A world without EHR certification
The following is a guest post from Stephanie Zaremba, director of government and regulatory affairs at athenahealth.
Some hot-button issues in healthcare these days are all too familiar: insurance premiums, access to coverage, drug prices, Medicaid expansion, and not to mention the recent MACRA proposed ruling.
But, perhaps we should be paying a bit more attention to an issue truly threatening the future of healthcare in this country: a little-known technology program tucked away in a corner of the federal bureaucracy that most people have never heard of.
Healthcare reform and streamlining of government health reimbursement programs alone won’t fix our broken healthcare system. Truly improving healthcare requires that we harness technology to improve quality and lower costs. And yet, federal requirements around the use of healthcare technology increases the administrative burden that drives up costs and perpetuates physician burnout.
EHRs are required for doctors to maximize Medicare or Medicaid reimbursement, and to qualify, EHRs must be certified according to a long list of government specifications. EHR certification—the design of technology through government regulation—distorts market forces that might otherwise yield user-friendly EHRs that augment doctors’ productivity. The evolution from PalmPilot to iPhone simply isn’t happening in healthcare.
The process of becoming a certified EHR takes months of developer resources—for some vendors it can even take years. This isn’t a certification process that assures any degree of quality or safety like an FDA drug approval, where the stakes justify the resource-intense process. Certification of EHRs merely checks that a litany of features and functionality are in place, and every developer hour spent proving functionality is an hour not spent improving the product.
There’s no question, as a company, we take our certification obligations to heart. But this system is in dire need of reform. Certification of EHRs should be lightweight and focused on whether a developer follows the right processes, not a checklist of functionality. Without a government mandated EHR checklist, as an industry, we’d be able to:
Utilize resources currently devoted to certification to help clients succeed under new payment models.
The horrible irony of EHR certification is vendor resources are shifted toward checking boxes to ensure compliance at the expense of the very value-based payment models that certification is meant to enable. Clinicians end up with EHRs certified to transmit data using a variety of standards that no one uses.
EHR companies should be competing to deliver products that guarantee clinicians’ success under government payment programs. Aside from technology (the quick dashboard view of quality performance or workflows that ensure program targets are met), innovative EHRs could deliver more usability, more efficiency, and more return on investment. Under a reformed certification system, EHR developer resources would be freed up to be a true value-add to clinicians. Vendors would use their data expertise to coach on performance, or take on administrative work like required reporting to the government.
Provide an environment for new, disruptive market entrants.
The certification regime does not just preclude innovation by existing EHR companies, but it boxes out new market entrants as well. At this point, having evolved over multiple stages of federal rulemaking, the certification requirements are so complex that an entrepreneur wanting to build the best EHR for pediatrics or for accountable care organizations simply could not. The administrative burden is too high.
Under a more sensible framework, innovative powerhouses and brand-new start-ups alike would have no trouble breaking more fully into the health IT space. And that competition, that rising tide to lift all boats, would be one of the best things to happen to doctors.
Enable developers of health IT to proactively identify workflows to better fill gaps in care and manage patient health.
Ultimately, healthcare is about patients. Today, far too many patients have gaps in care, like missing wellness visits or mammograms. Physicians typically lack insight into the health of their total patient population, but we have the technological capability to solve these problems. We can identify where clinical workflows breakdown and engineer EHR workflows to fix the gaps; we can pinpoint with accuracy which patients are at risk for the next Zika or other outbreak and proactively reach them.
A new certification regime would enable EHR companies to more rapidly develop and implement advances for patient health.
In Washington DC, there is no shortage of debate around healthcare costs and the policies needed to address them. But some of the biggest cost savings and improvements to care will come if the tech sector in healthcare can simply operate like it does in every other industry—with government setting the basic guardrails and market forces driving the bulk of the innovation. EHR companies not only want to, but largely know how to continually improve their products. The government just needs to let them.