Big decisions - Certification and Evaluation?

David Classen RevisitedThank you Dave Raths, for the "Big decisions await HHS secretary" post yesterday. Dave did a great job of capturing the essence of the HIMSS Webinar. He ended his post with a series of questions that invited more than a comment. Although I strongly agree with Mark Leavitt's conclusions, that Certification was created to meet a real need that was previously missing in our national strategy, and that it has earned credibility, I think one more topic needs to be in the conversation. Evaluation of live products, especially those addressing CPOE. This is not a new idea. Fran Turisco does the best job on these blogs of laying out the problem and solution here. Part of the gist is that even certified EMRs with CPOE, capable of catching and preventing lethal mistakes, can be configured and implemented such that they get failing scores. There's an excellent review of the issues and options in my prior blog post, " When Rules Collide, Alerts Fatigue, and Disruptive Innovation may be necessary." From that post, here is a small piece (the original with its comments are worthy to scan on their other dimensions): David Classen’s 2008 HIMSS presentation entitled, "Evaluation of Implemented EHRs," looked at this issue in detail, in the real world. Deployed EMRs were tested using the Leapfrog flight simulator. CDSS scores dropped to the 10% range (50% is passing), as a result of deferred or deliberately disabled CDDS. These systems (from many major vendors) had CDSS capable of meeting or exceeding the 50% passing grade threshold; the CDSS was turned off, reducing or eliminating the safety benefit. EMRs often performed at the 10% level for decision support.Classen has a distinguished career, having established himself as an expert in Adverse Drug Events two decades ago, and subsequently contributing to the topic from every major perspective. Per Mark's use of the word, "credible" and HIMSS' call for "market tested" approaches, the question of the evaluation David Classen, Jane Metzger, and Fran Turisco describe should be explicitly on the table. If chief of staff Rahm Emmanuel is right that “you never want a serious crisis to go to waste,” and if the goals are to expand coverage AND control costs, aren't certification and evaluation both critical?