Certification Commission for Healthcare Information Technology

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The Certification Commission for Healthcare Information Technology (CCHIT) is a private not-for-profit organization that serves as the recognized US certification authority for electronic health records (EHR) and their networks. CCHIT was founded in 2004 with support from three leading industry associations in healthcare information management and technology: the American Health Information Management Association (AHIMA), the Healthcare Information and Management Systems Society (HIMSS) and the National Alliance for Health Information Technology(the Alliance). In September 2005, CCHIT was awarded a 3-year contract by the U.S. Department of Health and Human Services (HHS) to develop and evaluate the certification criteria and inspection process for EHRs and the networks through which they interoperate. In October 2006, HHS officially designated CCHIT as a Recognized Certification Body (RCB).[1]


Contents

[edit] Mission

To accelerate the adoption of health information technology by creating an efficient, credible and sustainable product certification program.



[edit] Goals


[edit] CCHIT Certified(SM) Products

37 CCHIT Certified Ambulatory EHR products (as of November 17, 2006)

[edit] Commissioners

The Commission, chaired by Mark Leavitt, MD, PhD, is currently composed of 21 members[4], each serving two-year terms:

  • Abha Agrawal, MD, FACP, Director, Medical Informatics; Associate Medical Director, Kings County Hospital Center
  • Richard Atkin, President, Misys Healthcare Systems
  • Stephen L. Badger, CEO, George Washington U. Medical Faculty Assoc.
  • David Bates, MD, MSc, Chief, General Medicine, Brigham and Women's Hospital
  • Karen Bell, MD, Director, Office of HIT Adoption, Office of the National Coordinator for HIT, US Department of Health and Human Services
  • Bruce Nedrow Calonge, MD, MPH, Chief Medical Officer, Colorado Dept. of Public Health and Environment
  • Jane L. Delgado, PhD, MS, President and CEO, National Alliance for Hispanic Health
  • Andrea Gelzer, MD, FACP, Senior Vice President, Clinical Public Affairs, CIGNA Healthcare
  • Jeffrey Hillebrand, Chief Operating Officer, Evanston Northwestern Healthcare
  • Herb Kuhn, Senior Advisor to the Administrator, Centers for Medicare and Medicaid Services (CMS), US Department of Health and Human Services
  • Christopher Macmanus, Senior Vice President, Information Technology & CIO, Catholic Health Initiatives
  • Denni McColm, Chief Information Officer, Citizens Memorial Healthcare
  • Jane B. Metzger, Research Director, Emerging Practices, First Consulting Group
  • Susan R. Miller, RN, FACMPE, Administrator, Family Practice Associates of Lexington Kentucky
  • James Morrow, MD, Vice President and Chief Information Officer, North Fulton Family Medicine
  • Jonathan Perlin, MD, PhD, Chief Medical Officer and Senior Vice President for Quality, HC
  • Wes Rishel, Research Director, Gartner, Inc.
  • Don Rucker, MD, Vice President and Chief Medical Officer, Siemens Medical Solutions
  • Michael Ubl, Director, IT Strategy & eHealth, Blue Cross and Blue Shield of Minnesota
  • Andrew G. Ury, MD, Chief Executive Officer, Practice Partner, Inc.
  • Andrew Wiesenthal, MD, Associate Executive Director, Clinical Information Support, The Permanente Federation


Former Commissioners who have already completed two-year terms include:

  • Suzanne Delbanco, PhD, CEO, The Leapfrog Group
  • John Hummel, Clinical Solutions Director, Perot System - Healthcare Group
  • Sam Karp, Vice President of Programs, California HealthCare Foundation
  • Charles D. Kennedy, MD, VP of Clinical Informatics, WellPoint Inc.
  • Graham O. King, President, Information Technology Business, McKesson Information Solutions
  • Susan N. Postal, MBA, RHIA, VP, Health Information Management Services, Hospital Corporation of America
  • John Tooker, MD, MBA, FACP, Executive VP/CEO, American College of Physicians
  • Reed V. Tuckson, MD, Senior VP, United Health Group


[edit] Stakeholders

Certified EHR products benefit many interested groups and individuals:

CCHIT and its volunteer workgroups strive to fairly represent the interests of each of these diverse groups in an open forum, communicating the progress of its work and seeking input from all quarters. CCHIT has received the endorsements of a number of professional medical organizations, including the American Academy of Family Physicians , the American Academy of Pediatrics, the American College of Physicians, the Physicians' Foundation for Health Systems Excellence and Physicians' Foundation for Health Systems Innovation.

[edit] Operations

[edit] Present

CCHIT has focused its first efforts on ambulatory EHR products[5] for the office-based physician and provider and began commercial certification in May 2006.

CCHIT has begun the process of certification for inpatient EHR products[6] and expects to have certified products available in 2007.

CCHIT has started to assess the potential of certifying EHR for specialty medicine, special care settings, and special-needs popluations.[7] As part of this effort, an environmental scan is currently underway.[8]

[edit] Announcements of CCHIT Certified Products

  • On July 18 2006, CCHIT released its first list of 20 certified ambulatory EMR and EHR products [9]
  • On July 31 2006, CCHIT announced that two additional EHR products had achieved certification. [10]
  • On October 23, 2006, CCHIT released its second list of 11 certified vendors.[11]

[edit] Future

CCHIT works in a dynamic environment, collaborating with HHS and AHIC. Some standards are just gaining consensus while standards for interoperability are at an earlier state of development.

[edit] Controversies

[edit] CCHIT as a "Recognized Certification Body"

The collusion of government with the private sector under the umbrella of forming an official "recognized certification body" is worrisome. This collaboration will stifle innovation, markedly decrease competition by smaller vendors with less costly electronic medical record (EMR) products, and add a layer of fees and costs that is unnecessary. The growth of health infomation technology in the United States was already growing at an increasingly healthier rate.in the previous 5 years driven by decreasing EMR prices.


