TECHNOLOGY:

Proposed rule suggests testing long-term-care EHRS

Certification could be extended to long-term-care EHRS

HHS officials are mulling whether to extend federal certification of electronic health records to longterm-care settings, as well as requiring public price lists for EHRS. The Office of the National Coordinator for Health Information Technology raises those possibilities in a 184-page regulation that outlines the government’s second take on criteria for technology to be certified under the federal incentive programs for EHRS. It also sidesteps a presidential advisory panel’s recommendation on privacy protection. The proposed rule is due to be published in the Federal Register on March 7 with a final rule expected by summer after a 60-day comment period.

The ONC poses in the rule whether it would be “prudent” for the government to get involved in testing and certifying IT systems used by healthcare organizations ineligible for EHR incentive payments under the American Recovery and Reinvestment Act of 2009.

The ONC sponsors testing and certification programs for EHRS used by hospitals, physicians and other eligible professionals that can receive ARRA payments. As yet, the ONC has no testing or certification programs for IT systems used by long-term-care, post-acute-care, mental and behavioral health organizations, all of which are ineligible to receive ARRAlinked EHR payments.

The rulemakers also asked if this sort of testing is best left to the private sector, noting that the Chicago-based Certification Commission for Health Information Technology already runs a non-onc sanctioned certification program for long-term-care IT systems.

Only a few IT vendors have availed themselves of its certification programs launched last year for EHRS developed for long-term care and behavioral health, CCHIT spokeswoman C. Sue Reber said.

CCHIT formed work groups with representatives from those sectors to develop its testing and certification standards, Reber said. “They really felt left out of the incentive programs,” but word of government interest now might actually hinder other vendors from stepping up to have their products tested, opting instead to wait on the government to jump in, she said.

Michelle Dougherty, director of research and development at the AHIMA Foundation, has convened the Long-term and Post-acute Care Health IT Summit for five years. The chances are slim that Congress will extend Arra-style incentives to either the longterm-care or behavioral health sectors, Dougherty said, but she sees benefit in federal involvement, even absent incentive payments. “One could argue that having ONC in this role provides industry awareness and puts more attention and value on the process.”

The ONC also complains in the proposed rule that some EHR developers “do not provide clear price transparency” and requests comments on whether beneficial transparency could be achieved if developers were required to provide “clear pricing of the full cost” of their systems on their websites and in their advertising materials.

“I strongly applaud anything that encourages or requires price transparency,” said Dr. Jon Bertman, founder of Amazing Charts, an EHR vendor that posts its prices on its website home page. “I just can’t even imagine it’s going to happen, frankly.”

Carl Dvorak, executive vice president of Epic Systems Corp., which sells EHRS to hospitals and ambulatory-care physicians, was a bit leery, however. “If their intention is to set prices for the industry, it’s an inappropriate role for government, but we’re at least openminded about the problem they’re trying to solve,” he said.

Regarding privacy, the rule doesn’t follow a 2010 recommendation from the President’s Council of Advisors on Science and Technology saying HHS should push for affixing metadata tags to medical records, which would improve the ability of clinicians and researchers to locate them. The tags also could carry privacy constraints, affording patients better control over the movement of more sensitive elements of their records, such as an HIV/AIDS diagnosis.

But the ONC decided not to include a metadata standard for privacy in the proposed rule and instead opted to “continue to work with the industry to further flesh out what such metadata standards could be.” That stance irked Dr. Deborah Peel, head of Patient Privacy Rights Foundation. Metadata tagging, she said, is “a path to privacy. It’s not a perfect path, but it’s better than what we have now, which is nothing.”