CCHIT Proposes Expansion, Leaving Some Vendors Crying Foul

Since launching in 2004, the Certification Commission for Health Information Technology has become the de facto stamp of approval for EHRs, helping providers judge EHR product suitability, quality, interoperability, and security. For about $28,000, a vendor who meets the Commission's criteria can be certified, automatically proving to providers that their EHR is worth the money, say CCHIT proponents. Now, CCHIT is expanding its scope of certification, and not everyone is happy about CCHIT's increasing influence in the market.

The expansion includes two areas already named in previous years—behavioral health and long-term care—that will be developed as planned. In addition, four new program areas are proposed, all of which are optional add-on certifications for ambulatory EHRs: clinical research, dermatology, advanced interoperability, and advanced quality.

One of the main components being added to CCHIT's lineup will be increased flexibility and opening up the option of certifying advanced levels of technology for products that go "beyond the basics" in any domain, says Mark Leavitt, MD, chair of CCHIT.

"There is now a degree of sophistication with the technology and a readiness on the part of the end users that we need to have different levels of certification. You will still have the certification for ambulatory EHR, but those with advanced decision support, for example, would get additional certification that says this product also offers advanced decision support so if that's something you are ready for and looking for, this has it," says Leavitt.

He says the group chose the expansion areas based on a model that quantified the benefit of certification by looking at how many patients are affected by the specialty, how many dollars are spent in the specialty, the readiness of the specialty (for example, have providers gotten together and formed committees to define what they need or would CCHIT have to start from scratch) and then, "we balanced those out. We ultimately came out with a prioritization, and published that January 14 open for comment. We are accepting comment through February 5," says Leavitt. CCHIT also is considering eventual certification programs for software to support eye care, oncology, obstetrics/gynecology, advanced security, and advanced clinical decision support.

Just how much CCHIT certification should influence the decision about which EHR system to buy has become a point of contention for detractors who say smaller vendors are getting pushed out by the cost of getting certified ($23,200 for the initial review and $4,800 in annual maintenance fees over the three-year certification), giving vendors with capital to spare an unfair advantage. In addition, critics maintain that CCHIT certification will lead to higher prices for EHRs because vendors will be forced to pass the cost of certification on to providers and competition will be limited by narrowing the number of competitive software vendors.

"The people who are subsidizing EMRs or reimbursing providers are looking to drive them toward automation in their offices, and therefore financial incentives or the requirements that those organizations put on physicians are increasingly going to favor CCHIT-certified EMRs because it's easier to take a quick swipe at the market and lop off anything that isn't CCHIT certified," says Don Fornes, CEO of Software Advice, a consulting firm that offers advice to organizations looking to buy new software. "If you know that a CCHIT-certified EMR is absolutely going to give you a certain set of functionality and interoperability that you need, that's extremely useful."

For me, the whole "controversy" seems pretty cut and dry. At a time when very few people have money to spare, deciding to make an investment of this magnitude cannot be taken lightly. And I, as a tried and true consumer, would most certainly be looking for system that has all the stamps of approval. CCHIT is a private, nonprofit initiative whose stated mission is to "accelerate the adoption of robust, interoperable health information technology by creating a credible, efficient certification process." It's not as if the group is looking to make millions by fleecing small vendors through the certification process. Not only that, but all of the new EHR legislation being drafted at the federal level includes money to help stimulate the adoption of EHRs and all of that legislation requires that the EHRs be CCHIT certified, according to Leavitt.

As Gregory Spencer, MD, an internist and CMIO at Crystal Run Healthcare in Wallkill, NY, told me, "It's unbelievably helpful to have third party out there kicking the tires for you. People in the market need a product that they know matches what vendor tells them the capabilities are. We have that assurance. We know we are going to get a certain amount of capability if the vendor has been certified," he says. With three-quarters of the EHR market represented by vendors who have CCHIT certified products, it's looking like those vendors who don't want to or can't pay to get certified are going to have two choices: take a major hit in sales or be swallowed up by a bigger, CCHIT certified company.