Electronic Health Record (EHR) information and news

As the federal government works on finalizing the rules that will enable providers to receive ARRA funds, CCHIT is working to transform its certification programs to meet the needs of the health care community. The following podcast provides information on the updates to CCHIT certification programs that will reopen on April 7, 2010.

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Join Healthcare IT News from this year’s HIMSS conference as they interview CCHIT Chair Mark Leavitt, MD, PhD, and CCHIT Executive Director Alisa Ray.

In the first of two CCHIT podcast interviews at HIMSS10, Mark Leavitt, MD, talks about the “unprecedented amount of financial incentives for implementing electronic health records” and the ambition of the meaningful use criteria.

In our second of two CCHIT podcasts from HIMSS10, Alisa Ray, executive director for CCHIT, talks about what’s new with the organization and how meaningful use has affected all healthcare IT industry stakeholders.

To listen, visit Healthcare IT News for the podcast with Leavitt and the podcast with Ray.

Having reviewed the Notice of Proposed Rulemaking regarding certifying bodies, we feel confident about our prospects of becoming accredited. Today’s release of the Certification NPRM is an important step that will reduce the uncertainty that the health care community has experienced while awaiting this additional information.

CCHIT has four years of experience testing and certifying EHRs, and promptly adapting our testing to the latest Federal standards. We have also been benchmarking our operations against best practices for certifying bodies, including the ISO/IEC accreditation standards, and we are well prepared. We plan to file an application with ONC as soon as they are ready to accept them.

We feel confident about the future, and we look forward to the opportunity to continue playing a role in accelerating the adoption of health IT.

In a guest post on Health System CIO, Russ Branzell, CIO, Poudre Valley Health System, describes some of the collaborative activities in which CIOs are engaging to help address issues affecting health IT.

One example? Colorado:

When was the last time a majority of the CIOs and senior HIT leaders of the Colorado healthcare organizations met to work collaboratively on significant and urgent issues? Answer: Never!!!  Now a new group, Colorado CIO Communication Collaborative (C4)  formed in just six weeks.

For more information, read the post on CIOs coming together.

Entitled “Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology,” the Interim Final Rule (IFR) by the U.S. Department of Health and Human Services (HHS) was officially published on January 13 and becomes effective on February 12, 2010.

But what does this new IFR mean to EHR certification? Join Kris Rebillot as she examines the impact with CCHIT Chair Mark Leavitt, MD, PhD, and CCHIT Executive Director Alisa Ray.

A recent article, reporting that NIST awarded a $400,000 contract to Booz Allen Hamilton to develop a framework for electronic health record certification, stirred up lots of questions.

We needed to find out more. It took some time to locate the source document, because the terms “health IT” and “certification” aren’t in the title – instead, it’s entitled “Justification for Other than Free and Open Competition” and it is publicly available by searching fbo.gov for Department of Commerce/NIST documents released January 13, 2010. Or just use this quick link: http://bit.ly/6p2pDD

The NIST document refers to two task areas. First, “develop testing and certification program documents in support of the HHS Health IT Certification Program.” Second, “develop accreditation program documents and a proficiency testing framework to support HHS in authorizing certification and testing organizations.” Note the work product in both cases: documents, not actual programs. We see nothing here to suggest that ONC, NIST, or Booz Allen intend to build and operate a certification program themselves. They do need to develop a well-defined set of policies and processes for accreditation of those programs.

In the Interim Final Rule, ONC said they “decided to proceed with a separate notice and comment rulemaking (which we anticipate publishing shortly after this interim final rule) to establish the policies for the certification of HIT and the process a certification body will need to follow to become an authorized certification body, as determined by the National Coordinator.” [our italics] We think that’s still the most reliable description of what’s underway.

But the NIST document does offer some timing clues. This particular contract, described as a bridge to an upcoming acquisition (i.e. contract) runs 3 months, with a 3 month optional extension. Sounds to us like the soonest the accreditation package would be ready is July 2010, and of course the certifying bodies then have to apply and qualify. By which time, in our opinion, it would be impossible for a provider or hospital to begin shopping for a certified EHR and achieve Stage 1 Meaningful Use in time for the 2011 or 2012 incentives. Let us know if you agree with that assessment.

