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EHR developers sign on to code to conduct for patient safety, engagement best practices

Tuesday, May 27, 2014
Among the many things that took place at the recent HIMSS annual conference in March in Orlando was a big step toward getting the largest EHR vendors to commit toward initiatives to foster patient safety and push toward more patient engagement.

As adoption of EHR systems by physician groups continues to grow, the push for adoption, implementation and demonstration of meaningful use often results in situations where providers and staff are committed to pushing to use the system meaningfully as soon as possible, but it is not unusual for the group to not have a great sense of all of the functionality of the system itself.

Patients often know far less. Increased EHR adoption sets the stage for patients to play a much more active role in their own care, including faster access to their own health information and integration into personal health records, which many believe will ultimately put the patient in much greater control of his or her own health record.

The average patient has very little visibility into what is happening at the practice and how it might impact them. Because it is the provider that’s ultimately the customer generating the revenue, the EHR vendors usually – and rightfully, from a business perspective – focus first on making sure the system has functionality that will allow the provider to believe his or her own needs are being met.

Code of conduct aims to set standards
To ensure patient safety and engagement stayed on the radar screen of the industry, the Electronic Health Records Association (EHRA) began circulating a draft of an EHR Code of Conduct.

Of course, such a set of standards is only viable when the industry agrees to take part, so the effort moved significantly forward in March, when these 17 companies jumped on board:

Foothold Technology
GE Health Care
Greenway Medical
Modernizing Medicine
Practice Fusion

What they’ve agreed to do
The EHR code of conduct addresses general business practices, patient safety, interoperability and data portability, clinical and billing documentation, privacy and security, and patient engagement.

The code of conduct itself is actually a three-page list of commitments being made by the companies that have chosen to take part, preceded by a one-page preface and five pages of Q&A about the code of conduct itself.

Companies taking part aren't bound to a certification process or to take a specific number of steps or actions to achieve certain objectives. Rather, the code of conduct spells out a series of principles by which the companies have agreed to operate, with actions they will take to help ensure they meet those principles.

First, at a general level, the code of conduct calls for accurate communication about the functionality and benefits of offered products and services. 

When it comes to patient safety, the companies that have signed on to the code of conduct agree to product design, development and deployment with user-centered design and quality management approaches to ensure patient safety.

Members agree to participate with at least one patient safety organization to report and review health safety IT events, although there are some caveats in this area related to legislative and regulatory changes and standard definitions for safety events.

Customers will be notified of any software issues that affect patient safety and best practices for deployment and use of products will be shared with customers, who will not be limited from discussing patient safety issues in appropriate settings.

For interoperability and data portability, customers will be able to exchange clinical information with other EHR vendors through standards-based technology as much as possible; uniform standards will be used and best practices used to develop interfaces for interoperability will be shared.

Perhaps most critically, each vendor agrees to work with customers to facilitate the export of patient data when the customer opts to change vendors. 

Clinical and billing documentation is another key area addressed. The companies agree to support customer needs to document services accurately and make customers privy to how the products themselves approach documentation, coding and quality measurement from a guidelines, conformity and regulatory perspective.

The companies also commit to protect patient privacy through secure data handling and to foster patient engagement and patient-centered health care. 

What it all means
Jennifer Searfoss, president of SCG Health, a Vienna, Va., health care consulting firm, thinks that putting the code of conduct on paper is a good start. It’s a set of additional information easily accessible by physician group practices, physicians themselves and patients and families to push EHR vendors to deliver products that will deliver a set of standard features and benefits for users.

But as noted in the questions and answers that follow the code of conduct, the companies have complete discretion for how to satisfy the commitments they make under the code of conduct itself.

Companies will not be reviewed or audited to ensure they are doing what they say they will do as adopters of the code. Even for sensitive topics such as patient disclosure of safety issues that may arise from usage of the EHR are ultimately left to the developers themselves. In many cases, state and federal privacy and patient protection laws will continue to drive how the industry addresses safety issues that may involve the EHR.

Companies are allowed to communicate through their marketing materials that they've agreed to adopt the code of conduct, following standards laid out by the EHRA. 

It’s a good first step. It makes the benefits of EHR and the potential of electronic health records for the consumer a little less opaque to health care consumers, and gives providers metrics and measures to use to compare how each EHR system achieves the objectives of the code of conduct.

The objectives and goals are good ones, and health stakeholders can use this document as a means to push for even more key objectives for health providers, such as taking concrete steps to help providers use EHR for documentation and billing in a way that helps to ensure a more compliance-focused approach to billing. 

Even when doing so will slow down the provider, or cost the group money at the risk of future compliance hassle.

Left unmentioned in any meaningful way in the code of conduct is one of the biggest challenges group practices face when turning to the EHR for the patient-centered medical home and other data-driven payment initiatives, which is getting the EHR to be more effective at aggregating patient data for reporting and overall quality improvement purposes.

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