EHR Certification: Less valuable than a turnip

I was asked to give my opinion during an interview for an article on EHR certification.  As you know, I could benefit from the advice that implores one to keep their mouth shut less the whole world know you have nothing to say.  I had the right to remain silent, just not the ability.

I tend to think the certification process was something invented and supported by the large EHR vendors as a way to make the small vendors less relevant and as a way to slow the development of standards. As standards come into play, the EHR vendors furthest away from the standards, including the largest vendors, will become less relevant.

There is no legitimate business reason for having to certify a system AFTER having spent several hundreds of millions of dollars implementing it.

The logic behind the comment about there being no raison d’être for the existence of certification is as follows.

Certification, to be of value, must imply that the act of certifying–like the Good Housekeeping Seal of Approval–is intended to show that a certified EHR is somehow better (for healthcare) than a non-certified EHR.

The post-implementation impact of EHR is that far too many nine-figure EHRs have resulted in productivity losses of between ten and thirty percent. In English…a hospital spends a hundred million dollars on a system and as a result of having spend that money is only able to handle fewer patients than it could if it had spent a dollar on a turnip.  That same hospital, now operating less effectively, can do so with a certified EHR, and can qualify for Meaningful Use.

The certification process has failed to justify its existence or to bring any value to the process.  However, it has not failed to get hospitals to spend additional millions to comply.

According to the hospital CIOs and physicians I have spoken with it means the hospitals (physicians) are able to see fewer patients. This is because the physicians must spend more time searching, navigating, and typing. My cardiologist who works at a very prominent hospital in Philadelphia told me two memorable things about their $200 + million dollar EHR:

  1. The data is excellent if you are a patient or insurance company. You now have excellent data with which to sue us.
  2. My productivity is down thirty percent. The hospital has taken its most expensive and time-constrained resource and made us spend the majority of our time interfacing with a keyboard instead of our patients.

I would encourage you to ask others what additional benefit, if any, certification has brought to them and would they not have received those same benefits without implementation.  Certification is the lottery ticket hospitals must purchase to enter the Meaningful Use sweepstakes.  Meaningful Use has no Meaningful Use. Many hospitals will have purchased that lottery ticket but will not meet Meaningful Use. Hence, the cost to attain certification and the cost to attempt to meet Meaningful Use are wasted dollars.  Meaningful Use is binary Sudoku, you either get it or you do not.

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