Interview of Practice Partner CEO and President – CCHIT Commissioner Talks about CCHIT Certification Increasing EHR Adoption

I found a really nice interview of CCHIT Commissioner and Practice Partner CEO and President Andy Ury by HISTalk. There was some interesting information in the article. One thing that was a good comment was that Practice Partners seems like they finally figured out that EMR customer support would be their key to success. Doesn’t seem like rocket science if you’ve seen how many doctors talk. I think it has to do with the bonds created during medical school. Those long hours of studying really make students close to each other and so it continues after med school. I digress.

I also was very interested in what a CCHIT commissioner would say about the CCHIT certification process. HISTalk asked a very nice question:

Will CCHIT certification really increase EMR adoption by reducing customer risk?

I think it is a fair question. Here was CCHIT commissioner’s response:

I think certification is intended to increase EMR adoption, but reducing customer risk is just one of the ways it will achieve that. By ensuring baseline functionality, it does reduce customer risk. It also increases the chance that payors will provide incentives to physicians who use EMRs.

Certification won’t be a differentiator if either everyone or no one obtains it. Will CCHIT consider releasing specific details instead of pass-or-fail results so that physicians can make their own decisions based on the needs of their practices?

The certification scripts are public. At this point, certification is 100% pass-fail, so I’m not sure what there is to release. Certification is done using an anonymous jury, so there’s no record to look at for most of the certification process. The bulk of it is a juried pass-fail test. Certainly certification and the criteria will evolve over time. While it provides a baseline for the market, there’s plenty of room for product differentiation that certification doesn’t cover.

It’s still important for physicians to pick according to their needs. If they’re looking at five certified EMRs, they’ll need to look at awards, medical society recommendations, VHA, demonstrations, etc. There are plenty of other ways to differentiate product.

Not everyone will be certified. But let’s assume that most major EMR vendors will get certified sooner or later. The benefit of certification is a comfort level for the purchaser, but there’s still the possibility of payors providing incentives.

I think there’s no question that vendors have to work to pass certification. It is a multi-year process and the criteria change year by year. The 2006 criteria cover widely available features, but most vendors will have to make some software changes to achieve certification. In 2007 and 2008, vendors will have to continue to change their software to become certified.

Certification is year-dependent, so each certification is measured separately and is good for three years. Vendors can choose whether to be recertified every year on the stricter criteria. Customers will be able to ask if vendors if they’re certified under each year’s standards.

Certification also involves interoperability, which is important to many customers. It also includes security and reliability, which are harder for practices to judge and may be a source of comfort.

BULL!! CCHIT certification will not decrease customer risk, but could in many cases actually increase the risk because it will provide doctors more confidence in a product that may or may not be good for that Doctor. The problem with CCHIT certification(and any certification at this point) is that no one has figured out how to cerfify usability. Unfortunately, CCHIT certification is going to look like it has certified a product as usable when in fact the certification is only going to certify a feature set. Even certifying a feature set has some set of interpretation. What does it mean to have a prescription writer in your EMR? This could mean that you can type on a form that prints out. This could also mean that you select from a drug database that checks for contradictions with other prescribed drugs and allergies. This is very different and demonstrates the problem of certifying feature set.

At least Andy Ury does point out that the certification shouldn’t be all or nothing. That is a huge CCHIT certification mistake. Also, he makes a nice point that CCHIT certification will be irelevant if either all EMR vendors certify or no one certifies. Fine Points!

I think I’ll save more comments on the interview for a future post.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

2 Comments

  • As many of the doctors and IT people are aware it costs about $37,000 for a IT vendor to get his/her EMR certified by CCHIT. It costs about $200,000 to pass the certification. The certification is version specific.(So if you get an update it does not mean it is still cerfied). It is just a list of 300 items to be passed. It does not have anything about interoperability — that is the goal of payers and federal Government. It was paid $2.8 million by Federal Govt and more than $100000 by a California organization to develop this interoperability.

    Per Chicago Sun times recently CCHIT aims to be self sustaining by 2008. That means to say the fee will remain the same or may go up. Initially the vendors pay this fee to stay on top of game. They may feel like getting certified due to peer pressure, company XYZ is getting certified, they will get more market share and lock the customers, I should do the same. Ultimately they will pass this on to customers –which will be Doctors and Hospitals to pay for these expensive EMRs. The EMRs which are certified do the same functions as “non certified” EMRs- write the progress notes, view the imported items, write scripts, view old notes, demographics. The process is simple, but CCHIT is glorifying this simple process and charging a hefty money for this. For a doctors office in a day to day practice it means nothing to be certified as taking care of patients is still the same way, spend time with your patient, listen to your patient. Getting certified will no way improve the care of patient and the doctor has to use his/her due deligence as it always has been.

    In these days of diminishing office reimbursements, where EMR is supposed to make it easier to document and serve patients, CCHIT is a unwelcome intrusion between IT vendors (read EMRupdate.com-CCHIT discussions) and doctors. It does nothing to serve the patients.

    Ask any doctor if the HIPPA transaction standards implemented a few years ago did anything to improve the patient care. All it did was that many offices had to do buy new softwares that met the HIPPA guidelines, the remimbursements for doctors services and time remained the same. The same will happen with CCHIT certification too. Doctors and Hospitals need to open up the eyes as they are the ones paying for this ultimately without improving the care of patient. Duplication of tests is what everybody talks about. Certification by CCHIT will not eliminiate the duplication of tests. Doctor and offices being deligent in ordering tests, getting old records and reveiwing them is what will avoid duplicate tests. There are other ways of getting the results to doctors appropriately that need to worked upon at different levels, getting CCHIT certification will not make that problem go away.

    I spoke with lab chief at our local hospital, interfaces built between lab computers and EMRs fail at times as somebody made a mistake in the middle initial or forgot a character in the name of patient. This will be rejected. The only way of tackling those is to manually go and fix those. Getting a CCHIT certified product will not make that go away.

    Ultimately if this is widely adopted, the following will happen–

    1. The ones who are already using EMRS willbe forced to buy expensive EMRs, with organizations like ACP, AMA etc just stading as a innocent bystanders, not doing anything to avoid this unnecessary waste of precious resources.

    2. With reports of just 15-20% usage of EMRS in US, the adoption will be slowed as doctors will want to wait till the uncertainity settles.

    3. The ones who get certified will have support problems-if they gain market share and sign up more doctors. Doctors who get those certified ones already have to sign a contract with EMR vendor agreeing to pay for legal expenses of EMR vendor if the relationship sours and doctor has to file a suit against the EMR company. So doctors office will be at the mercy of EMR vendor if there is no support. So I caution doctors to read the contract carefully before signing any new contract with Certified EMRs.

    We have been running a paperless office successfully for more than 2 yrs using a small vendor EMR and so are many others. CCHIT has created an unncecessary burden in successful implementation of paperless office- a goal of many doctors who toil day in and out to take care of patients and EMR vendors who aim to keep costs down. CCHIT will stiffle innovation and kill competition

  • The following forces will drive physicians away from HIT:
    1) Any process, s.a. CCHIT that will increase the overhead of vendors will ultimately increase EMR prices.
    2) Insurance intervention with pay for performance schemes to decrease physician incomes will also dampen physician use of EMRs.
    3) I firmly believe that CCHIT was invented by HIMSS to eliminate the competition from small to medium sized vendors. This decreased competition will result in increased prices.

    Great blog, BTW.

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