CCHIT Certified EHR Becoming ARRA Certified EHR

Alfred from Infomd.net recently made the following comment:
If the product you use is CCHIT certified, it is a pretty safe bet to say that they will be certified under the Meaningful Use rule. Meaningful Use is but a subset of what it takes to become CCHIT certified

Here’s my response to Alfred:
Alfred,
I don’t think that the new certified EHR is a subset of CCHIT. There are some similarities and concepts, but it’s not a subset.

However, I think you’re right that many CCHIT certified vendors will become ARRA certified. Mostly because the EHR vendor that has the CCHIT certification has chosen to make EHR certification a priority for their company. So, they’ll likely make the ARRA certification a priority as well.

It is worth asking if you want to be tied to an EHR company that focuses so much on certification. One could make the argument that an EHR vendor that focuses so much on EHR certification might not be focusing enough on the customer’s needs. These 2 focuses will obviously create very different EHR products.

See Also this post: EMR Stimulus Q&A: Do You Have to Use a CCHIT Certified EHR Vendor?

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.

16 Comments

  • John,

    You are correct that HHS/ARRA certification is not a subset of CCHIT Comprehensive certification. That is why CCHIT offers testing on HIT applications based on their own generated criteria and standards (Comprehensive) but intends to be a Testing and Certifying Body for the HHS/ARRA certifications ( where the standards and criteria are determined by HHS/ONC and test procedures by NIST).

  • ARRA Certification is simply going to be about the ability of the EHR to capture structured data relating to the Meaningful Use criteria, along with things like making sure mandatory drug-drug/allergy interaction effects alert are enabled, and certain HIE functionality elements are in place. The NIST Registrar MU test SOPs have now been issued. See

    http://healthcare.nist.gov/use_testing/finalized_requirements.html

    Nothing about “usability” or “accuracy/precision/reliability” per se.

    As I observed to some of my REC colleagues:
    ___

    From http://healthcare.nist.gov/docs/170.302.g_smokingstatus_v1.0.pdf

    The “HITECH Certified EHR” documentation choices for this measure:

    • “current every day smoker”
    • “current some day smoker”
    • “former smoker”
    • “never smoker”
    • “smoker, current status unknown”
    • “unknown if ever smoked”

    From the NIST Procedure:

    “Using the NIST-supplied Inspection Test Guide, the Tester shall verify that the patient smoking status data entered during TE170.302.g – 2.02 have been entered correctly and without omission…The NIST-supplied test data focus on evaluating the basic capabilities required of EHR technology, rather than exercising the full breadth/depth of capability that installed EHR technology might be expected to support. The test data is formatted for readability of use within the testing process. The format is not prescribing a particular end-user view or rendering…”
    ___

    This cert test procedure says nothing about how these data are to be entered/updated – i.e., preferably, IMO, they might best presented to the EHR end-user as a mandatory (“without omission”) forced-choice radio button or drop-down pick-list screen with the above textual alternatives merely serving as narrative labels mapping to mutually-exclusive (“no dupes, no nuls”) binary 0/1 dummy vars in the actual database fields “under the hood.” Dummy vars quickly give you both sum and percentage counts (mapped back to their respective labels), whereas entering these as text phrases [1] is time-consuming (absent some macro in place) and [2] leads inevitably to the dozens of ways to spell/misspell the entries (re: “correctly”) – with all the tabulating/reporting liabilities such implies.

    I assume that the EHR vendor has the latitude to present the choices as button-click or drop-down pick lists etc. Maybe that’s what they mean by “[T]he format is not prescribing a particular end-user view or rendering…”

    Current “money fields” like the free-text narrative box in e-MDs (e.g., “Smoking/Alcohol/Supplements”) need to go away.
    ___

    Interesting that we hear increasing calls in some quarters for FDA regulation of EHRs as de facto “medical devices.”

