July, 2009: Why Is CCHIT (CERTIFICATION COMMISSION FOR HEALTH CARE INFORMATION TECHNOLOGY) so important to the practice of medicine?
An electronic medical record (EMR) is a computer-based patient medical record that contains documents that are generated in an electronic format. The EMR supports the record of events, decisions, and information pertaining to a patient’s care as well as the ability of ordering prescriptions and tests. In 2000 Malcolm Gladwell wrote that the “The Tipping Point” is when an idea or policy is at the levels at which the momentum for change becomes unstoppable. The conversion to digital records has reached the Tipping Point. The debate has moved from whether it is going to happen, to “how it will be implemented”. The policy makers understand the benefits and hurdles:
The Benefits include increased administrative efficiencies, a reduced need for paper and storage, preventing medical errors, enhanced coordination of care and avoiding duplication of medical testing, electronic prescription and lab, simultaneous and remote access to patient information, clinical decision support at point of care. It is believed that all of the above should lead to costs savings and improved quality of care.
Hurdles to adoption include: Cost, time and impact on the practice for implementation and training, loss of productivity when the provider uses the system directly, choosing the best system (which includes understanding the Stimulus funding), and the security of the data.
To accelerate the adoption of EMRs, the federal government (much through the Medicare/Medicaid program) has developed incentive programs to encourage the transition over the next 5 years. After year 5 penalties will be assessed for not adopting health information technology. There are current programs in place such as e-prescribing (see PRI Communication #2) and the federal stimulus funds (see PRI Communication #1). The key issues related to the debate on “how to implement” the national adoption of electronic medical records, are features, standards and interoperability (patient information exchange). The American Recovery and Reinvestment Act (knows as ARRA, Stimulus Plan, or HITECH) specifically requires the “meaningful use’ of a certified EHR. The only existing certification entity in the United States is, The Certification Commission for Healthcare Information Technology (better known as “CCHIT”). By law the Department of Health and Human Services has until December 2009 to specifically determine what CERTIFIED EHR means. So far all indications are that CCHIT will be that entity.
The Certification Commission for Healthcare Information Technology (CCHIT) is a U.S. Department of Health and Human Services (HHS) funded organization that serves as the recognized US certification authority for electronic health records (EHR/EMR).
History: CCHIT was founded in 2004 with support from three leading industry associations in healthcare information management and technology: the American Health Information Management Association (AHIMA), the Healthcare Information and Management Systems Society (HIMSS) and the National Alliance for Health Information Technology (the Alliance). In September 2005, CCHIT was awarded a 3-year contract by the U.S. Department of Health and Human Services (HHS) to develop and evaluate the certification criteria and inspection process for EHRs and the networks through which they interoperate. In October 2006, HHS officially designated CCHIT as a Recognized Certification Body (RCB). Currently CCHIT is self funded; however, it appears that the HHS will continue to fund the organization.
There are approximately fifty CCHIT certified 2008 EHR’s. The organization has combined the requirements for 2009 and 2010 and the application process will be proposed in August of 2009.
There are many arguing that CCHIT as it currently exists is an inappropriate standard for federal funding, authorization or endorsement of HIT systems because CCHIT 2009 has over 450 separate requirements, the collective effect of which tremendously increases the cost to customers as well as the complexity to implement, train and use the system. Also, these requirements may develop rigid and monolithic systems.
Last week CCHIT proposed three new paths to certification to replace the current one in order to address the naysayers. EHR-C: This will be similar to the current certification and will be very comprehensive. EHR-M: This will be a modular certification for electronic prescribing, personal health records, registries, and other technologies. This should be less costly, more flexible and work will with a health information exchange (which is an additional requirement to certified EHR to receive Stimulus Funds). EHR-S: This is a site-level certification for self-developed systems.
If you have an EHR/EMR and it is not 2008 CCHIT certified or you are first entering the EHR market you can choose to wait to see what the final definition of a Certified EHR. It appears that it will be more flexible to suit your cost and clinical needs.
KEY POINTS:
- The Federal Government will provide financial incentives for early adoption of EHR’s. Thereafter, there will be penalties for the failure to adopt by 2015.
- The law requires a certified system.
- CCHIT is the only certifying body at this point.
- CCHIT has in-depth some say onerous requirements.
- CCHIT will dictate stimulus funds as well as the future of the medical record.
KEY ISSUES TO THINK ABOUT:
- Do I need to have a CCHIT system now?
- I see 2006, 2007, 2008 CCHIT certified systems. Does it matter what year I choose?
- What will the definition of Certified EHR be?