EMR Ratings: How Relevant Is CCHIT Certification In the HITECH Era?

For nearly four years, the Certification Commission for Health Information Technology (CCHIT) has been the lone entity recognized by the federal government to certify electronic health record systems. Since being named a recognized certifying body by Health and Human Services (HHS) in 2006, CCHIT has awarded certifications to nearly 200 EHR software products based on CCHIT’s standards of functionality, interoperability, usability and security.

However, CCHIT’s role in the EHR market is changing. The Office of the National Coordinator of Health IT (ONC) and the Center for Medicare & Medicaid Services (CMS) announced in early March 2010 that they would name more than one organization to certify EHR software, countering previous claims that CCHIT would become the sole certifying body. The certification requirements are in accordance with 2009’s Health Information Technology for Economic and Clinical Health (HITECH) Act.

As this news swirled around, one doctor called Software Advice and asked: “Is CCHIT dead?

Dead? No. But it appears that the organization’s influence is waning.

In the spirit of point counterpoint, here are three reasons why CCHIT could become less relevant in the EHR industry:

  • Competition with other certifying entities;
  • Influence of regional extension centers; and,
  • Diminishing need for certification.

And here are three reasons why CCHIT could continue to remain relevant:

  • Institutional knowledge;
  • CCHIT products are a bridge to HITECH incentives; and,
  • Need for alternatives to government certification.

Why CCHIT Will Become Less Relevant
CCHIT became a recognized certifying body (RCB) in 2006 so that hospitals could donate IT systems, equipment and training to physicians and other healthcare providers without fear of violating anti-kickback laws. If the equipment donated by the hospitals was approved by an RCB, then it was perfectly legal. CCHIT was the only organization, and still is, to earn the RCB designation.

Fast forward to 2010 and you’ll see how CCHIT has outgrown this role. Even though we think that CCHIT has considerable staying power in the EHR software market, the organization’s fight to remain relevant includes numerous obstacles as the U.S. healthcare system enters the “HITECH era.”

Competition with other certifying bodies. In a recommendation released in August 2009, the Health IT Policy Committee, an advisory group to the National Coordinator for Health IT, said that it would be in the best interest of the healthcare industry to have multiple entities certifying EHR software.

This recommendation by the Health IT Policy Committee effectively ends CCHIT’s “monopoly” on certifying EHR software. Other groups, such as The Drummond Group, are beginning to step into the certification space. This company “has tested over a thousand international software products used in vertical industries such as automotive, consumer product goods, healthcare, energy, financial services, government, petroleum, pharmaceutical and retail.” While The Drummond Group hasn’t specifically certified EHR software before, they obviously feel comfortable enough with the government’s certification requirements to move forward with their application.

Private entitites aren’t the only groups involved in certifying EHRs. The National Institute of Standards and Technology, a government entity, is collaborating “with health IT stakeholders such as vendors, implementers, standards organizations and certification bodies to establish a testing infrastructure.” Essentially, the institute will monitor the organizations that become official certifying bodies and ensure they’re held to national data standards.

In short, there is now competition and oversight in a space where previously there was none. This alone reduces CCHIT’s influence and relevance. Organizations that become RCBs will have the opportunity to attack CCHIT’s perceived weak spots, such as evaluating more specialty-specific EHR software and offering certification programs with less stringent requirements.

RECs may not choose CCHIT-certified products. The HITECH Act established approximately 60 regional education centers (REC) whose goal is to “offer technical assistance, guidance, and information to support and accelerate health care providers’ efforts to become meaningful users of Electronic Health Records.” Spread throughout the country, RECs are tasked with getting approximately 100,000 physicians up to speed as meaningful users of EHR software over the next two years.

The RECs not only will help physicians implement EHR software but also will choose “preferred” EHR vendors to work with. For example, the NYEC Regional Extension Center, which serves New York state except for New York City, recently chose eClinicalWorks, Eclipsys, Greenway, NextGen and Sage as “preferred vendors.”

How does this affect CCHIT? Each REC can choose their own preferred EHR software vendors, CCHIT-certified or not. If RECs choose to promote vendors that don’t offer CCHIT-certified EHR software, then CCHIT is effectively cut out of that region’s REC physician pool. The more software vendors RECs choose that are not CCHIT-certified, the less influence the commission will have. Conversely, if RECs choose CCHIT-certified software or make CCHIT certification part of their preferred vendor selection process, the commission stands to actually increase their influence in the EHR arena.

Certification may become less important to new vendors. The list of EHR software providers that are currently CCHIT-certified leans heavily towards larger, more established software vendors. While some may take this as an indication of CCHIT bias towards larger vendors, others may argue that smaller or less established vendors may not choose to have their products CCHIT-certified because of the cost involved.

