An intended rating methodology to assess the abilities of EHR systems is getting mixed opinions from stakeholders.
If the Senate health committee has its path, the federal government soon will develop a star-rating system for EHRs deployed on 3 critical criteria—security, usability and interoperability.
Although, the policy is not getting great marks from industry groups like the EHR Association and Healthcare Information and Management Systems Society. In fact, many in the industry claims the private sector is better complimented to make those types of assessments.
Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative, is blunt about it—it deserves 2 enthusiastic thumbs down.
The intended legislative policy for a HIT rating network is a “terrible and misguided” concept, Tripathi states.
“The market is already doing this, and it is a much great place to do it,” he claims. “Every comment I have observed from industry is that it is a bad concept. The government is merely not equipped to do it with the type of complication and nuance that is going to be needed. For me, the problem is they will not do it well enough, and it has the potential to have insidious impacts on innovation.”
On the day of February 9, the Senate committee unanimously passed the Improving Health Information Technology Act (S. 2511), which involves provisions for a government-sponsored HIT rating network.
Those who established the legislation claims the intent is to assist contributors make more informed purchasing decisions in choosing EHR products and vendors. Under the proposal, the Office of the National Coordinator for Health IT will serve as the designated agency for publishing the criteria and methodology that will be utilized to determine the rating network.
The rating system, to be handled by a “development council” that will be composed of representatives from accredited certifying bodies, testing laboratories and ONC, would provide systems a 1-, 2-, or 3-star rating.
Additionally, the legislation provides the Secretary of Health and Human Services the authority to decertify vendors’ HIT products if they acquire a 1-star rating and do not make better their score; these vendors will have an opportunity to establish a corrective action policy, but will require acting on it and making better their rating.
Under the measure, EHR vendors are needed to report on the performance of their products every 2 years. Those that fail to report their performance would be termed to fines and potential decertification. The fines accumulated would be utilized to create a “revolving user compensation fund” to assist the offset costs of purchasing latest certified HIT for consumers whose products were decertified.
“I cannot conisder a government agency making yelp ratings for EHRs."
“Overall, we seek the proposed rating system to be duplicative—EHR assessment information is already presently available from private firms, as well as through the Office of the National Coordinator for the certification program of Health IT,” claims Leigh Burchell, chair of EHRA and vice president of government affairs for Allscripts. “We recommend instead that it would be more effective to utilize programs and resources already in place—like ACB surveillance, the Open CHPL and funding relevant research through AHRQ—to make certain that the market has the data required to make smart buying decisions.”
John Halamka, MD, CIO of Boston’s Beth Israel Deaconess Medical Center claims that the EHR rating system is the mere provision of the Senate’s Improving Health IT Act to which he objects. “I can’t consider a government agency making Yelp ratings for EHRs. The Health IT Standards Committee particularly pointed out that this is not a suitable role for government,” contends Halamka, who serves as vice chair of the HIT Standards Committee.
In accordance to Eric Helsher, vice president of client success for Epic, the EHR vendor gave feedback to the Senate committee that a government-led rating network would be “duplicative, more expensive and less effective” than what private firms such as KLAS and HIMSS Analytics presently provide.
“We recommended they look to making that kind of private data more available to the contributor community and also make CMS’s existing information on Meaningful Use and EHR certification more intuitive,” Helsher offers. “The latter is publicly present now but not easily utilized.”
Similarly, HIMSS discusses that such a rating system is not essential because private sector groups are already evaluating EHRs. “Instead of establishing a new rating system, consideration should be provided to leveraging these private sector attempts,” the group told the committee in a letter it submitted previous month.
The HIMSS letter also stated that a rating system deployed on user feedback would “introduce excess subjectivity, if not suitably weighted in the star rating methodology.” As the group points out, EHR consumers “don’t always have thorough understanding of what is executed by the product as opposed to the atmosphere in which the product is being utilized.” The rating system “should be highly deployed on objective measures with few grounding in existing certification criteria,” HIMSS emphasizes.
Nevertheless, the Senate is moving forward with a government-sponsored HIT rating network—the brainchild of Sens. Bill Cassidy, MD (R-La.) and Sheldon Whitehouse (D-R.I.), who in the month of October 2015 launched the idea in the Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act, which has now been incorporated into the Improving Health Information Technology Act bill.
Calling it “an unbiased rating system” for HIT products, Cassidy stated that the TRUST IT Act provisions would “help strengthen accountability and improve transparency” in EHR networks. “This bill aids to make interoperability by preventing data blocking, and making a business incentive through the rating program to make sure that all networks work together to seamlessly share data for patient care,” claims Cassidy in a statement he released after the unanimous approval of the act by the committee.
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