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Usability, Interoperability are Political Questions: We Need an EHR Users Group

Posted on October 6, 2017 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

Over the years, writers on blogs such as this and EMRandHIPAA have vented their frustration with lousy EHR usability and interoperability problems. Usability has shown no real progress unless you count all the studies showing that its shortcomings cost both time and money, drives users nuts, and endangers patient lives.

The last administration’s usability approach confused motion with progress with a slew of roadmaps, meetings and committees. It’s policies kowtowed to vendors. The current regime has gone them one better with a sort of faith based approach. They believe they can improve usability as long it doesn’t involve screens or workflow. Interoperability has seen progress, mostly bottom up, but there is still no national solution. Patient matching requires equal parts data, technique and clairvoyance.

I think the solution to these chronic problems isn’t technical, but political. That is, vendors and ONC need to have their feet put to the fire. Otherwise, in another year or five or ten we’ll be going over the same ground again and again with the same results. That is, interop will move ever so slowly and usability will fade even more from sight – if that’s possible.

So, who could bring about this change? The one group that has no organized voice: users. Administrators, hospitals, practioners, nurses and vendors have their lobbyists and associations. Not to mention telemed, app and device makers. EHR users, however, cut across each of these groups without being particularly influential in any. Some groups raise these issues; however, it’s in their context, not for users in general. This means no one speaks for common, day in day out, EHR users. They’re never at the table. They have no voice. That’s not to say there aren’t any EHR user groups. There are scads, but vendors run almost all of them.

What’s needed is a national association that represents EHR users’ interests. Until they organize and earn a place along vendors, etc., these issues won’t move. Creating a group won’t be easy. Users are widely dispersed and play many different roles. Then there is money. Users can’t afford to pony up the way vendors can. An EHR user group or association could take many forms and I don’t pretend to know which will work best. All I can do is say this:

EHR Users Unite! You Have Nothing to Lose, But Your Frustrations!

Health System Sues Cerner Over Billing-Related Losses

Posted on October 5, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

If I asked you what issues cause the biggest conflicts between EMR vendors and their clients, you might guess that clinical data management disputes or customer service issues topped the list. But actually, in my experience the most common problems health systems encounter in their EMR rollouts are billing-related.

For example, Dana-Farber Cancer Institute just announced a $44.2 million operating loss for the third quarter of fiscal 2017. The Boston-based hospital attributes at least part of its losses to billing issues associated with its Epic system. Leaders at Dana-Farber said that these billing issues had cost the hospital roughly $25 million since it rolled out Epic in May 2015, according to Becker’s Hospital CFO Report.

Another instance comes from Healthcare IT News, which reports that Cerner is being sued by a health system accusing the vendor of selling it faulty billing software.

The suit, by Wisconsin-based Agnesian Healthcare, accuses Cerner of fraud and breach of warranty, and asserts that issues with Cerner’s revenue cycle software led to losses of more than $16 million. The hospital system contends that these problems have damaged its reputation and generated $200,000 a month in damages. (Cerner disputes these allegations, of course.)

According to HIN, the hospital system went live with Cerner’s RCM software in 2015, for which it paid $300,000. Agnesian’s suit says that problems with the Cerner package began shortly after rollout, generating widespread errors in its patient billing statements.

According to the health system, its billing process was so compromised that it had to send out statements by hand. (Yes, I can feel you cringing from here.) Given the delays inherent in relying on manual processes, Agnesian ended up with a huge backlog of unprocessed statements, some of which it deemed uncollectible and wrote off.

When the health system alerted Cerner about its concerns, the vendor got involved, and in 2016 it told Agnesian that problems have been addressed.  Nonetheless, this year the health system found “major additional coding errors” which led to another round of lost revenue, Agnesian says.

And brace yourself for more cringing: according to the suit, the Cerner RCM software had been writing off reimbursable charges without informing the health system. If you’re an RCM leader or CFO, this is the stuff of nightmares.

Ultimately, Cerner agreed that the RCM solution needed to be rebuilt given the depth of the coding errors found in the software, but that didn’t happen, the suit says. In a final indignity, the personnel tasked with rebuilding the RCM solution left Cerner before completing the rebuild.

Given all the aforementioned mishegas, it will be many a month before billing processes normalize even if Cerner fixes its RCM software, the health system says. And of course, it’s likely to end up writing off more bills under the circumstances, which has got to be very painful by this point.

