate product.
Not everyone will be certified. But lets assume that most major EMR vendors will get certified sooner or later. The benefit of certification is a comfort level for the purchaser, but theres still the possibility of payors providing incentives.
I think theres no question that vendors have to work to pass certification. It is a multi-year process and the criteria change year by year. The 2006 criteria cover widely available features, but most vendors will have to make some software changes to achieve certification. In 2007 and 2008, vendors will have to continue to change their software to become certified.
Certification is year-dependent, so each certification is measured separately and is good for three years. Vendors can choose whether to be recertified every year on the stricter criteria. Customers will be able to ask if vendors if theyre certified under each years standards.
Certification also involves interoperability, which is important to many customers. It also includes security and reliability, which are harder for practices to judge and may be a source of comfort.
BULL!! CCHIT certification will not decrease customer risk, but could in many cases actually increase the risk because it will provide doctors more confidence in a product that may or may not be good for that Doctor. The problem with CCHIT certification(and any certification at this point) is that no one has figured out how to cerfify usability. Unfortunately, CCHIT certification is going to look like it has certified a product as usable when in fact the certification is only going to certify a feature set. Even certifying a feature set has some set of interpretation. What does it mean to have a prescription writer in your EMR? This could mean that you can type on a form that prints out. This could also mean that you select from a drug database that checks for contradictions with other prescribed drugs and allergies. This is very different and demonstrates the problem of certifying feature set.
At least Andy Ury does point out that the certification shouldn’t be all or nothing. That is a huge CCHIT certification mistake. Also, he makes a nice point that CCHIT certification will be irelevant if either all EMR vendors certify or no one certifies. Fine Points!
I think I’ll save more comments on the interview for a future post.