Tech Tips: This is Some CCHIT, Eh?

The aim of the Certification Commission for Health Information Technology (CCHIT) is to encourage the adoption of EMRs by establishing standards of functionality and rigorously evaluating which EMR products meet these standards. This is supposed to improve consumer confidence in certified products so that physicians will be more willing to invest in this technology. The CCHIT has also implemented standards of interoperability and security. It would appear that CCHIT-certified EMRs have a clear-cut market advantage, but I am not aware of any objective information which would substantiate whether the CCHIT has been successful in achieving its goal.

Is CCHIT the gold standard?

There are several arguments commonly off ered by smaller EMR vendors pointing out the potential shortcomings of CCHIT’s process and its certified products.

Cost — The EMR product will be more expensive. It costs each vendor $28,000 to have their product tested by the CCHIT—which is actually a small portion of the additional expense that successful certification requires. The larger fraction of the cost goes to the extensive development of the product demanded by the exacting standards required for certifi cation. These requirements, many of which may not be used by most neurology practices, may cost vendors hundreds of thousands of dollars for software development. User-friendly features – CCHIT does not assess the ease-of-use qualities of any product. The judgment of individual CCHIT criteria is on a “pass-fail” basis. Therefore, how many steps are needed to complete a task, how long it takes to complete computer tasks, and how diffi cult an EMR is to learn are not considered when evaluating a product. In fact, some of the smaller vendors assert that the complicated CCHIT requirements invariably add clicks and additional computer input in order to satisfy some of the standards. The implication, not proven, is that CCHIT products are less effi cient because they require more data input steps than functional but non-certified EMRs.

CCHIT products are geared toward larger, primary care groups — The CCHIT actually acknowledged this shortcoming a couple years ago when it stated its criteria “may not be suitable for settings such as behavioral health, emergency departments, or specialty practices and our current certifi cation makes no representation for these. Purchasers should not interpret a lack of CCHIT Certifi cation as being of signifi cance for specialties and domains not yet addressed by CCHIT Criteria.”

On the other hand, certifi cation does have its rewards

CCHIT-certified EMR products offer several advantages over their competitors.

Guaranteed functional, interoperable, and security standards — CCHIT is a wellrespected, forward-thinking entity that currently has nearly 250 criteria serving to set high standards for ambulatory EMRs. Regulatory standards – Although the CCHIT is theoretically a private, independent agency it actually functions with the authority of the federal government. As a result of this special infl uence, CCHIT certifi cation is increasingly being required to fulfi ll CMS initiatives. Many of these requirements are eminently reasonable and in fact necessary for the development of a national health information initiative. For example, a standard clinical vocabulary eliminates many problems with system interoperability (a hurdle that would not likely be overcome without governmental intervention).

Records must be exportable in a universal format so that chart information will be accessible in any certifi ed EMR. These are just two examples of highly desirable EMR features that likely would not have been implemented if left to vendor choice. Financial benefits — One financial benefit to choosing CCHIT-certified products is that they qualify under a special exemption to the Stark and anti-kickback laws, allowing a local hospital or health system to cover most of the cost for you. Another important consideration to keep in mind is that some pay-for-performance initiatives for 2008 specify that EMRs must be certified or have provable functionalities (obviously favoring CCHIT products) in order to qualify for participation. In the future, you may be required to report on all P4P or quality data using a CCHIT product. In fact, as further government mandates are implemented requiring the use of electronic prescribing and EMR in order to qualify for CMS reimbursement, it is likely that certified products will be required. Finally, some professional liability insurers are off ering premium discounts for the use of certified EMRs.

The final decision is up to you

Should your practice require CCHIT certifi cation when selecting potential EMR products? In order to answer this question, you must defi ne your current EMR goals into the next couple of years. Again, most neurology practices will only use a fraction of the features of a certifi ed product. CCHIT criteria should be reviewed to determine their relevance to your practice’s needs. A less complicated and possibly less expensive product may off er all the functionality of a certifi ed product but with greater ease of use and a lower price tag. Other considerations not addressed by CCHIT include vendor fi nancial stability, product training, and support. Th ese are important considerations when buying an EMR. Therefore, if all other considerations were equal, given the choice between a certifi ed vs. a non-certifi ed product, the current and expected regulatory demands clearly favor the certifi ed product.

Dr. Zuckerman is an MDNG Healthcare IT Advisory Board member, and the Chief of Neurology and Medical Information Officer at Baton Rouge General Hospital in Louisiana.