A proposed rating methodology to assess the capabilities of electronic health records systems is getting mixed reviews from stakeholders.

If the Senate health committee has its way, the federal government soon will establish a star-rating system for EHRs based on three critical criteria—security, usability and interoperability.

However, the plan is not getting high marks from industry groups such as the EHR Association and Healthcare Information and Management Systems Society. In fact, many in the industry say the private sector is better suited to make those kinds of assessments.

Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative, is blunt about it—it deserves two enthusiastic thumbs down.

The proposed legislative plan for a HIT rating system is a “terrible and misguided” idea, Tripathi says.

Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative.
Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative.

“The market is already doing this, and it’s a much better place to do it,” he says. “Every comment I’ve seen from industry is that it’s a bad idea. The government is just not equipped to do it with the kind of complexity and nuance that is going to be required. For me, the issue is they won’t do it well enough, and it has the potential to have insidious effects on innovation.”

On February 9, the Senate committee unanimously approved the Improving Health Information Technology Act (S. 2511), which includes provisions for a government-sponsored HIT rating system.

Those who developed the legislation say the intent is to help providers make more informed buying decisions in selecting EHR products and vendors. Under the proposal, the Office of the National Coordinator for Health IT will serve as the designated agency for publishing the criteria and methodology that will be used to determine the rating system.

The rating system, to be managed by a “development council” that will be composed of representatives from accredited certifying bodies, testing laboratories and ONC, would give systems a one-, two-, or three-star rating.

In addition, the legislation grants the Secretary of Health and Human Services the authority to decertify vendors’ HIT products if they receive a one-star rating and do not improve their score; these vendors will have a chance to develop a corrective action plan, but will need to act on it and improve their rating.

Under the measure, EHR vendors are required to report on the performance of their products every two years. Those that fail to report their performance would be subject to fines and possible decertification. The fines collected would be used to create a “revolving user compensation fund” to help offset costs of purchasing new certified HIT for users whose products were decertified.

“I cannot imagine a government agency creating Yelp ratings for EHRs."

“Overall, we find the proposed rating system to be duplicative—EHR assessment information is already currently available from private firms, as well as through the Office of the National Coordinator for Health IT’s certification program,” says Leigh Burchell, chair of EHRA and vice president of government affairs for Allscripts. “We suggest instead that it would be more efficient to use programs and resources already in place—such as ACB surveillance, the Open CHPL and funding relevant research through AHRQ—to make sure that the market has the information needed to make smart buying decisions.”

John Halamka, MD, CIO of Boston’s Beth Israel Deaconess Medical Center says that the EHR rating system is the only provision of the Senate’s Improving Health Information Technology Act to which he objects. “I cannot imagine a government agency creating Yelp ratings for EHRs. The Health IT Standards Committee specifically noted that this is not an appropriate role for government,” contends Halamka, who serves as vice chair of the HIT Standards Committee.

According to Eric Helsher, vice president of client success for Epic, the EHR vendor provided feedback to the Senate committee that a government-led rating system would be “duplicative, more costly and less effective” than what private firms like KLAS and HIMSS Analytics currently provide.

“We suggested they look to making that type of private information more available to the provider community and also make CMS’s existing data on Meaningful Use and EHR certification more intuitive,” Helsher offers. “The latter is publicly available now but not easily used.”

Likewise, HIMSS argues that such a rating system is not necessary because private sector groups are already evaluating EHRs. “Rather than developing a new rating system, consideration should be given to leveraging these private sector efforts,” the group told the committee in a letter it submitted last month.

The HIMSS letter also said a rating system based on user feedback would “introduce excess subjectivity, if not appropriately weighted in the star rating methodology.” As the group points out, EHR users “do not always have an in-depth understanding of what is implemented by the product as opposed to the environment in which the product is being used.” The rating system “should be largely based on objective measures with some grounding in existing certification criteria,” HIMSS asserts.

Nonetheless, the Senate is moving forward with a government-sponsored HIT rating system—the brainchild of Sens. Bill Cassidy, MD (R-La.) and Sheldon Whitehouse (D-R.I.), who in October 2015 introduced the concept in the Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act, which has now been incorporated into the Improving Health Information Technology Act bill.

Calling it “an unbiased rating system” for HIT products, Cassidy said the TRUST IT Act provisions would “help strengthen accountability and improve transparency” in EHR systems. “This bill helps create interoperability by stopping information blocking, and creating a business incentive through the rating program to ensure that all systems work together to seamlessly share information for patient care,” says Cassidy in a statement he issued after the unanimous approval of the act by the committee.

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