Testing to Destruction

The company I work for develops Electronic Health Record (EHR) software, which lets doctors' offices store patient information in computerized format rather than in paper-based charts that can be hard to read and easy to misplace. The federal government has recently gotten into the business of certifying EHR software, and in a couple of weeks, a company that represents the government will put us through a day-long, 35-step test during which we'll show how† our software does things like:

• Storing basic information like the patient's height, weight, blood pressure, and smoking status.
• Comparing new prescriptions against the patient's known allergies and existing medications (to prevent possible bad reactions) and transmitting prescriptions to pharmacies electronically whenever possible.††
• Allowing patients to access their basic health information (such as a list of the medications they currently take and results of some lab tests) in "real time" (which usually means through a web site called a "patient portal").
• Providing patients with summarized versions of their healthcare information as a printout, or as a specially-formatted computer file that could be imported into a Personal Health Record (PHR) like Google Health or Microsoft HealthVault.

Some of this stuff, like vital signs (height, weight, BP, etc.) and medication lists, we've done for years; other stuff, like patient summaries, is new to us. Getting ready for the test—developing new code, integrating the new features into our program and making them easy for doctors and their staff members to use, testing everything (the new stuff and the old stuff, to make sure that integrating the new stuff didn't break anything)—takes time. The test itself will occupy several employees for at least a full day, and we're paying a hefty fee to be tested. About 80% of the companies getting their software tested don't fully pass on their first try and have to have at least part of their product re-tested. If that happens to us, I'll be disappointed, but at least we'll have plenty of company, and I hope any needed fixes will be relatively minor.

It's the doctors and their employees who'll really have the hard part. Once we've updated their software to the certified version and trained them on the new features, they're the ones who actually have to use the software in a "meaningful" way. In fact, the phrase "Meaningful Use" is the unifying theme of this whole government initiative. It's not enough for the doctors to own and install the software,††† they also have to use it in ways that the government believes actually contribute to improved healthcare. The government is dangling incentive money in their faces, ostensibly to offset the costs of having to install new systems (for those who don't already use EHRs) or to upgrade their existing systems to certified versions, but the doctors are going to have to jump through a lot of hoops to get their checks.

And in the end, will any of this make a difference to the people who really matter...the patients? I'm not even going to venture a guess. All I know is that any EHR company that wants to stay in business has to get its software certified so its physician clients can at least try to earn the incentive money, so that's what we're doing. Wish us luck.

† Actually, at least at this stage of the game, the government isn't concerning itself with how the software does all this stuff, only that it can do it. The government-approved test script makes it clear that even if there's more than one way to fulfill a particular requirement, we should demonstrate only one method. They're not looking for razzle-dazzle, just results. It's very businesslike, and it also means that usability isn't a priority. An EHR system that can pass all 35 steps in the test script, but only by requiring users to fill out complicated screens or wander here and there throughout the system to complete a straightforward task, would pass the test, just as an elegantly-designed and intuitive system would. It's like that old joke: What do you call the person who graduates last in their class at medical school? "Doctor."

†† Not all pharmacies are hooked up to an "ePrescribing" system yet (although most are, and those that aren't are probably working on it), and not all prescriptions can be sent electronically. Although federal law has been updated to allow prescriptions for "controlled" substances like narcotic pain medications to be transmitted electronically, software for both doctors and pharmacies will need to be upgraded to handle the extra security measures that will be required.

††† Actually, for doctors with a sufficiently high percentage of Medicaid patients, just owning the software is enough to qualify for incentives in their first year of the program, but doctors who are attempting to earn incentive money from Medicare rather than Medicaid have to show 90 days' worth of "meaningful use" of the software to get the money. What's the difference between Medicare and Medicaid? In the U.S., Medicare is the federal program that helps the elderly and the disabled pay for medical care; Medicaid pays for medical care for low-income individuals and is managed by the states. (I believe that countries other than the U.S. also have programs called "Medicare," but I don't know how they compare to the American version.)