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EMR Vendors Struggle With Meaningful Use Stage 2

Posted on October 29, 2013 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

CCHIT head Alisa Ray, clearly, is trying to put it delicately. EMR vendors are “struggling a little bit” when it comes to meeting 2014 criteria. “It  has been a slow start,” Ray told Healthcare IT News.

Usually, hearing this would lead to an inside baseball discussion of vendor operations, which wouldn’t be very exciting. But the thing is, meeting 2014 certification criteria is necessary to allow providers to meet Meaningful Use Stage 2. So vendor struggles in complying with CCHIT’s criteria should concern providers a great deal.

There are three areas of Stage 2 that are proving to be an issue for vendors: clinical quality measures, interoperability and automated measure calculation for reporting metrics, Ray said.

This has led to a real lag in certifications. About 40 companies had listed products with the CCHIT in 2011, but a scant 21 percent of those have stepped up and gotten certified in the 2014 criteria.

According to Ray’s chat with Healthcare IT News, “almost everyone has struggled and been surprised by the complexities” of meeting 2014 standards.  Despite having gone through the process yearly since 2006 with CCHIT, several have had to go through repeated certification trials to meet criteria.

ICSA Labs’ Amit Trivedi, meanwhile, noted that while there were close to 3,000 listings, with many having multiple listings — Cerner alone had 800 — so far there less than 300 on ONC’s Certified Health IT Products list.

There are signs that EMR vendors will catch up, the HIT story suggests. For example, vendors have been working particularly hard to offer Continuity of Care Documents or Direct messaging, a capability providers must demonstrate for Meaningful  Use Stage 2, said Matt Kohler, vice president of Network Infrastructure Services at Surescripts.

But vendors clearly have some serious development challenges ahead if they want to keep up with the pace set by Meaningful Use Stage 2.  If I were a provider reading this, I’d call my vendor right away and see where they were at in the certification process.

ICSA Labs Questions Strength of ONC Certification Rules

Posted on August 11, 2011 I Written By

You’ve undoubtedly heard the argument before: EHR certification is about assuring that systems meet minimum requirements for functionality and interoperability, but the certification process falls way short in terms of usability, privacy and security. But have you heard the argument from one of the ONC-authorized certification bodies?

This is an excerpt from an e-mail I received today:

Meaningful Use criteria have become a massive EHR certification driver for healthcare organizations. Hospitals and other providers rely on the criteria to ensure that their health IT systems meet minimum government-specified functionality and interoperability requirements to support Stage 1 of Meaningful Use.  Achieving Meaningful Use also ensures a health care organization qualifies for reimbursement under the American Recovery and Reinvestment Act as a way to incent adoption of e-health processes among health organizations. The ultimate goal is to improve our nation’s healthcare system by leveraging technology to allow greater access to important health information and empower patients to securely access their own health information.

However, as one of only five organizations authorized to test both complete and modular EHRs by the Office of the National Coordinator (ONC) for Health IT, ICSA Labs questions whether EHR certifications are enough as the criteria represents only minimum requirements. Amit Trivedi, healthcare program manager at ICSA Labs, believes providers should take further steps to heighten the security and privacy of their health IT systems. He also suggests vendors should look beyond the current regulations to address and improve usability, data portability, and information exchange in their products.

That’s right, ICSA Labs, one of five organizations currently authorized to test and certify complete EHRs on behalf of the Office of the National Coordinator for Health Information Technology, seems to think that the standards it tests EHRs against are inadequate, which is something that critics of certification—particularly critics of the Certification Commission for Healthcare Information Technology—have been saying for years. Critics of many of the larger vendors have been saying that, too. But it’s shockingly refreshing to hear this from an actual certification body.

In fact, the publicist for ICSA, a unit of Verizon Business, has offered interviews with executives of two lesser-known vendors,  Health System Technology and Design Clinicals, to talk about how they are going beyond the minimum certification requirements. Deadlines beckon, so I didn’t really have time to wait for the publicist to try to find me an schedule opening for one of the executives, but here’s a statement from a March 30 ICSA press release that is somewhat telling:

“This year we are expanding our certification programs into health IT, a much-needed area of focus to help modernize today’s health care system,” said George Japak, managing director for ICSA Labs. “With our new focus on safeguarding patient information within electronic health records, we are committed to helping accelerate the adoption of health IT.”

We don’t hear too much about security in the context of certification from too many other camps, so it’s nice to hear that at least one certification organization is critical of the rules it is under contract to follow. Perhaps we’ll see tougher usability, privacy and security standards in the permanent certification program ONC needs to have in place by the beginning of 2012 to support the forthcoming Stage 2 “meaningful use” requirements from CMS.

Wishful thinking?

