Healthcare IT leaders are already praising some aspects of HHS' proposed rule for testing and certifying EHRs, praising the decision to eventually turn the certification process over to the private sector, a fast-track certification timeline, and the ability for organizations to eventually certify EHRs from multiple vendors.
The proposed rule, released on Tuesday, would create a two-phase certification program. The first phase would allow organizations to get certified quickly in order to meet deadlines to apply for the first round of meaningful use stimulus funding—as early as October for hospitals and January 1, 2011 for physician practices and other eligible professionals. The National Coordinator would oversee that temporary process.
The second phase of the program would transfer testing and certification to private sector organizations. It would also allow certification of both completed EHRs and individual modules.
A better timeline
"They got it exactly right," says Simeon Schwartz, MD, president and CEO of WestMed Medical Group, headquartered in Purchase, NY. A stimulus, by its very definition, is meant to get people to adopt as early as possible, and the first phase of the rules will help his group be ready by January 1, 2011, the deadline for eligible professionals to qualify for meaningful use incentives. And it's not just about getting the money, he added. The timeline will improve patient care more quickly too.
But not all healthcare organizations—or all vendors, for that matter—are prepared to meet those first deadlines.
"It's going to be interesting to see how much the vendors got out ahead of this and how much they've hedged their bets," says Eric Saff, CIO of John Muir Health in Walnut Creek, CA, which uses McKesson and its RelayHealth product. "It's going to be interesting to see if all of the vendors can get there fast enough and give enough time before the hospitals and people put their plans together. Certainly the folks that haven't even started yet, I would doubt that they have any hope of getting it done anytime soon."
"Vendors are nervous that if they don't deliver on this their clients are going to be livid," adds Schwartz.
In private hands
Putting testing and certification in the hands of private sector organizations was also a smart move, Schwartz says. Meaningful use is a tremendously complex process and the government would likely be slower to adapt to changes in technology, he says. Besides, private certifying organizations have worked well in other situations.
Saff agrees. "It would be great to have a private organization do it because many functions to meet meaningful use require multiple vendors, and so it's going to be pretty difficult to cross the line if you don't have a matrix that says 'here's my 20 functions to meet meaningful use, here's my eight vendors, and now you've met the threshold for all eight and you get there,'" he says. "Typically, when you deal with the government, it's one at a time and if the one doesn't do it, then you can't ever seem to get to completion."
The testing and certification model would likely be similar to Joint Commission accreditation, in that hospitals would pay an organization to get certified, Saff says. "But it seems to me that would be way better than CMS or the IRS," he said.
Several HIMSS attendees also speculated that the Certification Commission for Health Information Technology (CCHIT) would be a good choice for a certification organization. Not surprisingly, CCHIT agrees.
In response to the proposed rule, Alisa Ray, CCHIT's executive director said CCHIT is confident about its prospects of becoming accredited. "CCHIT has four years of experience testing and certifying EHRs, and promptly adapting our testing to the latest federal standards. We have also been benchmarking our operations against best practices for certifying bodies, including the ISO/IEC accreditation standards, and we are well prepared. We plan to file an application with ONC as soon as they are ready to accept them."
She added that the announcement is "an important step that will reduce the uncertainty that the healthcare community has experienced while awaiting this additional information."
A modular approach
The modular approach will be helpful to health systems that have hospitals on several different EHR systems as well as those who use different vendors to manage different types of health information. "Many of us rely on more than one vendor," said Schwartz. His practices' main EHR vendor is GE Healthcare, but it also uses other, smaller vendors, including a third-party image management vendor.
"That provides an opportunity for the smaller players to contribute," said Luigi Leblanc of Solink, a Silver Silver Spring, MD-based vendor of MyOfficeLink, who was participating in the HIMSS "Interoperability Showcase," a real-time demonstration of standards-based interoperable health IT systems. "Because what you now have is no matter where you are in the chain of this market, you can in fact certify those modules as opposed to waiting until you meet complete meaningful use to be certified. So I think that's great. I think that's really considerate of the ONC," he said.
"To the credit of the health information technology standards panel, working on standards with industry, they've come out with standards defining meaningful use and I think that's going to help in terms of information exchange. And I think that's evident when you look at how large this showcase is compared to two years ago. I think people are in the spirit . . . of sharing and that's because government has had a role in helping to promote fair exchange."