Agnesian’s suit asks the court to cancel the Cerner contract and award it direct, indirect and punitive damages. Cerner, meanwhile, seems to want to go into arbitration. We’ll see which side blinks first.

#SHSMD17 in 17 Tweets – Perspectives on Healthcare Marketing

Posted on October 4, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

The AHA’s Society for Healthcare Strategists and Marketing Development recently held its annual conference – SHSMD17 – in Orlando Florida. For three full days, 1,500 attendees shared ideas and traded insights on the latest trends healthcare marketing trends. The 60+ concurrent sessions covered a variety of topics including:

  • Developing online support groups for patients
  • Successful blog-driven content marketing
  • Media relationships
  • Communication and preparedness during a crisis
  • Chatbots
  • Consumerism

For daily summaries of SHSMD17, check out these Day 1, Day 2 and Day 3 blogs. As well see this blog on the release of SHSMD’s Bridging Worlds 2.0 report during the conference.

If I had to pick an overall theme for SHSMD17 it would have to be “perspective”. The four keynote speakers and many of the session presenters urged the audience to break out of our boxes in order to truly “see” healthcare from multiple viewpoints – including patients, clinicians and government. Only by putting ourselves into the shoes of healthcare’s various stakeholders can we create effective marketing campaigns and hospital programs.

During the conference, there was a lot of live-tweeting and there were many conversations happening via social media with people who were not in attendance. I thought it would be fun to highlight 17 tweets from SHSMD17.

Here goes.

Fun SHSMD17 Tweets

 

CareCloud + First Data Partnership a Hopeful Sign of Things to Come

Posted on October 3, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Earlier today, CareCloud and First Data (NYSE: FDC) announced they have partnered to create Breeze, a new patient experience management platform. Built on First Data’s Clover infrastructure, Breeze’s mobile, web and kiosk based applications provide consumer-style convenience to patients while helping practices streamline workflows. Through Breeze, CareCloud customers will be able to offer patients the ability to book appointments, fill out medical forms, check-in remotely and manage payments from their phones.

“We looked outside of healthcare for inspiration on what patients want” says Juan Molina, VP of Strategy and Business Development at CareCloud. “What we found was that consumer interactions have changed from in-person transactions to online experiences. We wanted to give patients the same experience in healthcare that they are used to from the rest of the world through apps like Uber, OpenTable and Amazon.”

At a Breeze-enabled CareCloud practice, the “happy path” patient interaction would be as follows:

  • Patient is invited to Breeze by their doctor’s office through a text with a specific link
  • Patient downloads the Breeze app to their phone through that link
  • Patient books an appointment through the app
  • Prior to the appointment date, patient is reminded by the app to fill in paperwork which could include: demographic information, consent forms and insurance data (photo of insurance cards can be uploaded)
  • On the day of the appointment, patient can check in remotely
  • After the appointment, patient can manage payments through the app (credit card on file, Apple Pay, Android Pay or other options made available by the practice)

By automating parts of the appointment booking, patient intake and payment workflows, Breeze reduces the workload on front-line staff.

“From the moment that the patient walks in, they are happier, and my staff no longer has to spend time dealing with packets of registration papers. Our front office can now focus on patient care and delivering the excellent level of service that they deserve,” says Barbara Arbide, a practice manager who is using Breeze in her allergy practice in Coral Gables, FL.

The CareCloud and First Data partnership is encouraging. For many years now, EHR vendors have tried to build their own walled gardens where customers and partner companies could play nicely together. Unfortunately, a lack of useful application interfaces (APIs) and a high cost of entry for potential partners, resulted in a barren courtyard with high walls (aka a prison) for customers rather than a thriving garden.

By partnering with First Data, CareCloud is showing that it is a company willing to break from traditional EHR vendor thinking. They have opted to play in someone else’s ecosystem in order to bring more functionality to their customers at a faster pace.

First Data’s Clover platform already has hundreds of useful business apps built for it including employee scheduling tools, customer loyalty apps, inventory management systems and survey programs. By basing Breeze on Clover, CareCloud’s customers have access to this rich library of apps.

“After just two days of using Breeze,” Molina told EMRandEHR.com, “A practice in southern Georgia went and downloaded a time-and-attendance app for their system from the Clover library. This replaced a cumbersome Excel spreadsheet that they had been using. This helped the practice become more efficient and sophisticated.”

Could CareCloud have developed a time-and-attendance app on their own? I’m sure they could have. Would it have been a wise investment of their time? Probably not. Would it have been delivered in two days? Absolutely not. Although in theory CareCloud is forgoing potential revenue, their partnership with First Data allows them to focus on what truly matters – improving the clinical and practice operations side of their own platform.

