joseph commented:

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

Alberto Borges MD commented:

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.

So, congratulations is deserved by each of the following systems for being able to certify. That is NOT an easy task to do and certainly represents hours of time spent by each company to meet the criteria. I should also mention that there are a number of very fine quality EMR’s on the list. You can find them in between the Jabba the Hut EMR’s on the list.

* Allscripts (HealthMatics Electronic Health Record 2006)
* Allscripts (TouchWorks Electronic Health Record 10.1.1)
* Cerner Corporation (PowerChart 2005.02)
* Community Computer Service (MEDENT 16)
* Companion Technologies (Companion EMR v8.5)
* eClinicalWorks (eClinicalWorks Version 7.0 Release 2)
* Emdeon Practice Services (Intergy EHR v3.00)
* e-MDs (e-MDs Solution Series 6.1)
* Epic Systems (EpicCare Ambulatory EMR Spring 2006)
* GE Healthcare (Centricity EMR 2005 Version 6.0)
* iMedica Corporation (iMedica Patient Relationship Manager 2005, version 5.1)
* Infor-Med Corporation (Praxis Electronic Medical Records, version 3.4)
* JMJ Technologies (EncounterPRO EHR 5.0)
* LSS Data Systems (Medical and Practice Management Suite Client Server Version 5.5 (Service
Release 2.1))
* McKesson (Horizon Ambulatory Care Version 9.4)
* MCS-Medical Communication Systems (mMD.Net EHR 9.0.9)
* MedcomSoft (Record 2006 (V 3.0))
* Medical Informatics Engineering (WebChart 4.23)
* Misys Healthcare Systems (Misys EMR 8.0)
* NextGen Healthcare Information Systems (NextGen EMR 5.3)
* Nightingale Informatix Corporation (myNightingale Physician Workstation 5.1)
* Practice Partner (Patient Records 9)

The Certification Commission for Healthcare Information Technology announced Monday that two more ambulatory electronic health-record products achieved certified status.

They are: iMedica Patient Relationship Manager 2005, version 5.1, by iMedica Corp. of Carrollton, Texas; and Praxis Electronic Medical Records, version 3.4 by Infor-Med of Woodland Hills, Calif. In addition, two products announced earlier as pre-market, conditionally certified, have now been fully certified. They are MEDENT 16 by Community Computer Service of Auburn, N.Y., and Medical and Practice Management Suite, Client Server Version 5.5, (Service Release 2.1) by LSS Data Systems of Eden Prairie, Minn. CCHIT certified the EHR component of the LSS product.

To put it bluntly, we are looking at a MINIMUM fee of $28,000 a year. We currently have a new release every 3 months, so technically, our fee could be MUCH higher. We could, of course, cut our own throats by restricting new releases to once a year and lose our pricing and customer service advantages.

The argument is that this certification is ‘Optional’ and we don’t have to do it. And then the rep from the MGMA gets up and says that they are recommending that their members only buy CCHIT certified EMRs and so does the AAFP, AMA etc. So how optional is it going to be? I don’t buy that argument at all.

One of our fellow EMRUpdate members at the meeting did mention the discussions here and essentially the response was ‘blogs never hurt me, so blog away!”

I am seriously convinced that the alternative certification option is looking more and more attractive. How many of the small vendors on this board want to pay a minimum of $28000 a year? The MGMA rep was essentially quoting a ‘per doctor EMR cost of $33,000 and so this is less than one sale’. How many of us charge less than a fraction of that per doctor? This certification pricing model is seriously flawed. If we used a model like this, our customers would leave a vapor trail out of our offices.

So bottom line? We could toe the CCHIT line and raise prices, cut innovation and eventually go out of business as all our competitive advantages will have evaporated. Or vigorously back an alternative standard. I think I know where I would like to be. All you thoughts and comments are welcome.

That doesn’t sound too good. They described the reason for the charges in this manner:

$28,000 up front to start the review process. 3 reviewers (1 doc and 1 security tech will be on each team) shall conduct the review for 8 hours. If the review takes longer than 8 hours, then the vendor will be charged for the extra. For the 8 hours, the Doc will be paid $1200 - $1600 and about $1200 each for the other 2 reviewers out of the $28,000 collected.

The real question I have is how do I get on that review board. That’s a lot of money to be reviewing an EMR system. Maybe I should created the EMR and HIPAA review board and charge them half the price. I’d be more than happy to review an EMR provider for $14,000 using the same criteria that CCHIT has already published. I wouldn’t even need $14,000 each year to renew it. After having seen it the year before it shouldn’t cost nearly as much to certify it again. I think it should also contain some component of actual user base information. You could spot check to make sure that the user base isn’t being tainted by the EMR provider, but if the user base says certain components haven’t changed over time then why should you check it again?

It looks like some of the Health IT media has picked up on the CCHIT meeting also. Neil Versel - the Healthcare IT Blogger wrote an article on this CCHIT meeting in Health IT World. Since I think the cost of the certification is one of its main problems, here’s an excerpt from the article:

Certification testing for 2006 costs $28,000, regardless of the size of the vendor seeking approval. Of that, $23,200 goes to the actual testing process and $4,800 is the annual fee to maintain certification. Vendors may use a certification for up to three years as long as they pay the annual maintenance fee, though they may choose to re-test annually to get a current-year certification stamp.

The cost and the renewal process were key targets of vendor ire. Several vendors promised that they will raise their prices if they have to pay the $28,000 testing fee. They also worried about spending money for a full re-testing next year so as not to appear that their products were out of date with a 2006 sticker in 2007.

Leavitt tried to assuage concerns by saying that certification will help business. “If you don’t see an acceleration in the [EHR] market, then we’ve failed,” he said.

I agree wholeheartedly that the $28,000 plus annual fees plus recertifications will raise prices for EMR providers which will get passed on to the doctors. More importantly, I believe that this large of a fee and the requirement for recertification with every major release will stifle innovation which sounds just like where many clinics are today. Lack of innovation would be the worst thing that could happen to EMR.