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Heck with "Meaningful Use"- It's "Certified EHR Technology" I'm worrying about

May 18, 2009
by jlee
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I confess that I’m coming down with a serious case of Meaningful Use Fatigue.
Since the ARRA included that phrase as a condition for receiving EMR incentive payments, the industry has been parsing those two words like a French literary deconstructionist. Google will give you about 9.1 million hits on “meaningful use”.

All the angst reminds me of those people back in school who were always obsessing over what was going to be on the test. Why not just learn the material? The test will work itself out.

Likewise, it seems to me that the best advice for providers to follow today would be:

1. Get a system that works

2. Use like it’s intended to be used

The end result will be real benefits for you and your patients- AND you’ll almost certainly qualify for a good chunk of incentive money.

HOWEVER…

The section of the act that addresses incentives under the Medicare program is titled “INCENTIVES FOR ADOPTION AND MEANINGFUL USE OF CERTIFIED EHR TECHNOLOGY.” What is “Certified EHR Technology”?

For the last few years it’s meant only one thing- CCHIT blessing.

I appreciate the role that CCHIT has played. As a voluntary certification body it has satisfied a very valuable need for organizations who are selecting a system; you had at least SOME independent confirmation that the system you were banking on was functional.

CCHIT’s approach to certification standards has been to influence system development by annually raising the bar. The exact same “certified” system that you contracted for last year, and are still going to be implementing into next year, may not be certified against this year’s standard.

The process of certification that the vendors have to navigate is onerous enough that they have to make a business decision as to whether it’s worth recertifying the superseded versions of their products against the new standards. With the relatively long development and upgrade cycles that are common in healthcare IT, it’s not at all unusual for vendors to have significant numbers of customers spread across three or even four versions of their product.

Let me give you a personal illustration…

We are one of those organizations that one would think is perfectly poised to leverage our status as early adopters of EMR technology into some serious stimulus money. We bought a big, capable system from one of the leading vendors, we’ve got a mature implementation, and we’re using it pretty darn meaningfully.

Our vendor was a big supporter of the CCHIT initiative and our product was one of the first to get certified.

But if you look at CCHIT’s web site, the version of the product we’re running is NOT listed among those with current certification.

It’s not that we’ve been negligent in keeping up with upgrades. We did two point upgrades in the last few months.

The issue we’ve faced is that the vendor is in the process of a major, transformational upgrade cycle that’s been painful for them and many of their customers. They’ve focused so much effort on the new version that they haven’t bothered tweaking the previous version to keep up with CCHIT’s evolving standard, or to run the gauntlet of testing and certification for a product that they want to have everyone off of in the next 12 months. (As if.)

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I'm glad that you went with "Shakespeare character" as opposed to "Latin heart throb"...

Making a decision on how quickly to pull the trigger on a system decision is a quandry.

IF the incentives work as designed, a lot of customers will be scrambling to get a system installed. If you wait too long, I'm concerned that neither the vendors nor the customers will have the people to get the applications installed and usable- meaningfully or otherwise.

But if you rush to judgment and pick the wrong system you're pretty much out of luck too.

You make the best decision you can, pay your money and take your chances.

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