What’s next for Breeze? According to Molina: “Patient expectations are only going to climb higher and higher as more and more consumer apps bring more sophistication into their lives. We have to pay attention to what’s happening outside of healthcare – how people are booking tickets online, speaking to Alexa, tracking their fitness with wearables and getting food from uberEats. Patients don’t want to be transported back to the 1980s when they come to a physician office where you have to fill out forms on a clipboard. With Breeze we have a flexible platform that can continue to grow and expand. We will be able to build new patient-centric applications faster, that help our clients with more and more of their workflows.”

Hopefully this new partnership is a sign of things to come.

MACRA Preparation, Are You Ready? – MACRA Monday

Posted on October 2, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program (QPP) and related topics.

I’ll admit that the timing of this week’s MACRA Monday is a bit rough for me given the tragedy that’s occurred in my town, Las Vegas. Instead of dwelling on the tragedy and the person who could do such an awful thing, it’s been amazing even in these early hours to see how many people in Las Vegas and around the world want to and are supporting the victims of this tragedy.

We heard that there was a need for blood and thought we could help. Turns out that hundreds of others had the same idea and the blood banks have their schedules full through Wednesday. We’ll go after that to replenish the blood banks that no doubt will take a while to replenish their supply.

Thanks to everyone on Facebook, Twitter, and other social media that have reached out to myself and the rest of us that live in Las Vegas. We’re in a bit of shock and it doesn’t feel real.

To keep with our tradition of MACRA Monday, I thought I could at least share this infographic from Integra Connect on how prepared specialty practices are for MACRA:

No doubt there are a lot of healthcare organizations that aren’t ready for MACRA and they are confused on how they should be ready. Hopefully, those who have read our weekly MACRA Monday posts feel better prepared than most. MACRA is upon us whether you’re ready or not. However, MACRA certainly seems much less important on this day of mourning in Las Vegas.

On this tragic day, it’s worth noting all the incredible stories I’ve heard about Las Vegas healthcare professionals that were prepared and ready for a tragedy like this. I read stories of UMC, a major Las Vegas hospital that was so full of victims that they asked to stop bringing people to UMC that didn’t have life-threatening injuries. I read of EMS people who were at home and went into the danger to help transport victims. No doubt there will be hundreds of other stories of heroism by healthcare professionals. Many that likely won’t be heard or seen, but saved people’s lives. We thank them for their preparation, care, and work that no doubt has saved hundreds of people’s lives.

A big thank you from Vegas to each of you for all of your support.

Physician Burnout Cartoon – Fun Friday

Posted on September 29, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

If you haven’t noticed, I love irony. That’s why this cartoon from Pediatrician and Cartoonist Dr. Maypole was perfect for a Fun Friday entry.

The sad part of this Fun Friday is that this is far too true for far too many doctors. The one good thing is that people are now recognizing it and working to address it in their workforce as Dr. Maypole suggests we do.

A Look At Share Everywhere, Epic’s Patient Data Sharing Tool

Posted on September 28, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Lately, it looks like Epic has begun to try and demonstrate that it’s not selling a walled garden. Honestly, I doubt it will manage to convince me, but I’m trying to keep an open mind on the matter. I do have to admit that it’s made some steps forward.

One example of this trend is the launch of App Orchard, a program allowing medical practices and hospitals to build customized apps on its platform. App Orchard also supports independent mobile app developers that target providers and patients.

Marking a break from Epic’s past practices, the new program lets developers use a FHIR-based API to access and Epic development sandbox. (Previously, Epic wouldn’t give mobile app developers permission to connect to its EMR unless a customer requested permission on its behalf.) We’ll have to keep an eye on the contracts they require developers to sign to see if they’re really opening up Epic or not.

But enough about App Orchard. The latest news from Epic is its launch of Share Everywhere, a new tool which will give patients the ability to grant access to their health data to any provider with Internet access. The provider in question doesn’t even have to have an EHR in place. Share Everywhere will be distributed to Epic customers at no cost in the November update of its MyChart portal.

Share Everywhere builds on its Care Everywhere tool, which gives providers the ability to share data with other healthcare organizations. Epic, which launched Care Everywhere ten years ago, says 100% of its health system customers can exchange health data using the C-CDA format.

