A number of physician groups, including the American Medical Association (AMA), have voiced their support for a proposed federal EHR certification framework.
But as they list what they’d like to see included in a certification program, it seems reasonable to wonder just how comprehensive any certification program can be given the form of EHRs today.
According to this review from the AMA, the groups think “federal health officials overseeing standards for electronic health records systems should revise system certification criteria to take usability concerns into account.”
While, on one level, it makes sense that providers would want widely accepted EHR programs to fit the preferences of a majority of practitioners, the very idea of “usability” strikes us as a pretty subjective category to be attempting to measure and standardize.
Yes, it’s easy to imagine certain core attributes that could be required across the range of EHR products, but beyond a certain point perceptions of “usability” are bound to vary according to product, specialty and user. It would be better, it seems, to be thinking in terms of how to shift the underlying technology of EHRs to render them more “customizable” while ensuring that attributes such as interoperability are universal.
Or, as this Texas doctor puts it, “what is needed is the standardization of a common computer code or database language for the storage and organization of healthcare information much like HTML is the universal computer language for Internet browsers. Once a standard database language is in place then different EMRs essentially become browsers. Their selling points then become based on how effectively and clearly they present the information to the user plus whatever additional bells and whistles the user prefers.”
A little later, the article notes that “the AMA and other physician organizations also have serious doubts about the long-term viability of these products, leaving physicians who invested in the technology vulnerable.”
But that, it seems to us, is a risk no matter what kind of technology an individual or organization is considering buying. It’s one thing to use that concern as a justification for not starting across the digital frontier in the first-place, but once the move has been made it’s hard to see how much the government can minimize the impact of changing technology or “disappearing” vendors.
In short, given the government’s push to move healthcare providers to EHRs, some guidance on, and certification of, the basics makes sense. But in a market economy defined by rapid technological change, there may not be much more policymakers can really do.