With more than 200 products in the ambulatory EHR marketplace, how do we begin?

Our physicians can’t agree on what should be included in an EHR—is there an authoritative source?

With all the talk of regional health information organizations, information exchanges, and a nationwide health information network, how can we be sure our EHR will be compatible with them?

Everyone is worrying about electronic data and privacy today, so how can we assure that the EHR we buy has adequate security?

The Certification Commission for Healthcare Information Technology (CCHIT®) was founded with the precise goal of helping you answer these questions and select an EHR product with confidence. We have created this guide to help physicians and practice managers understand the benefits they can expect when EHR products have been certified by CCHIT.

The Certification Commission is an officially “recognized certification body” in the United States for EHR products— a private, nonprofit organization that is to electronic health records what Underwriters Laboratories is to electrical products. The Commission is the official agency to apply standards, test products, and award a “seal of compliance” to EHR software. If you buy an electrical product, you expect to see the UL® seal. If you buy an EHR, you should look for the CCHIT certification seal.

As part of a broad federal initiative to create national standards for health information technology, the U.S. Department of Health and Human Services awarded the Commission a three year contract to develop certification criteria and manage an inspection process for certifying EHRs and the health information exchanges over which they transport patient information.

The Certification Commission brings together panels of volunteers— many of them physicians and nurses — with expertise in electronic health records. After thorough exploration and debate, as well as a review of thousands of comments from the public, the Commission reached consensus on standards-based criteria and other requirements that an EHR product must meet to attain certification. Certification is voluntary, but in the first year after the commission began offering certification, nearly half of the EHR companies in the marketplace brought their products to the Commission for testing. Both large and small companies, serving practices of all sizes, now offer certified products.

What Certification Means

As a provider contemplating purchase of an EHR product, you are about to make a substantial investment in a system that you and your colleagues must rely on for a long time — 10 or 20 years or more. Few practices have the time and resources to evaluate every detail of every product of interest.
Relying on certification can help with your selection process. When you are ready to purchase an EHR, you can use certification to narrow the initial field of vendors. CCHIT certification also assures you of basic functionality. That allows you to focus your evaluation on the special needs of your practice and on performing important due diligence on the companies’ track records of implementation success, after-sales service and support, and financial stability. While cost is a major consideration, an EHR purchase is a critical business decision that should not be based on cost alone. Physicians in practices of all sizes may want to share information electronically with other physicians, hospitals, pharmacies, laboratories, radiology groups, and others.

If its EHR does not have the appropriate interoperability and security features, a small practice and its patients will be at a serious disadvantage in trying to connect up with other providers and organizations.

Certification can also help reduce your risk when you select
an EHR. The Certification Commission stays abreast of the new demands that practices face, and ensures that CCHIT Certified® products have the capability of fulfilling those
needs. For example:

■ Certified products enable you to measure and report the quality indicators needed to satisfy payment incentive programs that are based on levels of performance.
■ Certified products qualify under a special exemption to the Stark and anti-kickback laws in healthcare, allowing a local hospital or health system to cover most of their cost for you.
■ Some professional liability insurers are offering premium discounts for use of certified EHRs.

Beware of “Wannabees”
Beware of claims that products are “CCHIT compliant.” Only the CCHIT Certified seal guarantees that
products have undergone the rigorous testing required for certification by the Commission.

The certification requirements have become more stringent since the inception of the CCHIT Certification. EHR companies with the best technology and resources are moving forward with the ever changing requirements of CCHIT criteria, and demands of the healthcare industry.

• 2006 - 83 EHR companies received CCHIT certification meeting the Ambulatory EHR criteria.
  
• 2007 - 51 EHR companies received CCHIT certification meeting the Ambulatory EHR criteria.
• 2008 - Only 12 EHR companies received CCHIT certification meeting the Ambulatory EHR criteria, and the year is almost over.

The most current list of CCHIT Certified® products can be found at: www.cchit.org/cchit-certified

New This Year:
Additional Certifications for EHRs in Physician Practice Areas
A main category of certification has to do with products designed to be used in physician offices and clinics— the Ambulatory EHR. In 2006 these products were required to demonstrate 116 criteria, and in 2007 another 96 were added. For 08 the certification requirements were further enhanced, including use of standard formats to exchange basic patient information with other EHRs for continuity of care. Also for 08, new refinements have been added to this category, covering two specific areas of practice.

If you are engaged in caring for children, you know there are needs unique to this population that may not be in an adult oriented EHR. You’ll want to look for an Ambulatory EHR that also carries the  additional certification for Child Health. Or, if your specialty is cardiology, you need test results and information that are specific to cardiovascular medicine. Look for an Ambulatory EHR that carries the additional certification in Cardiovascular Medicine. Child health and cardiology are special areas for which criteria have been developed and EHR vendors can optionally elect to meet. Products when tested for compliance must meet all the current criteria for ambulatory EHR certification and also deliver on the extra criteria for the targeted specialty.

Certification of EHR Systems in Other Settings
This year, there is a new certification available for systems for use in the Emergency Department.
Certification for systems in hospitals is also offered, with updated requirements this year. The requirements are particularly deep in the area of physician order entry and medication records. Work has begun on developing certification programs for information systems serving behavioral health and personal health records, with certification to begin in 2009.

What Certification Requires
Companies that apply for CCHIT certification must submit their products to a rigorous inspection process against comprehensive criteria.  A jury of three EHR experts—including at least one practicing physician—observes a carefully scripted product demonstration. This inspection takes a full day and covers four distinct clinical scenarios. One script, for example, simulates a visit by a well child to a primary care physician and checks an EHR’s ability to:

■ Correctly identify the patient and his parent
■ Document and track immunization history, prescriptions, and lab reports
■ Provide guidelines for prevention and wellness care.

In another scenario, an elderly man with poorly controlled
diabetes, hypertension, and other chronic conditions visits his doctor. In this case, the EHR under inspection must demonstrate that it can:

■ Monitor potential adverse drug reactions
■ Help with disease management
■ Provide treatment plans
■ Generate quality improvement reports.

Additional clinical scenarios are being developed as the Certification Commission expands its work into other areas. The criteria that must be met for a product to be certified by the Commission are developed by a broad team of volunteer experts meeting in multi-disciplinary work groups and expert panels. Recommended criteria are approved by a 21-member Board of Commissioners

Besides specifying the new criteria and tests required annually, the documents include a “Roadmap” that outlines
additional criteria that will be required in future years. The Roadmap provides guidance to providers and the industry
by offering a realistic time table for incremental improvements in EHR systems. Each year the Roadmap is extended
to project criteria two years into the future.

Three Good Reasons to Purchase an EHR Product Today
You shouldn’t delay an EHR purchase just because some criteria on the Roadmap are not yet required.
There will always be new requirements on the horizon.

1. Delaying could mean that you are also delaying your eligibility for pay-for-performance and other programs. It could take time—two years or more—for you to start up a new EHR system, collect data and implement a meaningful quality improvement mechanism that would lead to your receiving incentive payments under these programs. Waiting could cause you to miss several years of potential incentive payments, liability insurance discounts, and other benefits.

2. In a competitive environment, it might be hard to catch up with medical practices that implement EHR systems sooner. Practices with EHR systems gain a head start in measuring and improving quality, increasing efficiency, and providing better service for patients.

3. Having an EHR is becoming a notable benefit when attempting to recruit new physicians.