To be honest, the first time I heard that the EHR Association (EHRA) and its member companies were developing a code of conduct, I couldn’t help but think about the Pirate’s Code from Pirates of the Caribbean. However, during a meeting at HIMSS 2013, the EHRA invited stakeholders to offer comments on an earlier draft of the EHR Developer Code of Conduct that was released yesterday. In full disclosure, I represented the American College of Physicians (with two other colleagues) during one of those discussions.
It would be easy to be cynical given the considerable challenges faced by many practices implementing certified EHR technology. Some might view this Code of Conduct as too little, too late. However, it appears that the effort involved to get these principles approved was significant and the intent genuine. Here is a sentence from the document posted on the EHRA site: “We are making the Code generally available to encourage transparency and collaboration among EHR companies, as well as between an EHR company, its customers, and other industry stakeholders.”
Yesterday, I offered some comments at the public release of the document on behalf of ACP. In part, this is what I stated:
EHR vendors, eligible professionals and hospitals, and their teams are all experiencing tremendous pressure to comply with Meaningful Use certification criteria and to implement new features and functions in practice. This situation makes the key elements of the Code all the more important.
Speaking from the perspective of ACP’s members, physicians are essentially reinventing their practices…while treating real patients using technology that has been developed with multiple, sometimes competing objectives…while being expected to document quality for reporting…and while facing new payment models that place a premium on efficiency, quality, and patient experience metrics.
While the Code couldn’t possibly address all of these issues, I can go back to our members and point to its principles that are very responsive to the issues physicians would like addressed as they try to select, implement, optimize, and potentially change EHR solutions.
There are three principles I want to highlight, though they are all important.
Patient safety must be central to our efforts especially with all of the changes occurring in healthcare. We are pleased that the Code specifically references collaboration with Patient Safety Organizations, sharing best practices, commits to notifying customers if a software issue could affect patient care, and recognizes that it is in everyone’s best interest not to contractually limit discussions about patient safety.
Exchanging information using standards-based technology is critical to realizing the anticipated benefits of the patient-centered medical home, medical home neighbor, accountable care models, and patient-centered care in general. The Code addresses this nicely.
While we hope that physicians choose the correct EHR for their office the first time — it’s highly likely that many will wind up migrating to another platform for a variety of reasons. We are pleased that the Code acknowledges this reality and includes a pledge to facilitate export of patient data if requested. It’s not only responsive to physicians, it is another patient-centered approach to improving healthcare.
Of course, some have already pointed out areas that could have been a bit more robust. For example, in InformationWeek Healthcare, Ken Terry wrote, “… although adoptees promise to participate in one or more PSOs [Patient Safety Organizations], the code contains a long list of caveats about the timing of such participation…” and, “The EHR Association does not intend to check on whether EHR vendors that claim to adhere to the code actually do so.”
The Code just became available yesterday for vendors to adopt. It will be interesting to see which vendors and how many of them are going to commit to these principles. Of course, the most important determination of its effectiveness will be whether the behaviors and policies the Code was designed to address change.
What do you think about the EHR Developer Code of Conduct?