To use Share Everywhere, patients must log into MyChart and generate a one-time access code. Patients then give the code to any provider with whom they wish to share information, according to a report in Medscape. Once they receive the code, the clinician visits the Share Everywhere website, then uses the code once they verify it against the patient’s date of birth.

As usual, the biggest flaw in all this is that Epic’s still at the center of everything. While patients whose providers use Epic gain options, patients whose health information resides in a non-Epic system gain nothing.

Also, while it’s good that Epic is empowering patients, Direct record sharing seems to offer more. After all, patients using Direct don’t have to use a portal, need not have any particular vendor in the mix, and can attach a wide range of file formats to Direct messages, including PDFs, Word documents and C-CDA files. (This may be why CHIME has partnered with DirectTrust to launch its broad-based HIE.)

Participating does require a modest amount of work — patients have to get a Direct Address from one of its partners — and their provider has to be connected to the DirectTrust network. But given the size of its network, Direct record sharing compares favorably with Share Everywhere, without involving a specific vendor.

Despite my skepticism, I did find Share Everywhere’s patient consent mechanism interesting. Without a doubt, seeing to it that patients have consented to a specific use or transmission of their health data is a valuable service. Someday, blockchain may make this approach obsolete, but for now, it’s something.

Nonetheless, overall I see Share Everywhere as evolutionary, not revolutionary. If this is the best Epic can do when it comes to patient data exchange, I’m not too impressed.

The Value of Collaborating with Customers in EMR Optimization

Posted on September 27, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of the biggest challenges I see in healthcare IT is that the knowledge on how to get value out of EHR and other health IT is not evenly distributed. One healthcare organization that figures out how to optimize their EHR system for maximum benefit doesn’t have the opportunity to share that knowledge with other organizations across the country. Plus, even an organization that has optimized their EHR solution in one specific area is still missing optimization benefits in other areas.

Sharing optimization best practices is a massive problem that needs to be solved if we’re going to finally optimize EHR and other health IT systems to benefit both healthcare organizations and patients.

While some healthcare organizations are competitive and don’t want to share best practices, I’ve found that most hospitals and health systems are happy to share their EHR and health IT practices with their peers across the country. Healthcare is so regional and most people doing the optimization work want to benefit patients regardless of other competitive pressures.

Why then don’t healthcare organizations share if in fact most of them want to share their insights and experiences? The challenge is that most professionals don’t see any easy way for them to collaborate and share with their colleagues.

I recently saw where Galen Healthcare Solutions took this problem head-on as they gathered together a focused group of MEDITECH users in a project they called Claire[IT]. Check out this webinar on Claire[IT] to learn more about how Galen Healthcare Solutions involved their users to create enginu[IT]y.

Out of this user focus group they produced a package of MEDITECH rules and best practices which could be implemented by any MEDITECH user. What makes this package special is that it wasn’t just one person’s best thinking but Galen brought together a wide variety of end users to each contribute their best practices and insights into the MEDITECH rules they created. I love that one participant in the user focus group said “I am the only one in my organization that loves MEDITECH rules. It was great to finally be part of a group of other people as passionate as me about rules.”

This is the type of collaboration we need to see happening in healthcare IT and EHR for us to receive all the benefits technology can provide. Plus, now a company like Galen Healthcare Solutions can package up this knowledge and EMR optimization best practices and share it with all of the other MEDITECH users out there. This MEDITECH EHR rules knowledge doesn’t have to be confined to one organization.

The problem is that this type of focus group is really targeted and includes a lot of minutiae that only those that are deep in these systems will appreciate. These aren’t conversations that casually happen at an event like HIMSS. However, when you put the right EHR users together it’s like magic and the sharing and collaboration happens naturally. I love that Galen Healthcare Solutions called their webinar “Operation #NerdyWork.” Talking over MEDITECH rules really is #NerdyWork, but it’s also essential work if you want to truly get the most out of your MEDITECH EHR. The same is true for all the other EHR vendors. There’s a lot of #NerdyWork required to optimize them.

Props to Galen Healthcare Solutions for showing us one way EMR end users can collaborate together to share best practices and provide everyone with a better solution than if they’d done the EMR optimization alone. Now we just need to scale up this collaboration and sharing so that every EMR in every healthcare organization is working in the most optimized way possible.

Note: Galen Healthcare Solutions is a sponsor of Healthcare Scene and the EMR Clinical Optimization Series of blog posts.

