We finally now have the first ONC approved EHR certification bodies (Officially ONC-ATCB or ATCB or ONC Authorized Testing and Certification Body). The first 2 ONC-ATCB are very familiar names that we’ve been talking about on EMR and HIPAA for a long time: Drummond Group and CCHIT.

In an HHS and ONC press release they also noted that “Applications for additional ONC-ATCBs are also under review.”

Drummond Group has already posted information on their website about their EHR certification and testing plans. The most useful item is this 10 page EHR Testing, Pricing and Certification guide (PDF).

Lots of interesting information in the PDF which I’ll likely talk about later. The pricing however is worth noting now. It’s on page 8 of the PDF document and has certification set at $19,500 for the Complete Remote EHR certification and $23,500 plus travel for the Onsite EHR certification tests. There’s also pricing for the modular certification.

I haven’t found any published prices on CCHIT certification, but in the past the CCHIT EHR certification costs were $37,000 for the complete CCHIT certification and $33,000 for the Preliminary ARRA certified EHR.

Looks like we might have a bit of an EHR certification price way on our hands. $20k is still a lot of money for EHR certification, but $10-15k difference is quite a bit of money.

Here’s a short quote from the CCHIT press release about their time frame for accepting EHR certification applications and when we might see the first certified EHR.

CCHIT plans to launch its authorized HHS certification program on September 20 at 1:00 PM Eastern time with a Town Call Web-cast describing its application and testing process. CCHIT will take new health IT developer applications immediately after at http://cchit.org and the first group of HHS certified complete EHRs and EHR modules will be announced within weeks of that launch. More information about the Town Call will be available at http://www.cchit.org/towncalls. The call will be recorded for later viewing.

It will be interesting to see if Drummond Group of CCHIT can produce the first officially certified EHR vendor and which vendor will hold that distinction.

UPDATE: Weno Healthcare looks to be another potential ONC-ATCB (if they get approved) and their EHR certification pricing looks to be in the $14k-$18k range.

I found this interesting tidbit in the final rule for the EHR Temporary Certification Plan:

“In the Proposed Rule, we stated that we anticipated that there would be no more than 3 applicants for ONC-ATCB status. Based on the comments received, we now believe that there may be up to 5 applicants for ONC-ATCB status. In addition, we believe that up to 2 of these applicants will not have the level of preparedness that we originally estimated for all potential applicants for ONC-ATCB status.”

Interesting to hear that there are likely to be 5 applicants to certify EHR software. Of course, we know that 2 of those bodies are CCHIT and Drummond Group. I also know of one other, but I’m traveling and so I can’t look up the name. Although, I only know this other one based on a conversation. I’ve never seen anything in print.

That leaves a couple other possible EHR certifying organizations. Does anyone know who else is interested?

Well, it always seems to happen when I go out of town on vacation that HHS finally decides to go to work and make some announcements. The final rule for the Temporary EHR certification rule is out and will be published to the Federal Register on June 24th. It’s non-final format is available at the Federal Register’s Public Inspection Desk. Does anyone else kind of squirm when they read about this final rule for a temporary EHR certification. Final and temporary just don’t sound right together, but that’s what we have.

The Healthcare IT Guy attended an HHS ONC press conference and added a nice little summary of what was said:

*As of today if you’re interested in being a certification body you must request the HHS Certifying Body application in writing
*On July 1 ONC will start accepting applications
*By the “end of the summer” (HHS’s words) there will be one or more certifying bodies open for business (accepting products)
*By “this fall” (again, their words) there will be fully HHS certified products available

One important clarification was made by ONC — there is no grandfathering in CCHIT or previously certified products. Everybody is going to be re certified using the new NIST rules. This means that if you have even 2011 CCHIT certification now it won’t mean anything, you have to go through the process again. CCHIT is offering their “ARRA Interim Certification” but beware — the rules say that you have to follow the NIST plans, not what CCHIT developed. So, if you have the ARRA Interim Certification you may not have pay again but you still will be required to change your software to meet the HHS/NIST test plans and requirements.

Nothing that’s all that newsworthy, except it’s nice to finally have a little bit more solid timeline for when there will be some ARRA EHR certification bodies.

I think that Shahid’s analysis of the now meaningless 2011 CCHIT certification is spot on as well. Although, I’m sure we’ll still see quite a few EMR vendors using the marketing power of the CCHIT certification on unsuspecting clinics who don’t know the difference.

Yes, it does also mean that clinics will have to wait until Fall of 2010 (or later) before they’ll really know if an EHR will be a certified EHR or not. Of course, I’ll be very surprised if less than 98% of EMR vendors don’t become ARRA certified.

