Anx­ious ven­dors wait for feds to get rid of bugs in EHR test­ing tools

Ven­dors wait for feds to de­bug EHR test­ing tools

Modern Healthcare - - NEWS - Joseph Conn

With the clock run­ning to­ward the start of a tougher stage of the elec­tronic health-record in­cen­tive pro­gram, the government is strug­gling to hold up its end on test­ing and cer­ti­fy­ing the next gen­er­a­tion of EHRs.

The fed­eral in­cen­tive pro­gram, cre­ated un­der the Amer­i­can Re­cov­ery and Rein­vest­ment Act of 2009, has doled out $10.7 bil­lion to more than 190,000 hos­pi­tals, physi­cians and other el­i­gi­ble pro­fes­sion­als. But the stim­u­lus law called for HHS to dial up the rigor of the pro­gram over time. The more strin­gent Stage 2 mean­ing­fu­luse cri­te­ria go into ef­fect Oct. 1, 2013, for hos­pi­tals and Jan. 1, 2014, for physi­cians and other pro­fes­sion­als. Stage 2 ap­plies to those providers that have been paid for at least two years, and pos­si­bly three, at Stage 1.

“We’re a lit­tle more than nine months away,” warned Michele “Mickey” McG­lynn, chair of the Elec­tronic Health Record As­so­ci­a­tion, an af­fil­i­ate of the Health­care In­for­ma­tion and Man­age­ment Sys­tems So­ci­ety. McG­lynn said her group’s 41 mem­bers, mak­ers of EHRs for hos­pi­tals and of­fice-based physi­cians, are be­ing stymied by the pro­gram­matic glitches. “Our cus­tomers are so­lic­it­ing our help on a daily ba­sis,” she said.

On Jan. 22, the trade group sent the Of­fice of the Na­tional Co­or­di­na­tor for Health In­for­ma­tion Tech­nol­ogy an eight-page let­ter de­tail­ing tech­ni­cal prob­lems with the ONCled EHR test­ing and cer­ti­fi­ca­tion regime. To press the ur­gency, the as­so­ci­a­tion asked ONC to re­ply in five days.

The let­ter said soft­ware de­vel­op­ers can’t get their sys­tems ap­proved for use in Stage 2. That’s be­cause the EHRs can’t be tested and cer­ti­fied against the 2014 Edi­tion Cer­ti­fi­ca­tion Cri­te­ria. Com­pli­ance with the 2014 Edi­tion cri­te­ria in­di­cates that an EHR has the right stuff to en­able providers to meet their mean­ing­ful use tar­gets un­der Stage 2. But the five ONC-ap­proved in­de­pen­dent test­ing and cer­ti­fi­ca­tion bod­ies can’t do their jobs be­cause sev­eral es­sen­tial test­ing “tools”—cus­tom-made soft­ware pro­grams government con­trac­tors devel­oped for the ONC—have not been com­pletely de­bugged.

The EHRA let­ter fo­cuses on a tool called Cy­press, for use in test­ing EHRs on the ac­cu­racy of their cal­cu­la­tions of Stage 2 clin­i­cal qual­ity mea­sures. The let­ter also touches on some buggy, faux pa­tient data used in the

test­ing process. The EHRA let­ter called Cy­press “in­suf­fi­cient,” say­ing the data, if used, “would lead to in­ac­cu­rate test re­sults.”

“All of those things are hin­der­ing our abil­ity to do what we should be do­ing, help­ing our cus­tomers un­der­stand what they have to do and de­vel­op­ing our soft­ware and get­ting it into their hands,” said McG­lynn, se­nior di­rec­tor of strat­egy and op­er­a­tions at Siemens Health­care, Health Ser­vices.

In the EHRA let­ter, signed by McG­lynn and seven other as­so­ci­a­tion lead­ers, they say the is­sues threaten the timely cer­ti­fi­ca­tion of qual­ity mea­sures for their prod­ucts. The as­so­ci­a­tion asked that ei­ther test­ing for cer­ti­fi­ca­tion go for­ward with­out Cy­press, or that the ONC and the CMS “fix the iden­ti­fied er­rors and the test data, and em­ploy a thor­ough qual­ity as­sur­ance, val­i­da­tion process to en­sure its readi­ness.”

On Jan. 23, Carol Bean, di­rec­tor of the ONC’s cer­ti­fi­ca­tion of­fice, sent a memo to the test­ing and cer­ti­fi­ca­tion bod­ies, ac­knowl­edg­ing prob­lems with a dif­fer­ent tool, the pro­gram’s Trans­port Test Tool. That tool, devel­oped for ONC with help from the Na­tional In­sti­tute of Stan­dards and Tech­nol­ogy, is de­signed to test EHRs on Stage 2 re­quire­ments for ex­change of pa­tient-care sum­maries and other se­cure mes­sages, im­por­tant first steps un­der the pro­gram in a long march to­ward EHR in­ter­op­er­abil­ity.

“They need more help with that than they’ve got­ten so far, and we’re try­ing to re­spond to that re­quest with doc­u­men­ta­tion, tech­ni­cal as­sis­tance, train­ing and we­bi­nars,” Bean said in an in­ter­view.

The government ear­lier pushed back sev­eral dead­lines for com­pli­ance with tech­no­log­i­cal stan­dards, in­clud­ing a one-year de­lay, al­ready in place, on the start of Stage 2.

Asked whether the ONC is con­sid­er­ing an­other de­lay, Bean said, “Th­ese dates are set in leg­is­la­tion and reg­u­la­tion, and we’re try­ing to do ev­ery­thing we can” to meet the cur­rent time­line.

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