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First comes EHR certification

October 08, 2010 | Bernie Monegain, Editor

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PHOENIX – There can be no meaningful use of an EHR without product certification. To make the testing go without a hitch, practice, practice and practice some more, officials from the Certification Commission for Health Information Technology (CCHIT) urged CIOs gathered at the CHIME10 Fall CIO Forum.

"The biggest prediction of success is practicing," said CCHIT Executive Director Alisa Ray.

CCHIT is one of three government authorized testing and certification bodies (ONC-ATCB) so far. The other two are Drummond Group and InfoGard Systems. Though the CHIME program included them as part of the meeting, there were no representatives from the two entities at the session.

So far, a total of 36 EHRs and modules have been certified. But many more are expected, and Ray said CCHIT is ready. "We ramped up our capacity to be able to do this," she said. "One of the things we've been able to do with our program is scale it pretty well."

Moderator Pam McNutt, senior vice president and CIO at Methodist Health System in Dallas, and chair of the CHIME Policy Steering Committee, asked Ray what challenges vendors and providers encountered in testing.

Ray said because of the tight timeline, there had been no time for beta testing. So the 33 products CCHIT certified by default served as beta tests. Many vendors had to redo e-prescribing a number of times, she said. Also, "there are always some issues around security," she added.

To better understand how the technology is tested, Ray recommended going the ONC/HHS website.

While the majority of the testing CCHIT and the other two groups will undertake are vendor products, providers would be required to certify modules they may have customized or, in some cases, their in-house built EHR. Testing a security module might cost as much as $7,000. Other modules could be as little as $650. A full EHR test would be $30,000.

The Web-based testing of a full EHR could take six to eight hours, while a module test might be under one hour.

"This is for self-developed EHR technology" Ray said, "or vendor products you modified in some way, using older, uncertified EHR technology."

CCHIT is developing a certification specific to those situations, Ray said. The program is called EACH (EHR Alternative Certification for Hospitals), with pilots occurring this month and a launch planned next year.

Ray listed these characteristics of ONC-ATCB certification:

  • Meets one of more government criteria and standards (must be clearly labeled)
  • Criteria and testing tools developed by ONC and NIST
  • Two domains – eligible provider and hospital
  • Specific to each stage of meaningful use and can be modified at any time
  • Provider accepts responsibility for integration of modules and vendor implementation experience

CCHIT also provides a certification called CCHIT-certified, which was in place prior to the government-mandated certification. Some vendors are opted for certification under both programs, Ray said, adding that CCHIT-certified provides more assurance of integrated functionality and interoperability and security.

Related Topics:
  • Alisa Ray
  • Drummond Group
  • Health Information Technology
  • InfoGard Systems
  • Meaningful Use
  • Pam McNutt
  • PHOENIX
  • Electronic Health Records
  • Privacy and Security
  • Quality and Safety

Reader Comments (3)Login to Post a Comment

RobMyles says: Software Assurance & Code
October 14, 2010 | 4:23PM GMT

Software Assurance & Code Accountability is a huge, lacking area for most vendors and their refusal to implement good SDLC, third party code review & Vulnerability assessments before sales/product release, places business running their software, at risk. There has to be a way to make the suppliers of that software accountable for security problems.

Recent Stuxnet worm which targeted specific industrial control system (SCADA), is reason enough.

http://www.owasp.org/index.php/About_The_Open_Web_Application_Security_P...

CBones says: Investments with strings
October 12, 2010 | 5:58PM GMT

It amazes me how money continues to create barriers for the most important information, healtcare. In systems development there are open source languages and specifications that serve a global audience. However in healthcare everything has a cost, code sets have a cost, charting protocols have a cost, and now a high cost to certification. Seems like the same old equation runs this industry ... lower supply (those able to compete) and we increase demand for those who can afford to play. So much for the hype of innovation.

pjcasey75 says: Certification costs - a little help?
October 08, 2010 | 1:55PM GMT

The high cost of certification only adds to the price tag of every EMR purchased. For vendors, this means a higher price to the consumer for their product. This is in addition to very high costs of software development, ongoing maintenance and marketing in an extremely crowded and competitive field.

For those physicians, clinics or hospitals that simply can't find an off-the-shelf solution and have built their own EMR, these certification costs will need to be paid before they can qualify for meaningful use incentives. That may mean spending $30K or more to qualify for $44K or less. If this is the case, it would be wiser simply to skip certification and by default, ignore the standards as long as possible. Certification itself is a good idea. Making it so expensive, however, is counterproductive.

Simply put, the goals of ARRA and HITECH seem pretty clear. Ideally, we want every physician to use electronic medical records technology to document medical information. And we want the technology they used to comply with certain standards in order to ensure that the data is standardized, relevant and portable. Fair enough.

But we've developed these standards very late in the game. Now we're pushing everyone, including the oldest vendors with their old technology, to "get certified". And we're pushing physicians to buy a certified EMR as soon as possible. Result - we'll have a national system based on legacy software.

Such a strategy practically ensures that the oldest, largest vendors (with the most cash) will be first to certify and therefore be first to market in the rush to implement a national electronic medical network. It's kind of a "reverse-cash-for-clunkers"; instead of giving you money to trade in your clunker, we're giving you money to go buy one

It is an undeniable fact that leading edge innovation doesn't usually emerge from large companies who are protecting 40 years of sunk costs. Rather, new technology comes from small companies who look at the world as it is and as it is going to be, and give birth to solutions that were inconceivable just moments before. Where did Microsoft, Google and Facebook come from? IBM (had the idea for desktop operating system - didn't implement), Digital Equipment (created Alta-Vista - couldn't market it) and AOL (had the idea for a network of users - didn't "get it")? Don't think so.

Our current policies promote the adoption of old technology painted over, interfaced, layered with translators, API's and a myriad of other patches to one-way-or-the-other (but probably not the best, most efficient or simplest way) meet new standards. It's like asking Microsoft and Apple to work together seamlessly. Why not rather promote a new "company"? We should, at the very least, ALSO consider promoting and incentivizing the creation of new technology built to new specs.

It seems to me that one very large gaping hole in the stimulus strategy is incentivizing new technology development, technology that is, from the ground up, built with the current model in mind. High cost certification is one more barrier to entry for the small, innovative development firm.

How about we spend some HITECH stimulus dollars to fund the certification of home-grown and small company EMR's?

Patrick J. Casey, Consultant
AvivaEMR.com

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