I recently read an article by physician/blogger Fred N. Pelzman, MD that detailed his practice’s struggle to adjust to an EMR upgrade. In addition to one significant bug in the new version, he noted a number of smaller irritations, like a hard-to-view color palette and the re-location of several commonly-used icons. I was particularly struck by this comment:
“Unfortunately, what we see is more and more functionality, more bells and whistles, but less and less ability for us to really truly create a meaningful electronic record of our interactions with our patients.”
Sadly his words represent a new verse to an all-too-familiar song that clinicians have been singing for far too long.
This same week the Senate HELP Committee announced new details for its latest proposed fix for healthcare IT. Included in the draft plan was a government-sponsored HIT rating system for certified EHRs. The star-based system would focus on security, usability, and interoperability and ratings would be calculated based on vendor reporting and feedback from users. Developers of HIT products could be subject to fines and possible product de-certification if they failed to “fix” any EHR earning just one star.
Sounds like a great idea, right? Of course EHRs should meet minimum requirements for security, usability, and interoperability. And, without government oversight, vendors can’t be trusted to develop their products appropriately. Meanwhile, physicians are being hood-winked into investing in products that lack the essential bells and whistles they need.
If you have been in health IT any length of time, you can likely name a dozen or more vendors or products that have disappeared because they did not adequately meet the needs of the market. And arguably, there have been plenty of highly-rated products that have failed because of poor support, inadequate funding, or ineffective management. We have also seen quality products disappear following mergers and acquisitions between vendors.
The proposed government program would rely heavily on user feedback. If the system were anything like Yelp or similar online rating services, you can be assured that more of the feedback would come from disgruntled providers, since content people don’t weigh in as much. And of course, what’s to prevent vendor-promoted “ballot-stuffing” that is aimed to boost a product’s rating?
I highly doubt a government-sponsored rating system would be the panacea for all that currently ails the HIT world. In fact, such a program would add to the already bloated bureaucracy and administrative burdens surrounding HIT products, and further distract vendors from developing solutions that “create a meaningful electronic record” that enhances provider/patient interactions.
Perhaps a better alternative is to trust the market to assess what products adequately address users’ security, usability, and interoperability requirements. To supplement their assessment, users can also rely on existing organizations such as HIMSS Analytics and KLAS to evaluate functionality, as well as other important factors like the quality of implementation and support.
What we really need is less government intervention so that vendors have more time for innovation that addresses the needs of their users, rather than incorporating government-mandated functionality that is inconsequential to many providers.
If lawmakers are really set on creating a star system, I propose they develop one for politicians so voters don’t inadvertently elect lawmakers that lack an acceptable level of intelligence, honesty, and effectiveness. After all, everyone knows that without proper oversight, politicians can’t be trusted to be smart, honest, and capable of getting things done, while voters lack the ability to recognize when leaders are stupid, dishonest, or ineffective.
Please lawmakers, can we just let this proposal die?
Michelle Ronan Noteboom
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