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Certification Commission Charts Future

March 1, 2007
by David Raths
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CCHIT's Mark Leavitt lays out his organization's plans to keep certification efforts moving.

In the words of the celebrated TV chef Emeril Lagasse, the Certification Commission for Healthcare Information Technology is "kicking it up a notch" as it enters the second year of its three-year contract with the U.S. Department of Health and Human Services.Mark leavitt, m.d., ph.d.

In its first year, CCHIT certified 33 ambulatory electronic health records (EHRs) — about 80 percent of all that were tested, says CCHIT Chairman Mark Leavitt, M.D., Ph.D. In January 2007, it announced that 18 more products received certification, bringing the total to 55, representing about 25 percent of all companies in the market.

In 2007, CCHIT will roll out more rigorous standards for ambulatory EHRs and begin certification of the first components of inpatient EHRs.

CCHIT's strategy with ambulatory EHRs has been to start with moderate expectations of features and functions and build from there. The major additions for 2007 are e-prescribing and transmission of lab data.

"We have developed a roadmap to signal to vendors what lies ahead," Leavitt says. For instance, in 2007 products just have to be able to receive lab results, but in 2008 they have to be able to share results as well. In 2007 they don't have to be able to accept imaging results, but in 2008 they will. In 2009 they will have to be able to interact with state public health agencies' immunization registries. "We are ramping up the functionality gradually, so vendors don't have to swallow the whole thing at once."

Not all roses

CCHIT has drawn criticism from some vendors and consultants who argue that the $28,000 fee charged to test products will drive some smaller vendors out of business. Leavitt responds that it was never the intention of CCHIT to hurt small companies, and he claims the diversity of certified vendors refutes the claim about harming smaller companies.

He notes that a survey of certified vendors found 65 percent have revenue of less than $10 million and 40 percent say they sell primarily to one-doctor offices.

Although CCHIT will meet its goal of launching inpatient EHR certification in 2007, Leavitt admits that developing the critieria has proved much more difficult than anticipated, forcing the organization to scale back its first-year expectations. "It is so much more complicated than the ambulatory EHR," Leavitt says. "A hospital may have 1,000 employees, whereas a doctor's office may have only five. We decided not to take on the full soup-to-nuts comprehensive EHR this year."

Instead, the group chose to concentrate on CPOE (computer-based provider order entry) and eMAR (electronic medication administration record) modules. "We chose these because they are closely tied to patient safety and the penetration is low, so the potential benefit is huge," he says.

CCHIT also is scheduled to begin certifying healthcare IT networks such as regional health information organizations in 2008, but because many are still being formed, it's unclear whether they'll be mature enough to certify by then. "We're keeping our eye on it," Leavitt says. "We haven't formed any workgroups yet."

Sights on specialties

CCHIT is also getting ready to expand its mission to certify EHR specialty modules. Its expansion roadmap calls for beginning development of certification requirements for cardiovascular medicine EHRs in the first half of 2007.

Also to begin this spring are focuses on products geared toward emergency department settings and child health populations.

Of course, the overall goal of certifying EHRs is to help physicians make more knowledgeable purchasing decisions and to boost health IT adoption. But while Leavitt says it's difficult to measure the impact of certification on the market, he has noticed an increase in awareness about the process.

"In the last three to six months, there has been a real upswing in physician understanding of what we do," he says. Professional societies like the American College of Physicians have been very helpful in spreading the word, he says. "Uptake by the vendors is another important signal of certification's validity."

Author Information:David Raths is a contributing writer based in Philadelphia.