Electronic Medical Record (EMR) applications are viewed as a savior for the future of efficient, effective health care. An EMR records a patient’s medical history electronically, enabling more accurate records, better capability to exchange data, and enhanced reporting capacity. The drive toward EMR adoption is being fostered by CCHIT – Certification Commission for Healthcare Information Technology. EMR vendors are clamoring to achieve and maintain CCHIT certification, as some physician practices are narrowing their purchasing selections to only certified applications and governments are planning incentives based on using only CCHIT certified applications.

The drumbeat toward EMR adoption is taking on a new level of intensity as the New Jersey Legislature introduced legislation to make the use of a non-CCHIT certified EMR illegal.

Are laws required to determine which EMR to use by physician practices? Two perspectives are outlined below.

View Point One

  • The Government is already sponsoring CCHT EMR adoption. Governments provide many regulations already on health care, so one more defining regulation does not really make a difference. The American Recovery and Reinvestment Act (ARRA or the Stimulus bill) contains guidelines on “meaningful use” criteria which will determine whether a healthcare provider can receive Federal financial incentives for their EMR implementation. Part of the meaningful use definition will be using a CCHIT certified EMR or EHR – Electronic Health Record.
  • It’s about the patient experience. If the patient information required is different from doctor to doctor, then there will be gaps in medical information at each stop in the care receiving process. There will be inconsistency in patient data and a lack of complete information in order to ensure high quality, accurate care. Requiring CCHIT certified EMRs will facilitate consistency of functionality and data requirements. Similarly, making it illegal to use an EMR or EHR not certified will improve the patient experience and enhance the level of care offered.
  • Sometimes a stick is better than a carrot. Incentives may work, but sometimes a stick delivers the intended action more quickly. The New Jersey legislation spells it out in black and white, no gray areas. You either use a “legal” EMR or your will be fined. We do not provide financial incentives to auto drivers if they maintain certain speed limits; we define the legal requirements and then set stiff penalties if the legal requirements are not upheld. This approach is much more straightforward. Besides, with the recent regulatory failure in other industries, being strong in the intended approach is better than being soft.
  • CCHIT certified EMRs increase the opportunity for success. If an EMR meets certain defined specifications, then the chance for success during the implementation and use should increase. To stay with the driving analogy, cars that meet certain safety requirements provide higher standards for individuals in their protection during accidents. EMRs that meet defined specifications should ensure a base level of success in their use and experiences. By using certified EMRs, the Federal investment should have a greater opportunity to achieve the desired objectives of streamlining healthcare and delivering more efficient, quality patient care.

View Point Two

  • Focusing on EMR adoption is misplaced by the Federal government. EMR applications can deliver great value in collecting patient data, enhancing safety, and gaining efficiencies. However, regulating EMR applications and what each should contain is the wrong focus. The government should stay out of the EMR business and let the various vendors compete based on features, ease of use, and other market drivers. If the government needs to get involved in technology, it should facilitate a drive to ensure more common data standards in the exchange of patient information. Getting an EMR implemented may only create an island of information. Getting intrastate and interstate secure flow of patient data may be more challenging and costly than the implementation of an EMR. Government can serve a facilitating role in healthcare IT, but it should not be selecting which EMR vendor has the right application.
  • Why introduce legislation that cannot be enforced? To show how ridiculous legislating which EMR can be used, if the legislative bill passes, how will it be enforced? Will a new police force be started to investigate clinics? Will a hot line be setup to get tips from patients who may have seen an un-certified EMR in use? What are the costs in enforcing this bill if it passes? If legislation cannot be enforced, it should not be introduced. Common sense should prevail at some point.
  • There is no evidence to support CCHIT-certified EMRs produce better results. The market is better at picking winners and losers. Successful software vendors will survive by offering great applications that address real requirements. Successful vendors will follow a disciplined approach: listen carefully to customer requirements; understand the market trends and needs; deliver products that match customer and market requirements; and support the products with exceptional support. If an application does not meet the needs of the market, then the vendor will not survive. Physician practices and healthcare providers need to live up to their responsibility, too, by conducting responsible due diligence in the software selection process. Getting results from an EMR selection and implementation ultimately rely on the organization making the decision, undertaking the implementation, and using the application.
  • It is about workflow and service. EMRs can deliver value to patients and to the health care community. However, it is not the end-all in achieving the intended results. Implementing technology on top of undefined, unconnected processes will not improve care delivery. Time needs to be spent defining key processes, especially those around service to the patients. With defined processes and the right service delivery model, an EMR will enhance the care provider’s operations. With this as the approach, having a CCHIT-certified application will not matter much because the underlying, supporting infrastructure and care model is well-defined. Ultimately, patients will make selections for care based on who delivers the best care (and, service) and who delivers a confident image in their capabilities.

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