EMR and HIPAA Answer to EMR Stimulus Questions
Today’s question comes from an EMR and HIPAA reader:
If I may back up, I am not having much luck in finding how we, as a clinic, get ’signed up’ if you will for this program. We already have EHR implemented. We are a rural health clinic that accepts Medicare and caid. We have been told by our EHR provider that they are CCHIT Certified. From what I have read, we are likely eligible however not sure how to get started. Could someone please advise. Thank you

Unfortunately, the answer to this question is that we still don’t know how Eligible Professionals (EP) or Eligible Hospital(EH) are going to be able to “apply” or “sign up” for the EMR stimulus money. I expect we won’t know all the details to actually applying for the EMR stimulus until the end of this year or early next year.

Remember that starting in 2011, you’ll need to show 3 months of “meaningful use” of a “certified EHR” in order to get the stimulus money. That means that CMS has some time before they really have to publish the methods you’ll use to apply for the bonus money. Of course, we all hope it’s published sooner instead of later and ideally before the end of the year so that doctors can plan appropriately for the start of 2011.

Also, to clear up one misunderstanding from the question. CCHIT Certified is NOT the criteria that CMS/HHS will be using to know if you’re using a “certified EHR.” HHS/CMS/ONC have yet to release the final rule for EHR certification bodies and the final criteria that certified EHR software will have to meet to become “ARRA-Certified” or “HHS Certified” (or whatever they end up calling it). We aren’t likely to get all the details on the recognized certification and bodies until at least June and possibly the end of summer.

Justin Barnes, did give some good advice when he said that you should be ‘speaking with your EHR provider to understand how they are going to support you in achieving meaningful use using their “ARRA-certified” EHR.’ Although, I’m a little leery of an EHR company that told you that they are CCHIT Certified and left it at that. It makes me wonder how much they really know about the EMR stimulus money requirements since CCHIT certification doesn’t really matter.

While you wait for more details on the real EHR certifications to happen and for the application process to unfold, you might browse through the meaningful use matrix and other meaningful use details. This is the list of ways that you’re going to have to use your EHR in order to qualify for the money. Certainly would be worth reviewing to see what other EHR features you should be using if you want the EMR stimulus.

Check out the previous EMR and HIPAA EHR Stimulus Question and Answers and please send us other questions you might have in the comments.

I previously posted about the new head of CCHIT, Karen Bell. Most of you probably know that I’m not a huge fan of CCHIT, but I’ve decided that I’d like to give Dr. Bell some advice for CCHIT. Free consulting. How cool is that? Here we go…

If Dr. Bell really wants to solidify CCHIT’s position in the EHR world she’ll find a way to show that the CCHIT EHR certification improves usability, EMR implementation success, reimbursement, etc. CCHIT has some vague terminology about the “assurances” that CCHIT certification provide. Unfortunately, they end up being empty assurances about things that doctors don’t really value.

I’d be really impressed to see an independent study done on the EMR implementation success of CCHIT certified EHR versus non-certified EHR. Or how about a study comparing the usability of CCHIT certified EHR versus non-certified EHR. Let’s see some real data on assurances that doctors actually care about. Do that and everyone will want a CCHIT certified EHR.

Unfortunately, if you do go this route, you need to be open to the possibility that an independent study would find that CCHIT certified EHR have a higher EMR implementation failure rate or that CCHIT certified EHR are less usable. What would CCHIT do then (besides try to manipulate the study to look the way they want)?

What’s more unfortunate, is that studies like this should have been performed before Congress decided to just include the term “certified EHR” without actually knowing what consequence (good or bad) that term might have on the EHR industry.

As always, Chilmark Research has a nice post up talking about the new head of CCHIT, Karen Bell. You can see the official CCHIT announcement here.

Chilmark brings up two interesting points about what he thinks we can expect from Karen Bell as head of CCHIT.

Dr. Bell knows Washington DC and HHS quite well from her many years there. She is effective in a highly politicized environment and will be able to effectively lead CCHIT through that political minefield.
…
Dr. Bell will put up a Chinese Wall between CCHIT and the HIT vendor organization, HIMSS. She is fully aware of the perceived conflicts of interest between CCHIT and HIMSS and will seek to create some distance between these two organizations.

I first must say that the first part is a really smart move by CCHIT. I’d always wondered why CCHIT didn’t have more influence and connection in Washington. That seems like a core competency that they’d want to have to survive. They should have had all the information from HHS before anyone else and they didn’t. I wonder if Dr. Bell will be able to do that for them now.

The second part seems a bit like Chilmark dreaming and hoping. I have a strong feeling that Dr. Bell does indeed realize the conflict and would desire to create that separation. However, I have serious doubts that she will change much of the structure even if she could (which I think might not be possible).

I say this first because Dr. Bell was a representative on CCHIT’s board of commissioners from 2006-2008. Why didn’t she effect this separation back then? Seems like the board of commissioners would have some reasonable control over this.

