TECH­NOL­OGY:

Pro­posed rule sug­gests test­ing long-term-care EHRS

Modern Healthcare - - MODERN HEALTHCARE - Joseph Conn

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.”

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