EHR certification lacking usability factor, doctors say

Washington Federal health officials overseeing standards for electronic health records systems should revise system certification criteria to take usability concerns into account, the American Medical Association and other physician organizations said in comments on a proposed regulation.

In general, organized medicine supports a proposed federal framework for certification of EHRs. In particular, the AMA and others were pleased that the Health and Human Services Dept. Office of the National Coordinator for Health Information Technology outlined basic criteria and placed more emphasis on patient safety.

“However, we continue to harbor significant concerns over EHR usability issues and the lack of robust health information exchanges — challenges that must be addressed so that physicians are able to use EHRs to improve quality of care, delivery, enhance patient safety, as well as support practice efficiencies,” wrote AMA Executive Vice President and CEO James L. Madara, MD.

The ONC, which oversees the certification process, had proposed the new rule in February. At the same time, it drafted rules for the next phase of the EHR meaningful use incentive program. Physicians must use certified EHRs to satisfy meaningful use criteria in order to be eligible for bonuses from Medicare or Medicaid.

More than 1,700 EHR products have met previous certification standards, but the process itself provides no information to physicians on usability or which systems would best fit a particular practice. The AMA recommended that HHS hold a survey on satisfaction with these systems. Results would be disseminated and incorporated into future certification of the technology.

The AMA and other physician organizations also have serious doubts about the long-term viability of these products, leaving physicians who invested in the technology vulnerable.

“Another potential impact is the possibility that an EHR vendor or product might be bought or discontinued,” wrote Michael H. Zaroukian, MD, PhD, chair of the medical informatics committee at the American College of Physicians. “This has happened already, leading to additional costs for providers as they have to purchase another certified EHR to qualify for the EHR incentive.”

Including usability standards in the certification process would help ensure that physicians purchase products that will work best for them over the long run, the AMA said.

The ONC used the term “base EHR” to define the fundamental components that systems must have to be compatible for meaningful use. Functions include storing patient demographic information, supporting computerized physician order entry, and protecting confidentiality while storing and exchanging data.

Organized medicine commended the development of base EHR criteria. Specialists and their vendors would use the flexibility outlined in the proposed rule to tailor systems to their practices, wrote Michael X. Repka, MD, the American Academy of Ophthalmology’s government affairs medical director. “The base EHR concept will also eliminate the need for physicians to purchase technology to meet meaningful use objectives that are outside the physician’s scope of practice,” he stated.

The AMA further urged the ONC to require vendors to clarify which EHR measures their products can and cannot support. This information should appear in marketing materials and activities, the Association said.

Under proposed rules on reporting clinical quality measures, the Centers for Medicare & Medicaid Services would require that physicians use certified technology. But trying to keep up with changing program requirements can be difficult and expensive for doctors, the AMA letter said.

The AMA also is concerned that the onus would be placed on physicians to determine which combination of clinical quality measures to report and which systems to use. Doctors making a good-faith effort to meet meaningful use objectives should not be punished because of potential certification issues later on.

“If an existing EHR is determined to be noncertified, this means [an eligible physician] would be required to purchase additional certified modules, and their use would require onerous modifications to [a physician’s] workflow,” Dr. Madara said. “This burden and expense should not fall on the [eligible professionals], and we urge CMS to ensure this does not occur.”