It appears clearer than ever how crucial our current work is to the health care community and to the practical achievement of the ARRA goals. Next week we’ll release an analysis of the gaps between our current 2011 criteria and the IFR, as well as a plan for promptly closing the gaps.

A new report from KLAS indicates that 85% of providers believe their electronic health record (EHR) will help them qualify for federal “meaningful use” standards.

For the report, KLAS interviewed more than 1,400 health care providers about their experiences with EHR products from 26 vendors. The survey asked the providers whether they thought their EHRs would meet the preliminary meaningful use recommendations issued by the Health IT Policy Committee in July (Monegain, Healthcare IT News, 1/6).

The survey found that health care providers using athenahealth, Epic and NextGen EHR products had the highest confidence that their systems would meet the meaningful use requirements.

For more on the report, read iHealthbeat.

On October 7, CCHIT launched its new 2011 certification programs. We announced results from the first few inspections last week and have more underway, but with everyone eager for predictions about “life under ARRA” we thought it might be helpful to share some details that point to early trends.

Since opening up the two 2011 programs a month ago, we’ve received a total of 25 applications already. About two-thirds are for the CCHIT Comprehensive program – which aims for maximal assurance to EHR buyers — and one-third for the Preliminary ARRA program which maximizes flexibility instead.

Within the Comprehensive program, the optional add-on programs are proving popular, with a total of 12 applications seeking to demonstrate these extra qualifications. Although most Comprehensive applications are for Ambulatory EHR, as expected, we have Inpatient, Emergency Department, and ePrescribing vendors in the mix as well.

Under the Preliminary ARRA program, two-thirds of the products are for Eligible Providers and one-third are targeted to Hospitals. We’re also seeing a nice spread between vendors focusing on just a few meaningful use objectives, those aiming for all of them, and some more in between.

It’s too early for statistical analysis, but some things are becoming apparent. First, it looks like our decision to move ahead rather than waiting for final rules next summer was valid. And we believe these numbers will accelerate once the upcoming ONC and CMS postings help to reduce the general uncertainty. Second, it looks like a sizable and diverse group of certified products will be available in the pipeline, and that’s good news for the whole ARRA initiative.

But let’s not minimize the challenges ahead. We’ve also been gathering data on how well providers and hospitals understand the ARRA incentives, the role of certification, and the fact that having certified EHR technology is only the first step on a complex road to meaningful use. The scores here are not good. At a focus group we held for non-EHR-using physicians, awareness of the meaningful use concept was essentially zero. In recent conversations with hospital representatives, we find their understanding is much better, but fear and doubt scores run high.

We’re going to do our best to make certification efficient to obtain, and easy to understand, but explaining and motivating meaningful use to hundreds and thousands of doctors, nurses, and managers will take a coordinated effort from everyone in health IT. To do our part, we plan to increase the number of Town Calls and educational programs we offer, and we look forward to partnering with others in the public and private sector to maximize effective outreach and communications. We would be pleased to hear your ideas about how to take on this challenge as well.

David Blumenthal, MD, MPP, the National Coordinator for Health Information Technology, has some thoughts on the future of healthcare in the United States. But at the core of his argument is a very simple premise: “having an EHR alone is not sufficient.”

To the extent that they accurately capture past experience with EHRs, these studies illustrate something that the Congress and the President understand and have allowed for:  namely, that having an EHR alone is not sufficient.  Doctors and hospitals have to use this technology effectively, have to employ its extraordinary power to improve clinical decisions, in order to achieve its potential benefits.  The federal government’s new programs of incentives and penalties are totally focused on encouraging the meaningful use of EHRs.  The resources set aside by the Congress to encourage the adoption of EHRs will go only to physicians, hospitals, and other providers who meet carefully designed new requirements for the use of EHRs that will translate into health improvements and cost reductions for the American people.  And the plan passed by Congress includes new resources and support that will help make it possible for providers and hospitals to meet these requirements.

For more, read Blumenthal’s post on “The Evidence for HIT.”