How Important is Cchit Certification to Physicians in the Electronic Health Record Selection Process?

Your EMR / EHR – Does it have to be CCHIT certified?

What is CCHIT?

CCHIT or Certification Commission for Healthcare Information Technology was founded in 2004 by three industry associations (HIMSS, AHIMA and the Alliance) and is an independent non-profit private sector initiative that certifies EMR / EHR software (used interchangeably in this article) solutions based on a specified set of parameters. Its mission is to accelerate the adoption of robust, interoperable health information technology by creating a credible and efficient product certification process.

The purpose behind CCHIT

There are hundreds of EMR software solutions on the market, each differing in feature functionality, and it is easy for providers to get lost in the cacophony of vendors especially, considering that Providers are not IT experts and often find it difficult to properly assess and select an EMR solution that will best meet their current and foreseeable needs.  CCHIT certification was intended to reduce the risks of physician investment in EMR / EHR products, while achieving the following:

a. Facilitate interoperability of EMR products with the emerging national health information network, sometimes called RHIOs
b. Enhance availability of EMR adoption incentives
c. Ensure that EMR products protect the privacy of personal health information

EHR / EMR Certification Criteria

The main category of certification deals with products designed to be used in physician offices and clinics and commonly referred to as Ambulatory EMR.  CCHIT certified EMR products were required to demonstrate compliance with 116 criteria in 2006. Another 96 criteria were added in 2007 and in 2008, 19 new criteria were added to the certification requirements focusing on the following:

a. Additional electronic prescribing features including access to the patient's medication history, formulary, and eligibility.
b. Better and safer medication dosing, adjusted for patient weight and other factors.
c. Better ability to prevent adverse reactions due to drug interactions or allergies.
d. Use of standard formats to exchange basic patient information for continuity of care.
e. Enhanced ability to view X-rays and other diagnostic images.
f. Better management of patient consents and authorizations.
g. Increased use of standard formats when receiving and storing laboratory results.

How much do vendors spend for certification?

The initial cost of certification is about $28,000, which provides a three-year certification. Vendors then pay an additional $4,800 in each of the second and third years to cover marketing and licensing fees. An EMR is certified for three years, but if a product is significantly reengineered or re-architected before the end of the three-year period, it must be recertified.  Minor updates usually do not need re-certification.

As of January 2009, certified EMRs include the following:

a. Ninety-two EMRs that have received certification under the 2006 Ambulatory EHR criteria (latest certifications made on 30th April 2007).
b. Fifty-five EMRs (including multiple versions of the same product by the same company) that have been certified under the 2007 criteria.
c. Fifteen EMRs that have been certified under the 2008 criteria. These include a number of products that have been further certified for Child Health and Cardiovascular Medicine.

Compare these numbers against the 300+ EMR / EHR solutions available on the market and it is clear that the smaller niche players, offering cost-effective products, have neither the time nor the financial resources to spend on certification and especially, on re-certification every time they make any significant updates. This certification process is stifling competitors in the free marketplace and will only lead to higher prices and in turn, negatively impact Physicians’ pocket books.

What does certification really fetch?

EMR is a long-term investment and providers must be careful in choosing the right solution. Most practices have very limited time and resources to evaluate every detail of every product of interest.

On the other hand, certification can help with the evaluation and selection process by narrowing down the initial set of solutions because CCHIT certification assures implementation of basic functionality. This should allow a Practice to focus more upon performing due diligence about a companies’ track records in meeting individual practice’s special needs, ease of use, implementation success, financial viability, and after-sales service and support, and financial stability of the EMR vendor.

The flip side to this approach, insisting on certification will potentially cut out a significant population of more powerful (a better mousetrap) solutions from smaller vendors, who cannot afford the certification costs. Just because a product is not certified does not necessarily mean that it will not meet the specific requirements of the Practice. At the same time, a Practice may not really need the 300+ features mandated and evaluated by CCHIT. The real question of the day is, do you need a Rolls Royce when a Toyota Corolla might serve the purpose?

What must a Practice do?

Rather than getting fixated on CCHIT certification, a Practice would do well to create a checklist of features that are important to it. This list should include:

1. Does it support the specific requirements of the specialty? (CCHIT acknowledges that its criteria may not be suitable for settings such as behavioral health, emergency departments, or specialty practices.)
2. Does it allow the Practice to share information electronically with other physicians, hospitals, pharmacies, laboratories, radiology groups, and others? (from a technical viewpoint, any system that has HL7 interface, inbound and outbound, will be able to interoperate with other systems.
3. Does it enable you to measure and report the quality indicators, needed to satisfy payment incentive programs that are based on levels of performance?
4. Does the vendor have the reputation of providing outstanding customer support?
5. Are there any references of the same size practice, specialty, and type in the local market who can vouch for the ease of use of the selected product?
6. Does it help monitor potential adverse drug reactions?
7. Does the EMR interface with the Practice Management or Billing software? You should also find out if you need an integrated system with a common database.

These are only a few of the foundational questions, as there are many non-functional requirements that need to be addressed to ensure successful implementation of an EMR/EHR solution. These requirements are focused around people (commitment, volunteers, etc.), capital (cost, ROI, initial cost vs. annual costs), technology (server-based vs. ASP, tablets or laptops, etc.) and organization (stakeholders, selection and implementation leaders).

If all this seems too time consuming or overwhelming, the Practice must find a good independent EMR/EHR and Practice Management Solutions Firm who can assist in the initial needs assessment phase, vendor evaluation and selection process. These days you can find good Consultants who will do all of the up-front leg work for you at no cost to your practice. Therefore it would be wise to think twice before, employing a company wanting to charge hefty up-front retainers and steep per hour consulting fees ranging from $100 to $200 per hour.