There’s a New Medicare ID Coming in April – CMS Dumps SSN

Posted on September 26, 2017 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

Following a 2015 Congressional directive, CMS is abandoning its Social Security based Medicare ID for a new randomly generated one. The new card will be hitting beneficiary’s mailboxes in April with everyone covered by a year later.

The old ID is a SSN plus one letter. The letter says if you are a beneficiary, child, widow, etc. The new will have both letters and numbers. It is wholly random and drops the coding for beneficiary, etc. Fortunately, it will exclude S, L, O, I, B and Z, which can look like numbers. You can see the new ID’s details here.

                           New Medicare ID Card

Claimants will have until 2020 to adopt the new IDs, but that’s not the half of it. For the HIT world, this means many difficult, expensive and time consuming changes. CMS sees this as a change in how it tracks claims. However, its impact may make HIT managers wish for the calm and quiet days of Y2K. That’s because adopting the new number for claims is just the start. Their systems use the Medicare ID as a key field for just about everything they do involving Medicare. This means they’ll not only have to cross walk to the new number, but also their systems will have to look back at what was done under the old.

Ideally, beneficiaries will only have to know their new number. Realistically, every practice they see over the next several years will want both IDs. This will add one more iteration to patient matching, which is daunting enough.

With MACRA Congress made a strong case for Medicare no longer relying on SSNs for both privacy and security reasons. Where it failed was seeing it only as a CMS problem and not as a HIT problem with many twists and turns.

New EHR Certification Rules Including Self-Declaration – MACRA Monday

Posted on September 25, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program (QPP) and related topics.

Elise Sweeney Anthony and Steven Posnack recently announced on the ONC Health IT Blog two major changes to the EHR certification program. In some ways, it shows a maturity of the EHR certification program, but in other ways, it’s ONC kind of taking a more hands off approach to EHR certification.

Here are the two big changes they made:

  1. Approving more than 50% of test procedures to be self-declaration; and
  2. Exercising discretion for randomized surveillance of certified health IT products.

The first one is really fascinating since they’re making 30 out of the 55 certification criteria as “self-declaration only.” That basically means that EHR vendors will just have to claim they meet the requirements. The ONC-ACBs won’t be certifying those 30 test procedures. In many ways, it reminds me of the meaningful use self-attestation. Does that mean that ONC-ACBs will cut their costs in half? Don’t be holding your breath on that one.

Let’s just hope that most EHR vendors don’t self-certify the way eCW approached EHR certification. Although, the eCW EHR certification issues are the perfect example of why a company self certifying their EHR software or the ONC-ACB certifying the EHR software is just about the same. I haven’t seen which test procedures will be self-declared, but my guess is that it was the ones that the ONC-ACBs weren’t really doing much to test and certify anyway. Ideally, this will free up the ONC-ACBs to dive deeper into the 25 test procedures they’ll still complete so they can avoid another eCW like incident.

Some might wonder why we don’t just take the self-declared EHR certification tests altogether if there’s no one that’s going to be checking them. What those people miss is that the self-declaration still keeps the EHR vendors on the hook for properly implementing the EHR certification criteria. If it’s discovered that they claimed to be compliant but aren’t, then the government can go after the EHR vendor for false claims.

The second change has me a little more puzzled. I’m not sure why they would want to release ONC-ACBs from the requirement to randomly audit EHR certifications. Maybe they didn’t discover any issues during their random audits and so they didn’t see a need to continue them. Or maybe the ONC-ACBs said they were going to pull out as certifying bodies if the government didn’t lighten the EHR Certification load. This is all conjecture, but they could be some of the reasons why ONC decided to make this change. They did offer the following insight into their reasoning:

This exercise of enforcement discretion will permit ONC-ACBs to prioritize complaint driven, or reactive, surveillance and allow them to devote their resources to certifying health IT to the 2015 Edition.

I wonder how many complaints the ONC-ACBs have gotten about the EHR software they’ve certified. Have they just been so overwhelmed with complaints that they need more time to deal with those complaints and so audits aren’t needed? I’d be surprised if this was the case. At this point I imagine most people with EHR certification issues will be calling the whistle blower attorneys, but I could be wrong.

All in all, I don’t think these EHR certification changes are a huge deal. It’s largely a maturing of the EHR certification program and does little to help the EHR certification burden on software vendors. Maybe the ONC-ACBs will charge a little less for their certification, but that’s always been a negligible cost compared to the development costs to become a certified EHR. I’m sure the ONC-ACBs are happy with these changes though.

What do you think of these changes? Any other impacts I haven’t described above that we should consider?