Whether or not new competition drives down CCHIT’s certification fees remains to be seen. If their certification costs remain high, it’s plausible that more EHR vendors without interest in CCHIT certification will emerge. The emergence of cloud computing and Software as a Service (SaaS) applications is bringing software development and maintenance costs down. A lower barrier of entry to the market means more niche vendors will emerge, filling in gaps that CCHIT-certified software doesn’t fill.

Why CCHIT Will Become More Relevant
CCHIT has been entrenched in the EHR certification game for too long to just disappear. In fact, there’s an argument that CCHIT stands a good chance of becoming a permanent certifying body in the EHR software industry. Here are a few reasons why CCHIT will continue to remain relevant to providers searching for EHR software.

Experience counts. In the world of EHR certification, CCHIT is currently “it.” They’ve been carrying the torch of EHR certification since the organization was created in 2004. No other U.S. organization has been more thoroughly involved in testing and certifying EHR software than CCHIT. They’ve certified nearly 200 products since 2006.

With experience like that, it’s unlikely that CCHIT will be left out in the cold once Health & Human Services chooses certification bodies. CCHIT already has applied to become an official certification body under the program and created a preliminary EHR certification program designed to meet the proposed HITECH standards. Even if CCHIT isn’t the best choice to become an official certifying body, it’s tough to argue against including them as at least one of the options.

The bottom line: No other organization is as prepared as CCHIT is to begin certifying EHR software for the government.

CCHIT products are the “best bet.” Many providers and hospitals are waiting on the certification requirements of the HITECH Act to become final before they choose an EHR software system. At the same time, a provider needs to demonstrate meaningful use for 90 consecutive business days in the year 2011 to earn up to $18,000 in incentive payments for the 2011 calendar year.

So, providers need to have an EHR up and running relatively quickly but they’re still not sure what EHR systems are going to be certified. What can they do? Currently, CCHIT offers a Preliminary 2011 ARRA certification in addition to its it’s full 2011 EHR certification. CCHIT’s ARRA certification is “simpler and more flexible” than the normal CCHIT certification and is “designed to demonstrate that a developer’s technology is well-prepared to be certified once ONC-accredited testing and certification becomes available.”

It’s likely that in this time of uncertainty, many providers and even RECs are turning to CCHIT-certified products to guide them.

Alternatives to government certification are needed. The HITECH Act’s success is not guaranteed. And in the event that the government-sponsored EHR certification program doesn’t succeed or loses relevance, the market will need to fill a void. Some authority on EHR software will be needed and CCHIT is one of the best positioned organizations to become that authority.

Even if the HITECH Act is a rousing success, the EHR market will still have a need for an organization akin to what CCHIT and others do now – evaluate the functionality of EHR systems.

This article originally appeared on Software Advice: EMR Ratings: How Relevant Is CCHIT Certification In the HITECH Era?. Chris Thorman blogs at Software Advice, a website devoted to research and reviews of software used in construction, medicine, property management, retail, and manufacturing. Prior to SA, he worked in politics and with international non-profit organizations.

18 replies »

  1. Chris, nice post! Thanks for sharing. I would like to mention the Romexsoft company. It`s an outsourcing provider in Ukraine which has more than 15+ years of experience in healthcare software development. Also, I am sharing the blog that shows what we need to know about electronic health or medical record

  2. Thanks for sharing! Indeed, EHR development has a lot of benefits for patients and medical providers.
    But also we should always keep up with news regarding policies and software compliance, since cybersecurity and data protection are a core element in any

  3. This article is a decent, reasonably adjusted analysis, and it provided for me a lot of focuses to consider. Thanks for sharing.

  4. Also I think ROI is very important factor that should be duly considered when look achieve a ‘meaning use’ out of a EHR solution. Though one may get vendors providing ‘meaning use’ at a lower cost, their ROI / savings through the use of their EHR might be pretty low when compared to costlier initial investment. Found a pretty useful ROI tool that is pretty customizable and easy to use. It also accounts for the different specialty EHR’s too.

  5. Hi,
    An electronic medical record is not just a typed record of the patient encounter, but an extremely useful decision support tool. The data can be entered into the EMR via any of the two general mechanisms: direct entry by the physician using point and click templates or transcription of dictated notes.

