As providers look ahead to Stage 2 of the meaningful use electronic health records incentive program, they will see a greater emphasis on quality of care and improved patient outcomes, according Alisa Ray, executive director of the Certification Commission for Health Information Technology (CCHIT).

With this in mind, Ray said, the new 2014 criteria for certifying EHR technology to federal standards have been designed to support delivery of safer care.

"We are getting feedback that [the Office of the National Coordinator for Health Information Technology] has really, really raised the bar this time," Ray said Monday at the American Health Information Management Association (AHIMA) annual convention.

In its recently published 2014 criteria for certification of health IT technology, ONC called for "safety-enhanced design" in eight EHR functions, such as order entry, drug-drug and drug-allergy checking, clinical decision support and electronic medication administration records.

That program officially begins October 4, though the federal government will not finalize testing procedures until late December or early January, Ray said. Specific clinical quality measures that providers will need to meet in Stage 2 of meaningful use, which starts in 2014, also are not out yet.

This push for greater attention to safety and usability comes partially from public criticisms of earlier certification efforts than only tested functionality, but mostly from the November 2011 Institute of Medicine (IOM) report, "Health IT and Patient Safety: Building Safer Systems for Better Care." That report looked not only at technology, but also the implementation and appropriate usage of health IT.

The Department of Health and Human Services (HHS) has been asked to report back to the IOM on whether the Food and Drug Administration (FDA) should get involved in regulating EHRs like medical devices, and HHS is expected to provide annual updates. The IOM did not definitively say there was a problem with health IT compromising patient safety, only that more research was needed.
 
With this in mind, some points that CCHIT and other authorized EHR certification bodies will consider in the future include:

• How good is the backup? "A system that can lose patient data is one with a huge patient safety risk inherent to it," Ray said.
• EHRs should be able to reduce the risk of patient harm with closed-loop medication ordering even when a test result is not returned or a prescription is not filled as ordered.
• Verbal, telephone and electronic messages between users should be documented, including discrete data on the roles of each provider associated with each patient.
• According to Ray, vendors have not necessarily shown evidence of "pushback" from vendors, but she has heard "concern in the level of work that needs to be done."

This may put a design burden on EHR developers. "I think it will be a little easier for the larger vendors than some of the smaller vendors," Ray said.

Providers also have expressed concern about the burden of collecting quality data, a problem that EHRs are supposed to address, the CCHIT director added.