At the end of August, the Certification Commission on Health Information Technology (CCHIT) and the Drummond Group were named by the Office of the National Coordinator for Health Information Technology (ONC) as the first technology review bodies that have been authorized to test and certify electronic health record (EHR) systems. Since CCHIT got its start in 2004, the commission has certified a couple hundred EHR systems every year. CCHIT’s Chair Karen Bell, M.D., took time out to speak to HCI Associate Editor Jennifer Prestigiacomo about the commission’s dual certification approach and what’s changed with the announcement of the Stage 1 meaningful use final rule.
Healthcare Informatics: How has the certification process changed in light of the release of Stage 1 requirements for meaningful use?
Karen Bell, M.D.: Prior to the release of the certification criteria by the federal government in July, most products that we were certifying were pretty much state-of-the-art. Then in July, the federal government added on a number of criteria. One of them had to do with the ability to calculate a specific set of quality measures, and that had not been something that CMS had required earlier, so it wasn’t in our system.
Secondly, there were a number of requirements in the criteria that were based on standards that hadn’t been developed yet, so there was a need to think through how to address that [issue], because obviously, if there are no standards, then you’re going to end up with a situation where everyone does it differently. There were also some things like figuring out how to [record] smoking information, where there hadn’t been any standardized way of doing that electronically before. So there were a number of these kinds of things that [providers] requested, but none of the EHRs had them in place. In addition to that, because they [the U.S. Department of Health and Human Services] are very focused on assuring that structured data goes into the electronic health record, they have essentially postponed a lot of the requirements and criteria regarding interoperability, which we’ve been certifying for some time. So there are some differences between the two, and that’s why a number of vendors have to really work hard to come up to speed with assuring that they’re going to be certified by the new criteria that the government has put out.
HCI: Do you think with the inclusion of the emergency department (ED) in Stage 1, you’ll see more products have interoperability between their inpatient and ED systems?
Bell: Right now, they’re [ONC] not focusing on emergency department EHRs. They have quality measures that the hospitals are required to report, but they are not focusing on emergency room EHRs. They’re simply focusing on hospitals where the emergency department is already integrated in. I think we will be seeing a lot more need for interoperability as time goes on.
HCI: What are your goals for the Sept. 20 town hall meeting coming up?
Bell: This will be an opportunity to open up and start certifying all the vendors out there who are ready to go. We don’t have a process where we open up and take applications and tell them, ‘Well, we’ll get back to you in a few weeks.’ Once we open and start taking applications, we will be certifying those EHRs in a matter of a very short time period, and then announcing those very quickly.
HCI: How long does it take for CCHIT to certify a product?
Bell: To this point in time, we’ve kept it to a one-day process. There’s a lot of stuff that’s gone into that, and we’ve been lucky to have an opportunity to look at a lot of efficiencies over the course of the last several years.
HCI: Will CCHIT ever certify HIEs as EHNAC (the Farmington, Conn.-based Electronic Healthcare Network Accreditation Commission) is doing?
Bell: Well, we had actually prepared to do that core business under contract with the federal government, and then there were a change in priorities, so we stopped. The bottom line here is we do have expertise in that area, but where we go with it will depend on where the federal government decides to go in the next couple of years.
HCI: What about certifying master patient indexes (MPIs)?
Bell: That is an area that right now, no one is thinking of certifying. We’re keeping an eye on the environment; if there seems to be a good opportunity to do that, then we’ll consider it at that point. Right now, that’s such a dynamic arena that we’re holding back on going in that direction till we learn more.
HCI: What do you think about the other groups that are ONC-Authorized Testing and Certification Bodies (ATCBs)?
Bell: Well, the only one we know about is the Drummond Group, which was announced at the time we were. Actually, to be very honest, we don’t know that much about them. We know that they have done a lot of work in terms of interoperability of systems that are not related to electronic health records, and that’s a new area for them, but that’s pretty much all we know.
HCI: Why do you think it’s imperative that EHR products be CCHIT-certified?
Bell: The take-home message that I’d like to leave is that the delivery system has multiple needs. The very specific, narrowly focused certification criteria that matches Stage 1 meaningful use, will not meet the more robust needs of the delivery system. So what we have been supporting is the needs for both types of certification: our branded product, which is much more robust with respect to interoperability, functionality, and security. And then using our other certification, the HHS certification, to assure the delivery system that’s eligible, i.e. the eligible clinicians in the hospital, can obtain their meaningful use incentive payments. So we’re recommending a dual approach. And many of our vendors are doing that because we’re offering a very favorable pricing for the vendors that want both.
HCI: Do you think that as meaningful use rolls forward, the value of certification will be validated?
Bell: To be very honest, that’s already happened. We started with ambulatory EHRs, got into the area of hospital, and since then, we’ve met the request to have certification for specialties like cardiovascular, dermatology, etc., and we have expanded into other areas. A whole new area this year for us has been long term and post-acute care. So vendors, with respect to electronic health records, recognize there’s huge value to undergoing our process and guarantying they will have state-of-the-art functionality built-in.
HCI: What other CCHIT certification programs will come out in the future?
Bell: We’re working now on OB/women’s health and also cancer therapy [to be released] within the year.