Electronic health record certification: Next steps

So far the electronic health record (EHR) seems to be so much “sound and fury” for long-term care, signifying you know what. But there are organizations and facilities taking bold steps forward with it (e.g., see “An LTC Technology Summit Looks Ahead,” Long-Term Living August, p. 18), and an important process toward certifying EHR products, and thereby helping validate them for LTC providers, is just getting started. Recently Sue Reber, communications director of the private, nonprofit, federally contracted Certification Commission for Healthcare Information Technology (CCHIT) offered an unofficial progress report in an interview with Long-Term Living Editor-in-Chief Richard L. Peck.

Peck: First of all, would you describe what the concept of certification is in this field and what it implies for long-term care?

Reber: The idea of certifying EHR software products for healthcare goes back about four years. Physicians were saying they were skeptical about purchasing these because they didn’t have the information or the expertise to judge them. It was thought that, if we could create a certification program that used objective testing and that everyone trusted, physicians would feel more confident about adopting EHRs. So far we have developed testing processes for office-based primary care providers, cardiovascular specialists, child healthcare providers, inpatient computerized physician order entry and electronic medication management, and emergency departments. However, many provider groups have come forward asking for an EHR certification process as well. One result of this was that we put long-term care on the “road map” just this past July.

Peck: And what is the process going to be for long-term care?

Reber: We’re starting with basic information gathering: reviewing market research, vendors in the field, specific products available, and so forth. In the spring, the plan is to put out an open call to join CCHIT’s Long-Term Care Work Group, which will consist of 15 to 18 providers, vendors, payer representatives, government officials, quality improvement people, and the like—a mixed group. They will create the criteria and write the “test scripts” for the products in this field.

Peck: What areas of product quality will certification review?

Reber: In general, certification focuses on three areas: functionality—how the product creates and manages electronic records; interoperability—how the product shares information with other products and levels of care in the continuum; and security and privacy—how patient information is safeguarded.

Peck: What is the timetable for this?

Reber: As I said, we’re very early in this process. We should start developing criteria next summer and we’re aiming to open the program by July 2010.

Peck: You mentioned physicians’ skepticism before, and that abounds too in long-term care, where many think of the EHR as something that will be imposed upon them someday by government and for which they don’t have adequate resources. What would your message be to them regarding the business case for this?

Reber: Well, this goes a little beyond our realm at CCHIT, but commenting on my own behalf I’d say there has been a great deal of discussion nationally about ways to incentivize providers to adopt the EHR, and I have to say it’s a tough question. At first look, the benefits go the payers, not the providers, in terms of significant cost savings in healthcare efficiency. But looking at it further, we do see benefits for providers not just in administrative savings, but in possibly improving reimbursement. Payers, including government, are leaning more and more these days to pay-for-performance, and when diabetes care and cardiovascular care scores start to improve because of improved communication, providers will see this payoff in terms of better reimbursement. Just to extract the necessary data to document this is so much more practical and efficient using electronic means rather than a staffer going through paper charts. So there is that. For long-term care, the benefit has to lie in improved communication with hospitals, especially in the discharge process. I was once a discharge planning nurse and I know that, with all the back-and-forthing patients do, better communication can only improve patient safety and quality of care.

Peck: Any final observations?

Reber: I would also note that, although the certification process for long-term care is just getting started and has a way to go, the work CCHIT is doing in ambulatory and hospital care will spill over into the products developed for long-term care. Functionality will be different, of course, but interoperability and security will work the same at both ends of the continuum. So long-term care can look for progress in those areas relatively soon.

For further information and updates on the certification process, visit www.cchit.org.

Richard Peck

Richard L. Peck was editor in chief of I Advance Senior Care / Long-Term Living for 18 years. For eight years previous to that, he served as editor of the clinical magazine Geriatrics. He has written extensively on developments in the field of senior care and housing.