The HIS Talk Practice Blog has recently completed an interesting series, asking six specific questions to leading EHR vendor executives regarding the Federal government’s recent announcement on the latest proposed meaningful use definitions and EHR certification criteria. Ten major EHR companies provided responses, including:

  •  Allscripts – Glen Tullman, CEO
  • eClinicalWorks – Girish Kumar Navani, CEO and co-founder
  • Eclipsys – Philip M. Pead, President and CEO
  • e-MDs – Michael Stearns, President and CEO
  • GE Healthcare – Vishal Wanchoo, President and CEO, GE Healthcare IT
  • InteGreat, a MED3OOO Company – Tom Skelton, President
  • McKesson – Dave Henriksen, SVP and GM, Physician Practice Solutions
  • NextGen Healthcare – Scott Decker, President
  • Sage – Lindy Benton, Chief Operating Officer
  • SRSsoft – Evan Steele, CEO

Each of these executive’s responses to the six questions were interesting and varied. Some answered questions with great detail, some with ‘fluff,’ and others avoided answering the question altogether. Some provided what seemed to be honest personal opinion, and others took the opportunity to plug their company’s EHR product. I focused in on five questions- parts one, two, four, five, and six- of the series. Each of the questions and my impression of the responses are summarized below.

Question #1: Were any of the proposed meaningful use criteria a surprise and what effort will be required for your product to meet them?

All in all, most executives answered that there were no major surprises in the proposed meaningful use criteria. These criteria closely mimicked the earlier drafts of meaningful use from the ONC Policy Committee. However, concerns were expressed by Eclipsys that quality measure reporting is still ambiguous. McKesson is also looking for a clearer understanding of the reporting metrics for meeting Stage 1, 2 and 3 meaningful use standards. Even though there are still meaningful use criteria that are not completely defined, eClinicalWorks went on to say: “…our customers have already demonstrated meaningful use.” e-MDs is looking for more specific information on security and privacy issues in the final meaningful use criteria, while GE Healthcare hasn’t quite made up its mind; it’s …”still carefully reviewing criteria.” Sage made a funny comment, stating that the only surprising aspect of the meaningful use criteria was the 500+ pages! Sage is gearing up for CCHIT certification once the meaningful use standards are finalized, along with NextGen Healthcare. SRSsoft takes the brutally honest route, stating that these reporting standards are extreme and unattainable. It is perhaps one of the only EHR companies not tailoring its product to meet meaningful use and government incentive program requirements. SRSsoft reminds us that the Federal incentive program is voluntary, and providers should analyze their practice’s needs prior to participation.

Question #2- Which of the criteria do you expect to be the most difficult for physicians to achieve?

Most of the represented companies voiced concerns over the ability of physicians to enter 80% of their orders in an EHR, since that level of automation requires a significant change in their normal workflow. eClinicalWorks sees the need to standardize measures by specialty in a timely manner, as does Eclipsys, which added concerns about HIT design for interoperability. McKesson adds that reporting requirements will be especially burdensome to physicians working in rural settings and smaller practices. e-MDs is concerned with the five CDS rules and tracking compliance, while GE adds e-prescribing standards as a top concern. Sage believes “CMS and ONC got this one right by setting the bar high for ‘meaningful’ but making it incremental and leaving some fluidity in the first year;” however, SRSsoft maintains its skepticism noting that meeting, tracking, and reporting requirements for meaningful use will decrease physician productivity, especially high-performance specialists.

Question #4- Was there enough emphasis on clinical decision support and interoperability?            

The answers to this question were varied. Allscripts and eClinicalWorks would have preferred a more aggressive approach with higher standards for each of Stage 1, 2, and 3. On GE Healthcare’s “initial review” it felt the standards for interoperability and security were scaled back. In contrast, McKesson saw an increase in decision support requirements between HIT policy committee’s recommendations and proposed meaningful use criteria. Most companies are in agreement that the CDS requirements will need more defining, so criteria can become measureable. Sage and SRSsoft bring up an important point that work must be done to prevent CDS from becoming a workflow distraction. SRS, often the voice of the physician in this series, thinks it will be difficult for physicians to document, track, and report CDS and interoperability standards. Furthermore, SRSsoft makes the point that interoperability is not within control of physicians, and feels HIT is behind in its ability to meet the government’s reporting standards.

Question #5-  Practices are required to provide patients with electronic copies of their visit information. How will providers do that and how will patients use that information?

This question was basically an opportunity for companies to plug their EHR products and patient portal functionality. Allscripts suggested requiring that EHRs include access to PHRs, such as Microsoft HealthValut or Google Health. Could this be major security issue? Eclipsys mentions patient portals, but says the easiest way to meet requirement in Stage 1 would be to upload a simple encrypted file copy of the patient’s health information to a CD-ROM or USB-Memory device. Again, isn’t this a security issue? InteGreat offers different suggestions, such as a patient print out according to the HL7 CCD standards. NextGen Healthcare offers similar solutions, but is the first company to mention security and privacy issues associated with dispersing patients’ personal health information. And finally, SRSsoft sees things a little differently, indicating that electronic copies of patients’ health information is not a measure to save healthcare costs or provide improved care. SRSsoft also sees this as a privacy/security/access issue.

Question #6-  Which criteria do you expect to be changed after the comment period?

As much as EHR companies may want the proposed ‘meaningful use’ criteria to change, most are not optimistic that public comments will ultimately change final criteria drastically. Allscripts states that it is ‘recommending’ a broad list of changes. Eclipsys expects reduction in Stage 1 quality reporting requirements, and e-MDs expects additional clarification for the certification process. Overall, most companies are expecting more clarity, and precise definitions and guidelines on meaningful use and certification criteria in the final standards. NextGen Healthcare states that if the government isn’t listening to public comments, “it will.” And, while Sage doesn’t see major changes happening after public comment, it fully supports the NPRM and IFR for meaningful use and EHR certification criteria. Not surprisingly, SRSsoft is not seeking certification for its EHR product and believes the criteria are doomed for failure.  

Go to HIS Talk Practice Blog to review the entire series of EHR executive comments on the proposed meaningful use and EHR certification standards.  You’ll be glad you did!