"Project" and "Product" Certification

Last Friday night I testified to the President's Council on Science and Technology (PCAST). Many issues were discussed, but one of the most interesting was the idea of "project" verses "product" certification.

Here's the significance.

In Massachusetts, Partners Healthcare and Beth Israel Deaconess use home built EHR solutions based on Intersystems Cache. We both use Sun's eGate (now Oracle) and Intersystems Ensemble as middleware. We both use datamarts/data warehouses based on extracts from our clinical systems to support quality reporting, performance measurement and research. We both use NEHEN as our healthcare information exchange.

We'll achieve meaningful use via this combination of applications with many moving parts. Its totality provides the tools our stakeholders need. We need to certify the sum of the "project" and not the individual "products".

"Project" certification can be empowering in other ways.

Imagine that innovative products such as Microsoft Healthvault/Amalga or Google Health offer services to aggregate data from multiple data sources as part of quality reporting. They can become accelerators of meaningful use.

Imagine that a Modular EHR (such as Quest's Care360) plus a Healthcare Information Exchange can store the lab and medication data needed to coordinate care. Quest and iPhone app innovators can accelerate meaningful use.

My experience is that federated authorship - harnessing the talents of many companies and individuals - leads to the most rapid innovation.

Of course, some of the most advanced aspects of meaningful use, such as comprehensive decision support, may require larger, fully integrated EHRs. But other aspects such as the data exchanges required for 2011 - eRx, Lab, Quality reporting, and administrative transactions - can be empowered by assembling multiple products and services.

Since the theme of the work of the HIT Standards Committee for the next few months will be accelerating standards adoption and implementation (more on this in my blog tomorrow), encouraging all stakeholders to innovate by creating reusable components in support of meaningful use seems timely.

As the Notice of Proposed Rulemaking (NPRM) is written to define the certification process, I encourage policymakers to certify "projects" in addition to "products", encouraging innovation. I have no direct influence on this work, but I am hopeful that industry and clinician stakeholders will provide this input to those writing the policies.