Announcing EHR Vendor Attestation Report Card and Data

UPDATE (May 20, 2015) It looks like the forces for open data won this one! Here is the summary at fiercehealth and the actual policy change letter sent to payers.

DocGraph is crowdfunding releasing a dataset revealing how specific EHR vendors perform on Meaningful Use attestation, bringing greater transparency into the EHR industry. Until now it was easy to see how providers were performing on Meaningful Use attestation, but it has been difficult to hold EHR vendors accountable for attestation performance. What will likely be more controversial is that this data release will amount to the release of the “attesting” client list of every EHR vendor in the country.

An initial dataset will become available on the last full day at HIMSS, and the crowdfund will continue until Datapalooza. This post discusses our underlying motivation for creating a new dataset, as well as some of our goals with its release.

I enjoy and appreciate many aspects of the annual HIMSS conference: the people who run it, the attendees, educational sessions, and keynotes. Further, I find that regional and local HIMSS events are well worth attending. However, I am not a fan of the “big” HIMSS tradeshow floor. The parallels between walking down the “main aisle” at HIMSS and walking down the strip at Vegas creates are striking. The opulence of the Vegas strip and the excess in the HIMSS tradeshow floor both stir a sense of unease and bring up the same questions: “Who is paying for all of this? Is someone getting fleeced? Is it me? If it is not me, would that make the fleecing OK?”

The HIMSS tradeshow floor is a necessary evil because we have, in Health IT, no better way to make decisions about what products we buy. As it stands, figuring out which vendors have the biggest booths at HIMSS is probably not the worst way to make decisions about EHR systems.

The alternative is to hire someone to tell us which EHR vendor fits us best. Probably the most famous provider in this space is the “Best in Klas” service. However, Klas is famous for being payed by both sides of the industry. Klas is paid both by potential EHR purchasers and by those who sell EHR system. Like HIMSS, Klas creates a space for buyers and sellers to meet. I think Klas and HIMSS both do an admirable job trying to maintain fairness and objectivity, given the massive financial biases under which both organizations operate.

Both HIMSS and Klas are profiting from an underlying problem in the Health IT industry: Information Asymmetry. Anytime two people are making a business arrangement and one party has substantially more information than the other, there is a tendency to abuse that knowledge. This is why it is so uncomfortable to buy a car from a used car salesman. What do they know about this car that they are not telling you? Even though most used car salespersons are likely to be honest people who do not take advantage of their extra information, enough of them succumb to temptation to give that industry its seedy reputation. There are parallels between the Health IT industry and the used car marketplace:

• Buyers are less informed than sellers. Health IT is complex enough that buyers do not understand how to evaluate an EHR product effectively, or even how to gain that understanding.

• Vendors in the marketplace use Information Asymmetry to their advantage. Multiple vendors offer services that are very reasonable in cost. Some of those reasonably priced vendors do a terrible job, and some do a great job. Vendors with established reputations charge tremendously expensive prices. Buyers want to avoid fly-by-night operators, so they frequently overpay for merely adequate products.

• Established vendors want to control their reputation in the marketplace. But what is unique to the EHR industry is how they do this: frequently introducing contractual constraints to ensure that buyers do not leak negative information into the public. This makes it very difficult to establish transparency, since many EHR buyers are forbidden from discussing the performance of their EHR software or their EHR software vendor.

There are several services, most notably the Kelly Blue Book, that help to provide consumers with the information that they need in order to effectively make used car purchase contracts. While Klass and HIMSS attempt to take this role in the Health IT marketplace, both of them “serve two masters” and have become, in some respects, part of the problem. Of course, Blue Book likely sells more of its pricing guide information to car salesmen than it does to consumers. It should be noted that DocGraph is sponsored by EHR industry players as well. How does the Kelly Blue Book maintain its credibility? The Blue Book is purely objective data. It does not make subjective statements about a particular car, or a particular car manufacturer. Its role is only as a data aggregator.

Recently, Niall Brennan’s team at CMS, and their counterparts at ONC modified how the EHR Attestation data was released. This modification, which we will discuss in detail later, has made it possible for DocGraph to create a new merged dataset about the EHR industry. We cleaned up this dataset in order to make a functional data release. This “derived EHR dataset” allows specific EHR vendors as well as specific EHR products to be tied with specific healthcare provider attestation results. The “unmerged and uncleaned” original dataset only allows for EHR providers to be compared in their attestation performance. The new DocGraph EHR dataset will allow vendors and products to be compared too.

This dataset can produce is a “Blue Book” style report card on vendors and products in the EHR industry. Over the next few days, we will be releasing such a report card. As far as we know this will be the first time the EHR industry as a whole will be held accountable for their performance in Meaningful Use attestation.

This is the first of several useful reports that are relatively easy to produce, using a dataset which associates specific attestations with specific EHR products. It is also important to understand if some EHR products are more likely to be “fired” and swapped, or to “fall out” of the attestation program. We can calculate who has benefited most by the extension of the Stage 1 funding. We can generate report cards that detail which EHR vendors perform best on measures that are beneficial to patients, public health reporting, etc.

A more controversial side-effect of this data release will be the association of attesting providers with their respective EHR provider(s). This amounts to publishing the majority of the client lists for every EHR vendor in the United States.

In reality, completely measuring the nuances of the Health IT industry by leveraging Meaningful Use attestation data will not work. As a result, we are announcing a crowdfund to support our efforts to create more open data about EHR vendors. Like all crowdfunds we offer rewards like books and t-shirts. Like all DocGraph crowdfunds we are also offering exclusive early access, and significant discounts to the new EHR dataset.