    We also hear of calls to eventually make EHR adoption a condition of medical licensure — which begs some additional concerns. See

    http://www.dri.org/articles/MedicalLiability/FTD-1007-Brouillard.pdf

    I will be reflecting on this article in my next blog post. Many docs are wary of this double-edged sword of digital documentation.

    – BobbyG

  • Here’s some food for thought on the certification issue over at EMR Daily News. I think there’s still going to be a lot of confusion on what certification is required to qualify for HITECH, which may began to decrease one there are actual certification bodies and certified products live and in action. If and when someone besides CCHIT is recognized by HHS and approves a viable product on the market, I think we’ll see less of the CCHIT = HITECH $ idea floating around.

  • Michelle,
    Too bad that article only looks at currently certified CCHIT products. There’s no doubt going to be hundreds more non-CCHIT certified EHR products that will be certified thanks to the EMR Stimulus money.

    I think the confusion will improve once we have some official EHR certifying bodies and EHR certified products.

  • Has ONC approved CCHIT as an ARRA MU certification body?

    No doubt they will if they haven’t already … and that could be a market advantage for the CCHIT bubbas in advance of the other cert bodies getting their “merit badge”.

    The EHR saga is the IT equivalent of day time radio/TV’s “The Guiding Light”.

  • Don B,
    No CCHIT hasn’t been ONC approved, but no EHR certifying body has been approved. I expect they’ll wait to approve a couple of EHR certifying bodies at the same time. We’ll see though.

  • BobbyG, discreet data may be more analyzable for public health purposes, but is not the best way to describe data for any particular patient. For example, “current some day smoker” gives me no tools to approach the problem, whereas “smokes unfiltered cigarettes only when drinking gin outdoors,” gives me a much clearer picture and immediately brnigs up strategies for counseling. Your post shows that you have a gerat command of the technical aspects of HIT, but you might brush up on the patient-doctor needs (which after all, is the whole point).

  • Sorry about all the misspellings–I’m on a sticky keyboard in an ED and am not afterall entering discreet data from a dropdown menu,

  • @Brian –

    Agree.

    Currently, e.g., the Greenway EHR has rather nuanced check boxes that include type and amount of tobacco products consumed, whereas e-MDs’ current release is a simple free-text field.

    Moreover, I am not a clinician, and neither am I endorsing this “structured data” EHR certification approach. If fact, I find this particular cert spec rather simplistic and non-utilitarian.

    As to your admonishing me to “brush up,” I have by now studied in some sustained depth the salient aspects of the clinical mid-office piece (see my blog) and can recite in on-the-fly detail the myriad elements of FH, SH, PMH, CC, HPI, and ROS etc that go into (along with labs, consults etc) the SOAPe process. I am struck by how much of clinical decision-making is necessarily heuristic and “qualitative” (typically under great time duress, I might add) rather than strictly differentially deductive or directly empirically inferential.

    I’m still reviewing the other ARRA Cert specs, but this one is pretty weak.

  • Had the PCP community been aggressive years ago to implement EHR’s at the practice level (like the UK) … then the PCPs with the high ground could have agreed to port data to the Feds for community health reasons … for a fee.

    Feds would have had to adopt the disparite EHR data elements into a community picture. Practices could have sold x data elements for $, y data elements for $$, and z data elements for $$$.

    Just a wild thought.

  • BobbyG,
    Read your recent posts and like your blog. I will follow regularly. We docs get touchy when IT people tell us how to record data. It’s for us and the patients, not for computers or data analysts.

  • @Dr Brian-

    Thanks. For the record, I could not be more empathic with respect to the needs of and challenges faced by physicians. I have many concerns regarding mine own REC initiative. That should be clear from my writings.

  • (from John) “I expect they’ll wait to approve a couple of EHR certifying bodies at the same time.”

    Oh for sure. Goodness it would be so unfair to other certification entities if one entity was certified first and it was held up so it didn’t get an unfair jump on getting business and was out there MU certifying EHRs ahead of another certification entity.

  • I understand that there are currently 10 vendors that have obtained ARRA certification. Doe anyone know which are ARRA cdertified?

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