Will seal of approval spur EMR adoption?

Uncertainty about what an electronic medical record is supposed to contain, and the related fear about sinking money into a system that might not provide what physicians need, has kept many doctors, particularly those in small practices, from embracing information technology in their clinical practices.

On July 18, the Certification Commission for Healthcare Information Technology made what the AMA, among others, says is a significant stride toward helping ease physicians' concerns. CCHIT announced that products from 20 vendors had met its 2006 certification criteria for ambulatory EMR functionality, security and interoperability. This seal of approval should assure physicians that, at the least, these vendors' systems have the capability of providing what doctors need.

The product certification "is a big step forward" because it offers doctors a set of benchmark criteria for EMRs, Mark Leavitt, MD, PhD, CCHIT chair, told AMNews in a telephone interview after a joint news conference with Health and Human Services Secretary Michael Leavitt (no relation).

While no one is expecting skeptical physicians to immediately start buying EMRs, physician leaders do believe that the CCHIT's list, which is available online (link), does offer guidance.

"CCHIT's ambulatory electronic health record systems product certification will act as an important tool to help physicians make EHRs purchasing decisions," said Michael D. Maves, MD, MBA, American Medical Association executive vice president and CEO, in a prepared statement of support for CCHIT's program.

The certification should "stimulate more implementation of [EMRs] on the part of physician practices because it has reduced some of the risk that physicians face in making a decision," said Steven Lazarus, PhD, president of Boundary Information Group, a Denver-based provider of technology consulting services to physicians.

"It doesn't eliminate all the risk, but that was not the whole intent and it should have that effect ... if they stick to the vendors on the list or as the list grows," Lazarus said.

CCHIT is a private consortium that last year received a three-year, $2.7 million contract from the Centers for Medicare & Medicaid Services to develop, as CMS put it, criteria and evaluation processes for certifying EMRs and the infrastructure or network components through which they interoperate. But work on certification already had been under way since 2004, when CCHIT was developed as an alliance of the American Health Information Management Assn., the Healthcare Information and Management Systems Society and the National Alliance for Health Information Technology.

Setting standards

So far, CCHIT has developed and published about 340 standards for ambulatory EMR functionality, security and interoperability.

For 2006, vendors must meet 152 of these standards, while the remainder provide a road map to vendors for 2007 and beyond. All but one of the standards applicable to 2006 relate to functionality and security. CCHIT did not test products for interoperability this year, though vendors had to attest that their products could receive laboratory results. This demonstrated the ability to interact with other systems.

CCHIT is awaiting interoperability recommendations from the American National Standards Institute's Health Information Technology Standards Panel, Dr. Leavitt said. ANSI is a public-private consortium (the AMA is a member) that develops technology and operating standards for various industries.

More than two dozen vendors applied for certification, and a small number of products are still being tested, Dr. Leavitt said. Vendors who fail to pass the criteria will not be identified.

"We're here to accelerate the adoption of health information technology, not do anything that could be punitive," Dr. Leavitt said. Vendors who do fail can upgrade the product and reapply.

Alternatively, some experts said, there are plenty of quality systems that aren't on the CCHIT list but would still meet physicians' needs.

Upgrades each year

CCHIT will upgrade its criteria annually, and vendors may opt for annual recertification, Dr. Leavitt said. Fees for doing so have not yet been determined. Vendors who receive 2006 certification may promote that on marketing materials for up to three years, at which time recertification will be required.

"Having certified products in the market is a good thing and should be something that physicians take a look at [when making an EMR purchasing decision]. The process will hopefully continue, and add more and more value to physicians," said Steven E. Waldren, MD, assistant director of the American Academy of Family Physicians' Center for Health Information Technology.

But checking certification should not be the end of a physician's EMR investigation, Dr. Waldren and others cautioned.

It "doesn't mean that if [physicians] pick a certified product that they are guaranteed to find the right product for their practice."