Health Assist Tech Ehr Certification – A Fragile Balance
All this agency is that hundreds of functional points were required to last present, inward rattling specific form, for an EHR organisation to accomplish certification.
There are functional points mandating what information to capture, how it is recorded, how it is stored, how it is displayed as well as when it should display. Incorporating all these certification requirements into a software application created rattling comprehensive products amongst the might to practice many things, or equally they came to last known “bloated EHRs”. But in that location is another, in all likelihood unintended, effect when trying to enforce such incredible detail; the certification physical care for was inward effect dictating exceptional piece of work flows as well as distinct user interfaces. That was the dot where the grumblings nearly lack of EHR usability as well as complaints of EHRs non beingness built amongst physicians as well as patients inward mind, started gaining steam.
I cannot count the times when my only reply to a complaining physician was that the offending slice is required yesteryear CCHIT. Many vendors searched for places where the organisation shout for only conduct keep “the ability” to practice something as well as created customizations allowing physicians to plow off said ability. Nothing to a greater extent than so than the endless, as well as generally useless, alerts. At ane dot yous could nation at starting fourth dimension glance if an EHR was or was non CCHIT certified. All the certified ones had this foreign piffling dropdown box adjacent to each diagnosis inward the occupation list, where yous could select if the occupation was acute, chronic, resolved, bi-lateral, controlled, etc. I conduct keep never seen it used inward existent life. Does anybody recollect that unless nosotros grade it chronic, in that location is a danger that a Dr. volition assume that DM is needlelike or bi-lateral?
Well, if it’s all so counterproductive, why are nosotros certifying EHR technology? Honestly, I don't know that nosotros should. The master copy idea was that certification volition assure prospective buyers that the organisation is able as well as willing to practice the job, hence separating the wheat from the chaff. Unfortunately, certification acted inward a to a greater extent than simplistic way as well as separated the heavy from the lite, regardless of usability, value as well as stability.
The novel idea at ONC is that certification should furnish a guarantee that ane tin accomplish Meaningful Use yesteryear employing a certified system. So instead of trying to dictate every detail, the ONC certification is all nearly the specific criteria of Meaningful Use; 25 criteria for Stage 1. As a result, unopen to pocket-size uncertified vendors of rattling visible radiations EHRs are expressing involvement inward the ONC certification, if the cost is right, of course. CCHIT gracefully turned on a dime as well as created a much slimmer ARRA certification process. But is it possible that the slimming as well as trimming physical care for is going likewise far?
Is it possible to certify likewise little?
It is in all likelihood likewise before long to nation if the novel ARRA certification volition last able to nail an acceptable residue betwixt allowing vendors the liberty to acquaint as well as ensuring that Meaningful Use tin last achieved amongst a certified product. However, the proposed NIST test procedures quest a possibility of certifying likewise little.
For example, certifying that a slice of software is capable of receiving electronic lab results inward discrete format, piece allowing the vendor to select the structured format inward which lab results are received could Pb to the inability of hereafter users of the software to regard Meaningful Use requirements, if the vendor selects anything other than HL7 for their preferred structured format. Laboratories practice non post results out on a regular reason inward either CCR or CCD, which are specifically allowed yesteryear NIST, or whatsoever format other than HL7. An EHR, or EHR module, capable of receiving lab results inward a CCD format exclusively, may give-up the ghost ARRA certified, but its proud possessor volition last unable to give-up the ghost a Meaningful User.
Influenza A virus subtype H5N1 dissimilar as well as to a greater extent than troubling number arises from looking at a requirement inward a rattling narrow way as well as neglecting to trace concern human relationship for ramifications non straight related to the exceptional Meaningful Use criterion. For example, testing for the might to alter a medication listing without concern for historical integrity of the listing creates a foreign as well as unsafe province of affairs where adjustments made to the SIG (strength, dosage,etc.) of a exceptional prescription are allowed to overwrite the entire history of said prescription (think Warfarin). The narrow reach of testing that modifications are possible fails to assert the shout for for those modifications to last made inward accordance to full general principles enforcing the integrity of the medical record. Presumably this larger concern is left to vendor discretion. Existing vendors that certified their products nether the erstwhile regime volition in all likelihood furnish a reliable production anyway, but novel innovative vendors, writing software to published specifications as well as attempt out procedures could easily practice a certifiable, even so clinically unsafe product.
We are all aware that an over prescriptive certification physical care for has non produced massive improvements inward EHR offerings. The temptation to err on the side of oversimplification is large, peculiarly since the fourth dimension is brusque as well as nosotros must come upward up amongst a temporary certification physical care for sooner rather than later. However, if nosotros await at certification equally a physical care for designed to aid vendors prepare improve products as well as assist buyers inward selecting tools to accomplish Meaningful Use, so nosotros must prepare certain that, piece non overbearing, ARRA certification is indeed meaningful.
