The clock is already ticking for hospitals, especially those eligible and participating in the EHR Incentive Programs. Stage 2 Meaningful Use is already underway for these hospitals which must complete their attestation during one of four mandated reporting quarters. At the same time, they must continue their preparations for ICD-10 come Oct. 1, 2014.
The convergence of mandate and incentive certainly has repercussions for healthcare CIOs, but before they can even begin their work they need the health IT tools and services in their hands, which puts pressure squarely on the shoulders of their vendors.
“Operationally, the requirements for Stage 2 are embedded in the way we work, but ultimately we are subject to what the vendor makes available to us,” Anne Searle, the CIO of Princeton HealthCare System, told EHRIntelligence.com last month in answer to questions about her organization’s readiness for Stage 2 Meaningful Use.
It was an experience mirrored in the health system’s preparations for ICD-10. “Regardless of when we start our implementation, what makes me very nervous is that we do not have any confirmed dates from our vendors or the payers for the testing windows,” she added.
So what caused the healthcare industry to get to this point? According to a top healthcare CIO, the answer to that question has everything to do with how EHR certification is handled by federal officials. Writing on Life as a Healthcare CIO, Beth Israel Deaconess Medical Center (BIDMC) CIO John Halamka, MD, MS, calls into question the approach used by the Office of the National coordinator for Health IT (ONC):
When Meaningful Use Stage 2 regulations were being written, ONC entered a “quiet period” in which smart people wrote regulatory language and certification scripts isolated from the rest of the world to ensure there was no bias introduced. This was a “waterfall methodology” in which elaborate specifications and a long planning process was followed by an isolated development process resulting in a single huge deliverable with little opportunity to validate the result, pilot the components, or revise/improve the product after the fact. The flaws in the Stage 2 certification scripts are an artifact of the regulatory process itself.
To ease the burden on vendors and by extension their customers, Halamka advises the adoption of an agile methodology, an iterative approach that would give stakeholders the ability to test components, offer feedback, and ensure more efficient development cycles.
But above all, the healthcare CIO draws attention to the need for less prescriptive certification requirements that address larger issues rather than fixate on irrelevant details. “If certification focused entirely on interoperability, EHRs would be a bit more like USB drives. They might be big or small, black or red, key shaped or sushi shaped. However, they’ll work with any device you plug them into,” Halamka argues.
What’s more, this kind of approach should prove more satisfactory to all stakeholders. ”If certification required rigorous demonstration of outbound and inbound interoperability with no optionality in the standards (use this standard OR that standard), Congress will be happy, patients will be happy, and vendors will be happy,” the BIDMC CIO adds.
