Dr. David Blumenthal, the new National Coordinator for Health Information Technology, has stressed that the goal of the ARRA/HITECH initiative is to improve patient care, not to mindlessly adopt health information technology. In this regard, he wrote that many CCHIT-certified EHRs “are neither user-friendly no designed to meet HITECH’s ambitious goal of improving quality and efficiency in the health care system.”
It is therefore disconcerting that the Association of Medical Directors of Information Technology (AMDIS) just weighed in on the issue of meaningful use with their letter to Dr. Blumenthal, recommending that the new national HIT Policy Committee use the 2008 CCHIT certification criteria to determine which hospitals and physicians get HITECH incentive dollars.
Even more disturbing is the AMDIS recommendation that meaningful adoption (their newly coined term) substitute for meaningful use until at least 2013.
We see placing the reporting of quality measures in advance of reporting measures of meaningful EHR adoption as akin to putting “the cart before the horse” — the fields that form the basis for automated quality reporting must first be populated on a regular basis . . .
What’s going on here? As I read it, AMDIS is acknowledging that CCHIT-certified EHR technology is so difficult for hospitals and physicians to use that it will take years of training before meaningful use can even be addressed. AMDIS states that process of EHR adoption and use must follow a ‘crawl-walk-jog-run’ progression requiring continuous cycles of training and practice that ‘cannot be skipped or shortened’ [italics mine] without risking failure, introducing errors, and causing the frustrated physicians to give up.
Most disquieting of all is the AMDIS recommendation to exempt hospitals (but note, not office-based physicians) from HITECH’s computerized physician order entry (CPOE) requirement until 2013 or beyond. AMDIS states that even in the hands of its most experienced members, working with EHRs that are already up and running (most inpatient EHRs are CCHIT-certified according to HIMSS) successful implementation of CPOE is a challenging, multi-year undertaking.
AMDIS therefore recommends that inpatient CPOE be deferred for an indefinite time period because “it requires more advanced planning, building, testing, training, experience, data capture, data sharing, and decision support than many practices and hospitals can successfully achieve in the next 2-3 years.” Ironically, CCHIT makes CPOE a cornerstone of its inpatient certification.
AMDIS is warning us about the risk of EHR and CPOE system failures on a national scale. These software system failures have real life consequences. To list just one example, physicians from the Children’s Hospital of Pittsburgh reporteda highly statistically significant increase in mortality after implementation of a CCHIT-certified CPOE system.
The first step in fixing a system failure is to acknowledge that there is a problem. Although AMDIS clearly is aware that a problem exists, they continue to promote the flawed CCHIT model. I doubt, however, that their solution (try harder, you can do it!) is what most physicians and patients would choose.
What happens after 2 or more years? Where is the evidence that most physicians will ever be able to ‘jog’ or ‘run’ with EHRs built on the CCHIT model? Where is the evidence that these CCHIT-certified EHRs will be any more usable after causing 2 or more years of inefficiency, error, and potential harm to patients?
As I have written in a previous post, the CCHIT certification model is fatally flawed because it mandates hundreds of required features and functions, which take precedence over good software design.
Fortunately, the situation is not nearly as bleak as it seems. EHR technology can begin to improve patient care right away if we adopt the right model. There is no reason that it should take 2 or more years for physicians to train to use EHR technology. With well-designed, user-friendly EHR software, physicians can be up and running with core functions in 2-3 weeks, not 2-3 years.
We need to remember that Congress and the Obama administration have entrusted the national HIT Policy Committee, not CCHIT, with the mandate to shape our new HITECH policies. The national HIT Policy Committee needs to keep EHR certification rules simple and focused on standards for data, interoperability, and privacy. Keeping certification rules simple will allow physicians and hospitals to select well-designed, user-friendly EHR software that can be used meaningfully from the start.
(Note: for those readers who don’t live in the world of health information technology (HIT) acronyms, AMDIS is the sister association of the Healthcare Information Management and Systems Society (HIMSS), whose members include Siemens, GE, Allscripts, McKesson, Epic, Nextgen, and other large EHR vendors. HIMSS helped found and fund CCHIT, the Certification Commission for Health Information Technology.)
Rick Weinhaus practices clinical ophthalmology outside Boston. He trained at Harvard Medical School, the Massachusetts Eye and Ear Infirmary, and the Neuroscience Unit of the Schepens Eye Research Institute.