CCHIT Has Become Irrelevant

Posted on June 22, 2011 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

For those of you that are relatively new to EMR and HIPAA, you might not appreciate this post as much as long time readers of EMR and HIPAA. A few years back, I admit that I was pretty harsh on CCHIT and their EHR certification. I remember one guy stopping me at a conference and after realizing who I was asked, “so what’s your issue with CCHIT?” I was happy to answer that I thought they misled the industry (doctors in particular) by saying that the CCHIT certification provided an assurance that the EHR was a good EHR. They never came outright and said this, but that’s what EMR sales people would communicate during the sales process.

In fact, EHR certification was incorrectly seen by many doctors and practice managers as the stamp of approval on an EHR being of higher quality, more effective, easier to use, and was more likely to lead to a successful EHR implementation. EHR certification today still has some of these issues. However, the fact is that the EHR certification doesn’t certify any of the great list above. If EHR certification of any kind (CCHIT or otherwise) could somehow assure: a higher implementation success rate, a better level of patient care, a higher quality user experience, a financial benefit, or any other number of quality benefits, then I’d support it wholeheartedly. The problem is that it doesn’t, and so they can’t make that assurance.

So, yes, I do take issue with an EHR certification which misleads doctors. Even if it’s the EHR salespeople that do the misleading.

I still remember the kickback I got on this post I did where I said CCHIT Was Marginalized and the post a bit later where I said that the CCHIT process was irrelevant. Today, I came across an article on CMIO with some interesting quotes from CCHIT Chair, Karen Bell. Here’s a quote from that article.

In addition, the Office of the National Coordinator for Health IT’s (ONC) new program has provided two new reasons for certification: proof that an EHR can do the things that the government wants it to do, and to enable eligible providers and hospitals to get EHR incentive money.

“The idea is not to assure the product will do all things that are desired for patient care, instead, the idea is to stimulate innovation,” said Bell. As a result, the program is considered a major success because more than 700 certified health IT products are now on the ONC website. “The idea was to get a lot of new products started. This is a very different reason for certification than what we began doing several years ago,” she said.

However, just because CCHIT or another ONC-Authorized Testing and Certification Body (ONC-ATCB) doesn’t test and certify for a particular ability, that doesn’t mean the EHRs don’t have it. “It’s just up to [the provider] to make sure the vendors have it,” said Bell.

I first want to applaud Karen Bell and CCHIT for finally describing the true description of what EHR provides a clinic assurance that:
1. The EHR does what the government wants
2. You are eligible for the EHR incentive money
Then, she even goes on to say that it’s up to the providers to make sure the vendors have the right capabilities for their clinic.

I imagine Karen and CCHIT would still probably say that the CCHIT “complete” EHR certification provides assurance that…< fill in the blank >, which the ONC-ATCB EHR certification doesn’t provide. The happy part for me is that even if CCHIT says this, no one is really listening to that message anymore.

Yes, CCHIT has essentially become irrelevant.

I can’t remember anyone in the past year asking me about CCHIT certification. From my experience, many people care about ONC-ATCB EHR certification, but they really couldn’t care less if it comes from CCHIT, Drummond Group, ICSA Labs, SLI Global, or InfoGuard (That’s all of them right?). Have any of you had other experiences?

I also do enjoy the irony of this post coming right after my post about differentiation of EMR companies (Jabba vs Han Solo). CCHIT is the reason that I know so much about the challenge of EHR differentiation. CCHIT’s efforts provided some very valuable (and lengthy) discussions over the past 5 years about ways to help doctors differentiate between the 300+ EHR vendors. As you can see from my comments above, I was just never satisfied with CCHIT being the differentiating factor. As you can see from my post yesterday, I’m still searching for a satisfactory alternative for differentiating EHRs. Until then, we’ll keep providing an independent voice a midst all the noise.

New Medical Transcription Service Consortium for Sharing Patient Data

Posted on November 6, 2009 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently got an email about a new consortium of medical transcription service organizations (MTSOs), called the Medical Transcription Service Consortium. The basic concept is that these organizations will provide the tools for doctors who use their service to share patient information. The new framework they’re working to create will support structured narrative notes which read like a text document, but include XML tags that allow for granular patient data to be imported into an EMR.

I like the concept and I’m intrigued by the involvement of transcription companies in the sharing of data. They already are sharing the data between the transcription company and the doctor’s office. Seems like a reasonable suggestion to be able to share it with other doctors offices. I’m told that it’s still very early for this consortium. It will be interesting to see it evolve over time.

The consortium members include: ICSA Labs, an independent division of Verizon Business, the MTIA, MD-IT, MedQuist, MxSecure, Sten-Tel, and Webmedx. The press release from MD-IT says these organizations represent 2,500 hospitals and 375,000 physicians nationwide. That’s an estimated 200 million narrative patient notes created annually and 2.5 billion patient records in electronic archive. I’ll just say, that’s a lot of patient data that could be easily shared.