Back in February I posted a poll asking the question “Which EHR certification criteria should HHS use for the HITECH Act?” Of course, at the core of the question is whether HHS, ONC, David Blumenthal and co. should use CCHIT certification as the “certified EHR” criteria for obtaining EHR stimulus money. Here’s a look at the results from the poll:

I will grant you that this website probably has a bit of a readership bias against CCHIT. However, there are also a lot of CCHIT certified EHR vendors who read this blog and so that would certainly bias the voting the other direction.

With that disclaimer, I think that this poll shows a real growing trend to people wanting an alternative EHR certification to CCHIT. I’m sure that CCHIT will be one option, but I hope that the government provides another option besides CCHIT for those wanting EHR stimulus money.

There’s a whole lot of discussion going on (rightfully so) right now about CCHIT EHR certification and of course the term “certified EHR.” I don’t know if anyone else has noticed or not, but there seems to be a bit of a growing movement towards not having ONE EHR certifying body (presumably CCHIT).

A post over on John Chilmark’s blog highlights a really interesting point about having only one EHR certifying body. The point is that there’s little accountability if CCHIT is the only body that’s certifying EHR vendors. What reason would CCHIT really have to improve its certification if it’s the de facto standard for certification? CCHIT admitted that their CCHIT EHR certification wasn’t up to the ambitious goals of HITECH/ARRA. That doesn’t mean they can’t change (although I have my reasonable doubts). However, if they are set up as the sole EHR vendor certification body, then what reason would they have to change?

OK. Yes, you could make an argument that they would want to change for the common good of man. Yes, that means we would see some change on their behalf towards that goal. However, to really change the game in EHR, we need something that requires people to innovate and a sole EHR certification of any kind will have a rough time doing that.

What scares me is that I think that CCHIT is aware of its weaknesses and realizes that it wouldn’t be able to iterate it’s EHR certification to meet the ever changing technology. It seems like the market is ripe for some really smart person to do something to better certify EHR. I wonder what type of game changing certification that will be.

In a really thoughtful post on HISTalk, Dewey Howell MD, PhD, Founder, CEO Design Clinicals, Inc. wrote a n article called “The Real Problem with CCHIT Certification.” In it, Dr. Howell basically makes the case against CCHIT, because it doesn’t take into account all of the various specialized EHR which only need to do a few things really well. His example was an EMR for “ambulatory, inpatient, and emergency settings.”

These arguments remind me when near the beginning of the CCHIT certification process it included such things as growth charts. Sure, growth charts are essential to a pediatric EMR, but not so much so for other EMR companies. Luckily, the vetting process did remove this criteria and what CCHIT ended up with was much better than what they started to create. Unfortunately, it’s still an onerous process for a specialized EHR to be CCHIT certified.

Dr. Howell also provides this really interesting insight:

Another deficiency of the current certification process is the lack of requirement for certification of results or outcomes. How do we certify and validate that the system actually delivers the outcomes that we are trying to achieve? The current process encourages vendors to throw a button or screen into their application that produces a specific action or display. But, there is no accountability to the patient and quality of care delivered with the tool. It encourages technology for technology’s sake, presuming that outcomes will be “better” just because a product is certified, instead of really validating results. Maybe this is a much tougher nut to crack, but it is considerably more important than things like, “The system shall provide the ability to allow users to search for order sets by name.”

I like how he described the need to measure results or outcomes. We’ve often mentioned on this blog CCHIT’s biggest problem is actually measuring usability, but results and outcomes are another way to look at the challenge of certification.

If you’ve read much of this blog at all, then you know that I’m not a big fan of CCHIT. The basis of my feeling is that it’s expensive, doesn’t measure EHR usability (despite the impression that it does), and really feels like a coalition of big EHR companies trying to secure their position in the EHR world despite having often inferior products.

All of that aside, the health care IT blogosphere has been posting some amazing accusations about CCHIT. I’ll admit that I don’t have any inside information on the organization and structure of CCHIT. So, I’ll just post all of the various information being posted about CCHIT and let you decide what might be true and what might be conjecture.

Remember that the things below may be rumors, misinformation, politically motivated, flat our wrong, mostly correct, or from disgruntled individuals.  Read everything below and judge for yourself.

See the full coverage of the CCHIT drama after the break
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