  6. Really, could not agree more on this topic. Great post, flushed out many of the certification issues in this incentive era.
    I feel today medical practitioners are looking to avail of this federal incentive by trying to comply with the definition of meaningful use but at the same time EHR providers are looking at their own set of profits.
    This misunderstanding is mostly I believe as a result of wrong interpretation of the federal guidelines. The EHR providers need to look at these guidelines from the prospective of the practitioners who deal with different specialties.
    Each specialty EHR has its own set of challenges or requirements which I believe is overlooked by in most EHR vendors in a effort to merely follows federal guidelines. This is resulting in low usability to the practitioners, thus less ROI, finally redundancy of the EHR solution in place.
    I think ROI is very important factor that should be duly considered when look achieve a ‘meaning use’ out of a EHR solution. Though one may get vendors providing ‘meaning use’ at a lower cost, their ROI / savings through the use of their EHR might be pretty low when compared to costlier initial investment. Found a pretty useful ROI tool that is pretty customizable and easy to use. It also accounts for the different specialty EHR’s too.
    Also the introduction of REC’s through the HITECH act. is a great way to avail of quality EHR solutions at competitive prices. The stiff competition among not only these REC’s but also among EHR vendors ( to become a preferred vendor of a given REC) will result in lot of positives to medical practioners.
    Looking the funding provided to the REC’s, the staggered grant allocation system also promises to be an unbiased way of allocating funds. It will also help in the concept of REC’s helping out each with their own unique business models. It can be one of the possible answers to the ‘safe EHR vendor’ challenge as discussed by many critics.
    There are other good references on the topics of:
    Usability/meaningful use
    Certification criteria for EHR
    Sorry to have diverted a bit from the topic but I feel this HITECT act and the REC’s are going to play an important role, as discussed above in the successful EHR implementation in the medical practices in our country.

  7. I never rode in a fraud mobile but when using CCHIT certified EMRs, I was on a magical mystery tour. I saw never never land where patients die and no one cares, I saw heaven on earth where morphine drips put the mistakes out of their misery, all due to the comedy of certification.

  8. In the land of make believe known as “Never Land” , Tinker Bell might actually be able to do something interesting beside playing dead and waiting for people to clap her back to life. Here in the real world, I believe we would all applaud Tinker Bell packing up the CCHIT fraud-mobile and taking it to the junk yard, complete with the teapot and unused tea leaves.
    Unfortunately the next act means we have to applaud before Tink is animated enough to realize this is what needs to be done. She will have to rescue the taxpayers checkbook away from Captain Hook-Lieber of Crook County and his EHRA ship of thieves with no help from Peter as Peter has gone back to paper based medical records and a land in which the printed word actually means something like integrity, honesty, safety and efficacy.
    Ok Boys and Girls, everyone clap now.

  9. While reading the article and comments I am reminded of the sleuthing by a young Calvin Jablonski, and later, his revelations that exposed CCHIT for what they are and perpetrated. I remember the words of readers who said their computers overheated and began smoking when CCHIT was discovered for selling rubber stamps, bogus laboratory operations, connections to HIMSS and HIMSS payroll.
    How much does a fake d
    Drivers License cost in L.A. and what happens when you get caught with one?
    OK , perhaps that’s unfair, but here is the thing. The Government has sponsored an artificial marketplace and now requires the adoption of the products made for this marketplace, EHRs. CCHIT is a government sponsored Brand around which a technocratic elite class have been allowed to profit by selling into this marketplace with the profits running into the billions of dollars. Statements about testing and relevance in this article are an effort to raise CCHIT up out of the ashes and landfill, the landfill Calvin Jablonski provided them.
    The notion of safety, testing and efficacy are a hoax upon the American people and another fine example of Government not doing its job to protect the people but instead allowing private business interests to do whatever they want. And this is now the new normal, breaking the law is ok because nobody gives a damn as long as they are making money. The rationale is offered: “Gee, they must be legitimate, they are making money”.
    Government brands like CCHIT present the potential for another perfect storm just like the BP scenario in the Gulf. So, are are we going to wait for the death toll to rise before we realize its another man-made disaster? Or are we going to wake up from the pathetic delusional dream and get a grip on regulation before its too late?
    If this was all about corn flakes it probably wouldn’t matter too much but this is about patients and human lives so the relevance here is not snap , crackle, pop and no person nicknamed Dr.Tinker Bell or Dr. Clancey the Clown is going to fix this and don’t try to sell us on the idea of appointing a fake Vietnam Veteran to head up the organization either.

  10. Dr. Jones,
    I was one of several people fortunate enough to take the C$HIT tour, and have a bite to eat in their “cafeteria” located behind the receptionist area on the 31st floor. The tour took 5 minutes.
    As a matter of record, CSHIT is a “virtual office”. CCHIT has used its $8.9 million in grants to pay for a mail box and a receptionist on the 31st floor (from $99/month). Alisa Ray picks up CSHIT mail on Fridays, Mark Leavitt had his mail bundled up and mailed to him in Oregon. I wonder what Tinker Bell will do?
    Anyone can take the tour with Regus, who manages the building. Give them a call:
    200 South Wacker Drive
    31st Floor
    Chicago, Illinois 60606
    United States
    Main tel: +1 312 674 4500
    Main fax: + 1 312 674 4501

  11. One problem: C$HIT ignores matters of safety and efficacy, but the vendors through C$HIT’s parent, HIM$$, deceived the Congress that certification consisted of safety criteria.
    Has any one visited the international headquarters of C$HIT on the Wackers in Chi town? Does any one know what is there?

  12. This article is a good, fairly balanced commentary, and it gave me plenty of points to ponder. I’ve posted a complete response over at the Occam PM blog. Be sure to check out the full article over at Software Advice, and vote in the survey (there’s only 17 votes right now).