EMR Adoption - Should we have a National Certification Program for EMRs in Canada?

With a greater number of provinces preparing for EMR incentives or funding program for physicians, is it time that we developed a national certification in Canada for EMR systems similar to the CCHIT program in the US? Canadian certification could have some distinct advantages in terms of cost for vendors to meet requirements. Vendors could be required to undergo certification once yearly (or at pre-determined intervals) and in return be certified across Canada. This could also have advantages for physicians who could have a greater level of confidence in their product being in conformance across provinces.

Certification is a very complex issue and each province would have additional requirements that make their situation unique in some respects. However not taking this approach potentially places the viability of the EMR market at risk with vendors having to commit significant resources in order to certify separately in each province.

I have included an excerpt from an article discussing the CCHIT program in the US. Canada Health Infoway is currently leading a process to define pan Canadian physician office system (EMR) requirements, but is this enough?

Please weigh in on this discussion. In this particular posting, I would like to invite physicians, vendors and policy makers to comment on whether this could be an approach we should be taking in Canada.

PHILADELPHIA – U.S. physician practices should become more familiar with the certification process for ambulatory electronic health records and give feedback to EHR vendors, a pair of healthcare IT experts said Monday. “Adoption of an EHR is an ugly, ugly process,” said Robert Tennant, senior policy adviser for health informatics at the Medical Group Management Association. “Things are always more expensive and more difficult than vendors claim.” Tennant spoke at a CCHIT Forum at the 2007 Annual Conference of the Medical Group Management Association. Mark Leavitt, MD, the chairman of the Certification Commission for Healthcare Information Technology, joined him on the podium. Link: EHR adoption an "ugly process," but CCHIT can improve appeal.

To add your thoughts or comments, click on the 'Comments' link 

Comments

[Jim Busser]

It would be useful if every province's requirements, technical and functional, could be indexed and accesed from one place. That could really help EMR vendors / programmers and thereby consumers (health organizations including doctors, and the public).

Likewise if the provinces were to converge their technical and functional requirements, so that they became less arbitrarily different. This has for years been highly vexing,

I am open to the possibility that national certification might be worthwhile... but I am concerned that for it to occur without the above would be to substitute process for value.

[Dave Ludwick]

A national certification program is certainly a non-trivial task. Of course in Canada, healthcare is devolved to provinces. Each province has different jurisdictional healthcare requirements as established by their constituents. There are different health human resource policies, drug policies, and funding models. Each province also has varying levels of funding. These all effect implementations of EHRs and EMRs.

The likelihood of convergence within significantly different healthcare models seems unlikely. Getting governments to agree on a set of requirements would be like herding cats. The more experienced ones would not take the time to get involved in discussions and the less experienced ones would not have much to offer. All the while, both would be spending money toward a national agenda, which, historically, provincial governments have had little patience for doing.

If healthcare is unique in each province, is a national certification program be viable? An alternative could be for a national body (The Collaboratory?) to develop a base set of requirements which provinces build on top of to achieve their needs. Of course this still requires that provinces can attract the needed IT talent to test and certify products in their jurisdictions. So, some might just take the base offering. Some will build more sophisticated requirements. Alberta currently does this (VCUR), BC is going to as is Ontario. Maybe a more feasible alternative is for a national body to sponsor the development of certification requirements through a jurisdiction which is already well down the road on this matter.

[Morgan Price]

Agreed that this is non-trivial.

The scope and interpretation of what is a "standard" is hard enough.

I think that a national group consistently providing national "certs" would be the only way to provide consistency. That would leave the provinces to focus on provincial pieces (e.g. billing, lab connections).

Standardization doesn't necessarily mean uniformity and I think that what is looked for at a national level would need to be carefully thought out. Data standards (so we can move patients between EMRs when they move, etc) are important but so are safety standards.

Safety evaluation is a key but missing component often - there are a growing list of unintended consequences of electronic systems that are not looked at. Key safety components should be part of a certification process.

BTW - the recent BC requirements explicitly provided references to corresponding requirements from other provinces to help out the respondents.

[Karim Keshavjee]

Some good ideas have been discussed above. I especially like the idea of a base certification with 'add ons'. I also like the idea of safety certification. However, this is likely to increase the cost significantly. EMRs are increasingly becoming interventions --for improving patient care instead of just documenting and storing records of care. This means that we need to have more information about their efficacy.

Certification is only useful within a broader EMR implementation context that includes good governance, project management, workflow redesign, technical support, incentives and communities of practice that can support EMR use.

I would certainly like to see more usability requirements in certifications. Also, we need to consider much more indepth testing than is typically done in most certifications. We need to test in the context of live/production data --not test data. I have seen too many problems arise in real-life scenarios that don't appear in test situations. Truth is sometimes stranger than fiction and testing on fake databases could lead to erroneous conclusions about the effectiveness of certain functionality.