How CCHIT influences your health tech purchasing

If you've sought help shopping for an electronic health record system in recent years, you probably have been advised to shop for "CCHIT-certified" systems.

But unless you are as entrenched in the health IT business as the consultants hired to help you, you may not know exactly what CCHIT is, and how it impacts what systems end up in practices across the country.

The basic mission of CCHIT -- the Certification Commission for Health Information Technology -- is to certify technology systems so that physicians could be assured what they were buying did what vendors said they would.

But its power comes from being the only Dept. of Health and Human Services-recognized certifying body for health information technology. More than likely, that means CCHIT will be the major force behind determining what health IT products physicians must use to get tax breaks under President Obama's stimulus package, and to get bonuses under Medicare for using health IT and avoid penalties (after 2015) for not using it.

CCHIT was formed in 2004 by three organizations -- the American Health Information Management Assn., the Health Information and Management Systems Society, and the National Alliance for Health Information Technology. In 2006, it got a federal contract to certify electronic health records systems.

CCHIT reports it has approved more than 200 electronic health records products, representing more than 75% of the market.

"The greatest gift that CCHIT gave to the marketplace was an ability for people to look at a list ... of functionalities and help set the bar for now and begin to look towards the future," said Laura Adams, who serves as president and CEO of the Rhode Island Quality Institute and is on the board of the National eHealth Collaborative.

"Funders could begin to give incentives out on the basis of adoption with some level of confidence that what systems they were paying for and incentivizing weren't going to turn out to be non-functional systems," she said.

However, experts said the downside was that CCHIT's approval was expensive, and that the cost was passed on to physicians. Cost is often cited as one of the main reasons EHR adoption rates among doctors has stalled at around 20%.

Critics claimed the expense of CCHIT meant that only the biggest-named vendors could submit products, leaving out potentially innovative products by small producers.

Reed Gelzer, MD, MPH, who has served on CCHIT workgroups and whose wife is a former CCHIT commissioner, said there's no question CCHIT has done good work. But the problem is the governance, which includes representatives from large vendors. "The trouble is they are picking and choosing not on the basis of what makes the best EMR, they are picking and choosing ... to facilitate the interests of the EMR vendors at the table."

CCHIT said with the greater federal push for records adoption, it is making systems more diverse in price and functionality.

"We've spent the last couple months ... explaining to those who are new what we do and how we do it and our track record and also acknowledging we need to change," said Mark Leavitt, MD, PhD, CCHIT chair.

Dr. Leavitt said the organization does not allow vendor commissioners to vote on items that could have an impact, negative or positive, on their own companies. He said there also is a limit to the number of vendors who can serve on the work groups, board of trustees and board of commissioners.

In a June 17 town hall-style Web conference, Dr. Leavitt outlined major challenges that have engendered opposition to CCHIT. Most notably, the price of certification, which could exclude nonprofit developers and small vendors as well as open-source and homegrown systems that aren't commercially available.

In response to those concerns, the commission is creating three pathways to certification: the EHR-C (comprehensive), the EHR-M (module) and the EHR-S (site) pathways.

EHR-S might have the greatest impact on physicians. It is for certifying open-source systems or those created by physicians for their own use. It generally would cost less than $5,000 for certification. EHR-M might have an effect on any practice that buys software packages from different vendors and puts them together for a single system. EHR-M would certify individual functionalities, rather than a system as a whole. That would run an average of $5,000 per software package. EHR-C is essentially what CCHIT does now, at an average cost of $30,000 per system.

Usability of the CCHIT-certified systems has also been a big issue, experts say. "It's wrong to say [usability] is totally in the eye of the beholder," Dr. Leavitt said. "There is some science behind it." He claims the organization will develop a rating system that makes sense to both novice and savvy users.

Dr. Leavitt said he feels confident CCHIT will continue its relationship with HHS. He also acknowledges the group's need to adapt as more physicians look to EHR adoption.

There was a lot of confidence placed in the organization by HHS and industry insiders before the American Recovery and Reinvestment Act was enacted, Dr. Leavitt said. But a larger, more mainstream spotlight was placed on the organization after ARRA passed.

Because of ARRA, "A lot of people came [around] that didn't understand us and didn't know about us that heard about certification when suddenly $34 billion got put on the table," he said.