Regulatory Compliance + Clinical Practices Compliance?

As providers move towards tracking their Meaningful Use Progress, we are starting to see instances where Certified Software does not fulfill all the needs of regulatory compliance. Actually, it is pretty impressive the degree to which the vendor world has responded to Meaningful Use. Vendors who have been around for years, building in clinically sound EHR capabililties have had precious little time (in software development terms) to add in Regulatory Tracking functionality.

Let’s face it: Little (maybe even nothing) in Meaningful Use Regulations creates clinically usable or necessary functionality that the vendors didn’t already envision and have in their software. ARRA didn’t create the concept of CPOE, Quality Reporting, Problem List Tracking, or any measure Hospitals or Ambulatory docs are required to track for EHR Stimulus. But what ARRA does in many cases, is add functionality that is necessary to track ARRA. Here are two examples.

  • Emergency Department Software: A couple of our hospitals use a certified EHR by a long-time vendor providing successful ED software. This particular product tracks lab results as structured data for all patients for which the ED receives results. Of course the results are often delivered a couple days after the patient has left the ED. Because the volume of these reports is quite high, and the clinical need to retain the specific results is low, the system automatically purges unreferenced data after 30 days retention. Clinically valid. ARRA Oops. (ARRA requires a 90 day reporting period, during which hospitals must aattest to having this data for 40% of all EHR Patients). Note that the EHR in question is certified, since the test did not “stress” for volume. Here’s a case where a hospital could attest to a requirement, but a subsequent by-the-book auditor could feasibly find the hospital non-compliant.
  • Tracking patient requests: Two specific measures require that providers give patients electronic copies of EHR data upon request. One of our hospitals is using certified EHR which does a nice job of selecting out data and providing electronic versions in a couple formats for patients. But this particular (certified) software product lacks the capability to log those requests from patients! The measures state that for 50% of the patients who request it, the provider must generate electronic results. Oops again. Now, this is a first-class vendor, and it is a good bet that they will provide tools to their customers pretty soon. But until then, users will have to come up with a sub-system to track these requests, and satisfactory responses. On the other hand, we don’t think this kind of request is likely to generate much volume in the near future …

The point is that ARRA creates the need for vendors to incorporate into their software functionality that is not clinically necessary, but is required for administration of the ARRA program. And this is the arena where well-intentioned providers might stub their toes without even knowing it. It seems prudent that providers have a process, and maybe even some third party tools, to help keep track of each individual requirement, and the results of your progress against not only clinical, but also regulatory compliance.

Read more about Meaningful Use.

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