The answer might lie in the inability to make such a change. Notice I didn’t say her inability. I said the inability. It’s quite possible that there are just too many external pressures for her to break CCHIT’s strong ties with EMR vendors. Of course, nothing would make me happier than for Dr. Bell to prove me wrong. No doubt that would be a most impressive accomplishment.

With all of this said, the real question is, “Does anyone care?” As Chilmark aptly points out, “have yet to see any demonstrable proof that CCHIT certification has moved the EHR/EMR adoption needle in any statistically meaningful way” Beyond that, if ONC does there job, doctors will finally get the information that it’s ARRA EHR Certification that matters and not CCHIT certification. That will take some time to change, but it’s starting to happen. If (and when?) it happens, will anyone care much about CCHIT anymore?

The Drummond Group has just officially announced on their blog their intent to apply for and test EHR software to provide an alternative EHR certification to CCHIT. Here’s a few portions of their announcement:

After a thorough review of the recent NPRM along with months of consideration, DGI is excited to announce that we will be applying to be an ONC-ATCB this year.

As mentioned before, receiving the HHS requirements to become an authorized EHR testing and certification body was the missing piece in our decision to move forward. Now that we have that piece, we feel confident in announcing our intention to formally apply.

In our review of the NPRM, we found it sound, reasonable and a big step forward for formal testing and certification criteria to support Health IT. We will offer our comments as requested, but overall it was an excellent effort.

And this point about Drummond Group’s long term plans for EHR certification:

Last point. We won’t spend too much time here on this blog talking about the Permanent Certification program given the more immediate concerns of the Temporary Certification program. We will say we plan on being part of the Permanent Certification program. More importantly, we want to convey that since our initial press release last November, we have known that we are not in EHR testing for the short haul, but rather, the long term.

Sometimes it’s the little things you catch at an enormous conference at HIMSS that are the most powerful. One of those came for me when I was talking to the VP of marketing from one of the EHR vendors on the floor. This was one of the most interesting people I met with at HIMSS.

As we were talking he kind of said off hand that one of the visitors to his booth had said Allscripts isn’t CCHIT certified.

Now I should clarify. Allscripts was CCHIT certified back in 2007. However, they didn’t do CCHIT certification and in 2008 but they still haven’t done any of the 2011 full CCHIT certification or Preliminary ARRA certification either.

As a side note, CCHIT has moved or taken down the previous years certification lists from their website (not sure why or where they moved them) (UPDATE: You have to drill down to the categories and you can find the previous years). However, they are listed on the EMR and EHR wiki.

The interesting point here is that Allscripts, an EHR company with possibly 21% EHR market share, hasn’t bothered with the CCHIT certification.

I have no doubt that Allscripts will be HHS certified (or whatever they end up calling the certification). However, they haven’t seen the need to go after the CCHIT certification. No doubt there sitting there waiting to get a cheaper EHR certification. This is true for a few hundred other EMR vendors as well.

Another interesting sign of the move away from CCHIT certification and on to the HHS certification.

And yes Allscripts, I am still mad at you for shutting me out of your party at HIMSS despite having registered and read the dozen or so emails you sent reminding me that I registered, but never telling me that I had to stop by your booth for a wristband.

I must admit that I’m so happy to be home from HIMSS. It was a fantastic couple of days, but it’s always nice to be at home. Not to mention, posts are so much more fun on a regular keyboard with 2 monitors. Of course, my email box is full of the notes that I took during the various interviews I did at HIMSS. So, you can expect a lot more posts talking about the things I learned and saw at HIMSS. Not to mention a video series of innovative and interesting products at HIMSS (Sponsored by Practice Fusion).

For my first post after HIMSS, I decided that I couldn’t help but post about the CCHIT town hall at HIMSS. I really said a lot of what I thought on my twitter account, but I’m sure that many missed it. So here’s a short summary of my thoughts with some other commentary on Mark Leavitt’s swan song at HIMSS.

The first thing that bothered me most is what has bothered me about CCHIT for a long time. However, this time I could document first hand the things that CCHIT was saying that was confusing doctors about what the CCHIT EHR certification was all about. Here’s what I recorded them saying (usually on their powerpoint too) that really doesn’t tell the whole story:
“Maximal assurance of comprehensive, integrated EHR capabilities”
Maximal assurance of what? That the EHR is comprehensive? No doubt doctors will see this as saying that a certified EHR will have all of the EHR features that they need. However, how does CCHIT know that it will have all the features all of the various types of practices need? Of course they don’t. They would even admit that it doesn’t. It just is able to run their test scripts based on a list of requirements. That’s where they confuse doctors.

“EHR with all necessary functionality”
and
“Everything you need in an EHR if you do the comprehensive certification.”
Same principle as the previous comment. How can they know what’s necessary? They don’t.