This involvement by government has set up an environment where physician consumers will now have to purchase much higher priced "certified" EMR systems. Abuse will be seen on both ends of this process- on the government side by the use of mechanisms such as pay-for-performance to further decrease physician reimbursement..In the private sector the large, powerful vendors which control CCHIT from within will profit from the fees paid for certification, and also will profit from the loss of competition from smaller vendors unable to pay for the high cost of certification.


CCHIT blurs the truth of their goals as stated above. Mr. David Merritt, project director at the Center for Health Transformation states that CCHIT should strive "to make the process as easy as possible for people so as not to price out those smaller vendors." Unfortunately, Mr. Merritt’s advice was ignored.


The most important issue that CCHIT is supposed to address, but hasn’t (and doesn't plan to address fully through 2008), is interoperability. The Continuity of Care Record (CCR) interoperability standard from ASTM International, is a proven method for sharing a patient’s health information between care providers. The cost for vendors to implement the CCR standard is minimal and already vendors are being verified by entities such as the American Academy of Family Practice. CCHIT instead focuses more on “enterprise” type functionality that would never be used by an individual provider or small group practices. This is especially disturbing when you consider that individual providers and small group practices represent 88%.of all practicing physicians.


CCHIT also does not certify an EMR system will be truly functional for the purchasing physician office. It only tests a set of preordained list of features some of which are inappropriate or simply unwanted by the vast majority of purchasing offices. Cost is the main barrier.to the growth of HIT. The only real way to increase the use of health information technology is to make EMR systems much less expensive, not by some esoteric certification-based "assurance" theory.

[edit] Controversy Over Insider Stakeholders

One of the 3 organizations that incorporated CCHIT, the Healthcare Information and Management Systems Society (HIMSS), is a trade association which comprised 20 of the biggest EMR vendors in the United States when CCHIT was founded. In financial disclosure documents posted on their website.it is noted that CCHIT is a not-for-profit LLC owned, operated, and managed by many of the same vendors and affiliated staff. Their own incorporation papers state that: "Any profits that are made by CCHIT are disbursed among the same CCHIT vendor-owners at year's end." An obvious conflict of interest arises for not only suppression of competition but by forcing small business vendors to lose profits by paying large fees that eventually flow to the competition who are the actual owner/operators of the CCHIT organization. For the fiscal year 2006 their own Commission meeting minutes has an income statement: "...we could end up with net income of one million dollars at the end of the fiscal year, which is December [2006]."


It also has been noted.that HIMSS has in the past made lavish payments to Congressional lawmakers as a powerful lobbyist for the nonprofit CCHIT organization.

[edit] Controversy: Future Effect on Competition, EMR Adoption, and EMR Prices

The CCHIT certification process flies against everything that living in the United States stands for- free enterprise, decreased taxes and user fees, increased innovation, increased heterogeneity of choice, and finally the growth of the American HIT industry into world leadership.


The typical CCHIT EMRs are almost twice as expensive as that of non-CCHIT EMRs using an established price comparison matrix..This divide will worsen, as CCHIT will likely end competition from free, open source, and low cost EMR products and will affect the viability of not only small to many mid-level EMR vendors, but also physician offices alike by markedly increasing the cost of HIT. CCHIT has won the backing of big government, of the large insurance industry, and even of a small handful of medical societies. It has been able to collect a large sum of money to conduct its activities. Even with all of this, it's overall survivability still is tenuous. The second phase of certification saw 6 of 17 EMR vendors quit the process. CCHIT must also strive to win over the hearts, minds, and financial support of those physicians who work in small to medium sized offices in the United States.


The upcoming year (2007) will determine whether vendors and physicians alike are willing to practice under this CCHIT cartel and pay the extra costs associated with certification. Even Mark Leavitt MD.recently said that "certification will help business. If you don’t see an acceleration in the [EHR] market, then we’ve failed.” If this becomes a reality, then a smaller, less onerous to competition, less costly and a fairer system focusing on interoperability verification would most likely become the more accepted and successful process to advance HIT for the healthcare system in the United States.


Important link that discusses controversies further: emrupdate.com, the Unbiased Independent Portal..Retrieved on 2006-10-20.

[edit] See also

[edit] External links

[edit] Notes

  1. ^ U.S. Department of Health and Human Services (October 26, 2006): HHS Officially Recognizes Certification Body to Evaluate Electronic Health Records
  2. ^ Streamline MD 9.0.9 is powered by mMD.net 9.0.9, a product of MCS-Medical Communication Systems, Inc.
  3. ^ Sage Software acquired Emdeon Practice Services in September 2006; for more information see: Sage Software Completes Acquisition of Emdeon Practice Services
  4. ^ Certification Commission for Healthcare Information Technology (September 19, 2006): CCHIT Names New Commissioners
  5. ^ Public postings of CCHIT work products for the ambulatory domain
  6. ^ Public postings of CCHIT work products for the inpatient domain
  7. ^ CCHIT to Expand Electronic Health Record Certification to Some Specialties (November 28, 2006)
  8. ^ CCHIT: Certifying EHR for Specialty Medicine and Special Care Settings
  9. ^ Certification Commission for Healthcare Information Technology (July 18, 2006): CCHIT Announces First Certified Electronic Health Record Products Retrieved July 26, 2006
  10. ^ Certification Commission for Healthcare Information Technology (July 31, 2006):CCHIT Announces Additional Certified Electronic Health Record Products Retrieved July 31, 2006
  11. ^ CCHIT Announces New Certified Electronic Health Record Products (October 23, 2006): CCHIT Announces New Certified Electronic Health Record Products
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