EHR regulations, interoperability top patient record concerns
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With its recent release, the EHR Association became the latest member of the health IT vendor community to publish an EHR development code of conduct. The move could help the industry stave off stricter EHR regulations.
It's very positive to see the community coming together and creating those social norms. These are things that are important for the industry to grow and have our patients prosper.
Farzad Mostashari, M.D.,
national coordinator for health IT
The EHR Association (EHRA), a partner of the Healthcare Information and Management Systems Society, and which counts among its members some of the largest IT vendors in the country, including Allscripts Healthcare Solutions Inc., Cerner Corp., Epic Systems Corp. and McKesson Corp., published its nine-page Code of Conduct in June. The document sets out principles that would dictate certain practices to vendors who choose to sign on. The principles cover the areas of general business practices, patient safety, interoperability and data portability, clinical and billing documentation, privacy and security, and patient engagement.
At the time the code was announced none of the EHRA vendors had committed to following it, but Farzad Mostashari, M.D., national coordinator for health IT, said during a Web conference unveiling the code that the announcement was a sign of progress in the industry.
"It's very positive to see the community coming together and creating those social norms," Mostashari said. "These are things that are important for the industry to grow and have our patients prosper."
He said he was pleased to see the code cover the area of patient safety. He noted that EHRs have the potential to improve safety, but if designed or implemented improperly could lead to unintended consequences.
Mostashari has been an outspoken critic of the EHR vendor community. In several presentations he has talked about the need for the industry to come together and agree upon common standards that would foster interoperability. He has said if vendors do not stop competing by hoarding data and locking providers into siloed systems, his office may have to consider new EHR regulations.
Michael Barr, M.D., senior vice president of the American College of Physicians, said during the Web conference that the code is a "bold step forward toward improving care in the U.S."
He said many physicians are experiencing difficulty complying with all the meaningful use measures, as well as other pressures hitting the healthcare industry. The fact that many are trying to alleviate these pressures with multiple IT systems that may have been developed with competing objectives makes this challenge even more difficult. However, he said getting EHR vendors to abide by the code could help with some of these issues.
"I can now go back to our members and say this code addresses some of those concerns," he said.
The code would address more specific issues that have grown in prevalence in recent years. Vendors that sign on to the code would agree to enable customers to share data freely with other providers, regardless of the system used by their trading partner. Vendors would also agree to help customers export patient data in the event the customer wants to switch to another EHR system.
The code also states that participants must make information about their billing and documentation approaches available to customers. This is intended to make providers aware of coding guidelines and encourage "conformity with applicable regulatory and documentation standards." During the EHR upcoding controversy, some commentators said EHR systems make it too easy for doctors to bill for services they did not provide. This provision could help doctors understand their options and limitations.
The code released by the EHRA is not the first of its kind. Toward the end of last year, EHR vendor athenahealth Inc. published its own Code of Conduct, which it is encouraging other industry stakeholders to sign. This code includes many provisions that are similar to the EHRA code, including allowing providers to take patient records to a new vendor, supporting patient safety and encouraging interoperability.
In some cases, the athenahealth code goes further than the EHRA code. For example, the EHRA requires participants to make providers aware of coding practices to discourage fraudulent behavior, while the athenahealth code explicitly states that companies that sign will monitor customers for changes in billing patters indicative of fraud or upcoding.
Dan Haley, vice president of government and regulatory affairs for athenahealth, said athenahealth is supportive of the EHRA code and the company will sign on to it. However, he feels it is more of a declaration of principles, whereas athenahealth's code is a set of hard commitments.
"We think it's useful, but of course the EHRA is a large membership- and consensus-driven organization," Haley said in an interview. "We have the benefit of corporate structure -- we're basically a dictatorship. A membership organization governed by consensus may have started with what we did, but those statements have to endure thousands of slings and arrows and what comes out at the other end is considerably softer."
Still, Haley said the fact that the industry as a whole is moving to create these codes, with individual vendors signing on in the future, is a positive step. He said the criticism that vendors have done to further the cause of interoperability is fair. The industry is far behind most others in terms of creating networked systems, but by getting vendors to sign on to a code of conduct -- whether it's the EHRA or athenahealth -- that requires them to support data portability is a step in the right direction. It might also help the industry avoid stricter EHR regulations.
"Everybody talks about interoperability in healthcare as if it's some horribly difficult hurdle," Haley said. "The way I reference it when I'm doing our thing in Washington is, for whatever reason, health information technology lags roughly a decade behind the rest of the economy and everybody pretends that makes sense somehow."