EHR certification up and running
HIMSS attendees received an overview of current certification projects and a sneak peak into future initiatives of Certification Commission for Healthcare Information Technology (CCHIT) during a Tuesday Town Hall meeting.
The mission of CCHIT – to accelerate adoption of robust, interoperable health IT — is achieved via certification, said Mark Leavitt, MD, PhD, chair of CCHIT.
Certification benefits healthcare in four ways:
  • To reduce risks of buying an HER;
  • To ensure interoperability;
  • To unlock dollars from payors and reduce government barriers; and
  • To ensure privacy protection.
CCHIT serves as a coupling mechanism between EHR initiatives and the private sector and was awarded a Health and Human Services (HHS) contract that outlines objectives for the organization. The certification timeline began in 2006 with the development, pilot testing and launch of ambulatory EHR certification. Inpatient EHR certification follows in 2007, and health information networks are scheduled for 2008.
In addition, the organization will update criteria for each domain annually. This process consists of reviewing, prioritizing and testing existing standards; gathering public comments; developing criteria and roadmaps; developing and holding tests and launching the certification program.
The inpatient EHR certification initiative, which is in process, is open for public comment through March 16, 2007. Pilot tests are scheduled for April and May, and a launch is planned for August 2007.
The inpatient EHR certification is significantly more complex than the ambulatory EHR process, said Leavitt. CCHIT decided to focus inpatient certification on areas that have a high impact on patient quality and safety and a low current level of adoption: CPOE and medication administration; however, these modules are not a necessary first step to implementation, said Leavitt. In 2008, CCHIT will broaden coverage to other areas.
During the ambulatory development process, many respondents questioned whether or not a single set of criteria can cover a wide array of practices and enterprises. Leavitt defined the issue as a multi-dimensional challenge with various professional specialties, care settings and patient populations bringing unique issues and challenges to the table.
In the future, CCHIT will address these diverse needs by differentiating certifications and developing a roadmap outlining expanded certifications.
The organization plans to prioritize specialized certifications via an equation that calculates the benefit of expanded readiness, effort required to develop certification and the benefits of expanded certification. Initial feedback indicates top populations that could benefit from expanded certification are child health and behavioral health. Top care settings are the emergency department and long-term care; and priority specialties are cardiovascular medicine and allergy/immunology, dermatology, neurology and opthalmology.
Currently, CCHIT envisions certification structures that consist of universal foundation criteria. On top of the universal certification, vendors can meet setting specific criteria or population specific criteria and earn optional endorsements. Leavitt invited the audience to comment on the draft plan at
Certification is a consistent, standardized process, said Alisa Ray, executive director CCHIT. It is a high stakes test that vendors either pass or fail. The process includes fail-safe mechanisms that allow vendors to repeat a step in the same day, re-test with a new jury or appeal to the commission.
The inspection process relies on web-conferencing among three practicing physician jurors with vendor personnel following a test script to demonstrate approximately 300 steps. Fifty seven products, or 25 percent of the market, have achieved ambulatory EHR certification. 
Certification has established a level playing field with vendors of all sizes achieving certification, said Ray. Other evidence of the credibility of certification includes endorsement by professional societies and payor incentives.
Ray concluded with tips for creating an RFP and advice for vendors preparing for certification.
On the buyer side, sites should not copy and paste CCHIT criteria, which will cause confusion and add cost and complexity to the process. Instead, buyers should ask if the product is CCHIT certified.
On the vendor side, vendors can prep for certification by completing a complete practice run through test scripts, make revisions before application and ensure consistency through the application and product documentation.