As I sat there listening to this, I wondered if I should get up and ask them a question. I wasn’t sure that me asking a question would be of any value. Then, I decided that I should at least try and help those in the audience to understand the real benefits (or lack thereof) of CCHIT certification. So, I got up and asked the following question (more or less):

What type of assurance does CCHIT offer to doctors? Does it offer better patient care? Are certified EHR more likely to be implemented successfully? What assurance can you offer beyond just talking about the process you went through to create the criteria?

They both (Mark Leavitt and Alisa Ray) kind of looked like they didn’t quite understand the comment. However, Mark basically responded that CCHIT doesn’t make any guarantee of increasing successful EMR implementations or improve patient care. He said that he didn’t think anyone could make that guarantee. CCHIT assures doctors that it meets the criteria that has been created.

Many people wonder what I have against CCHIT. I actually don’t really have any real ties to CCHIT (see my previous post). It just really bothers me when doctors get the wrong impression based on a miscommunication. I don’t like it when EMR salespeople confuse doctors through EMR sales miscommunications and I don’t like when doctors don’t understand what they’re really getting from a certified EHR.

The real problem is that even writing this post, far too few people will get the real message about the benefits (or lack thereof) that are provided by CCHIT certification. Although, I was pleased by all the people I’d never met before stopped me around the conference and told me that I asked a very important question at the CCHIT town hall.

Enough of that for now. Here’s some of the other items that I tweeted about CCHIT (some additional comments in italics):
CCHIT to certify Oncology and Women’s health(Obstetrics and Gyn). Will doctors care? EMR vendors might.

CCHIT had 23 comprehensive and 23 modular EMR cert applications.
46 brave EMR vendors. Although, I think this number is a little misleading. I talked to one of the EHR vendors that has the comprehensive certification and they said that there are only 2 that really have the comprehensive EHR certification. All the rest are “provisional.” I didn’t check those facts, but that says something if indeed it’s true.

CCHIT has announced site certification, but we don’t yet know if HHS will recognize an EHR site certification, no?
After the ONC town hall we now know that ONC will be fine with this as a secondary method of certification if the EHR certifying bodies see it as appropriate.

Nice to see that Mark Leavitt’s recommendations all use CCHIT products. I have a few other options people might consider that don’t.
Mark also referred to not going after a certification to be like gambling. Coming from Vegas I’m not sure I like his gambling reference. However, I really do think there are other options to CCHIT certification. Drummond Group and a third one I learned of at HIMSS which I’ll be writing about shortly too. Although, it certainly makes sense why Mike wouldn’t have acknowledged the other bodies. Although, isn’t CCHIT a non profit? Shouldn’t they just want the best interest of the industry?

With the government program we don’t create the criteria anymore. -Mark Leavitt of CCHIT

CCHIT site certification will be hospitals first. Ambulatory site EHR certification later?
Makes sense that CCHIT would go where the money is, but not a happy thing for the small doctors offices.

“We’re doing EMR usability at a kindergarten level and some EMR vendors don’t pass that.” -Mark Leavitt
This is a really sad fact. It’s nice of Mark to acknowledge it. One other person I talked to at HIMSS suggested to me that CCHIT shouldn’t be doing EMR usability testing at all. However, I’m really not sure what it says about an EMR that can’t pass the simple usability tests that CCHIT does do.

I’m always amazed at how little connection CCHIT has with ONC/HHS. Seems like a telling thing that they don’t.

FierceEMR has really hit the healthcare IT arena in force over the past 6 months. They even have a big party planned for HIMSS. I’ll probably be stopping by since it’s the day after the New Media Meetup at HIMSS. Well, one of my favorite healthcare IT writers, Neil Versel wrote an article for FierceEMR that really caught my eye. It was titled, “Kibbe: New ONC standards make CCHIT process ‘irrelevant’”

If you’ve read this blog for any time you know that I’m an enormous fan of CCHIT (that was in the sarcasm font in case you couldn’t tell). I even declared the Marginalization of CCHIT back in July of last year. So, obviously I agree with David Kibbe’s assertion that the CCHIT process is irrelevant thanks to the HITECH act. A section of the article linked above describes some of the major problems with CCHIT:

Kibbe long has said the CCHIT certification process discourages innovation by being too complicated and costly for new, small companies that otherwise might shake up the EHR market with lower-priced, easier-to-use products. He also has held that the certification body was too closely tied to the health IT establishment. “CCHIT in effect acted as judge and jury for its own industry’s definition of EHR software, inhibiting alternative approaches that would embrace component or modular architectures, web-based delivery also known as ‘software-as-a-service,’ and practical means of achieving interoperable data exchange between applications from different vendors,” he says in a recent blog post.

No doubt the CCHIT criteria is no longer meaningful. The only problem is that a question still haunts my mind, “Did we just move the flawed process from CCHIT to ONC?”