Certification Commission for Healthcare Information Technology
CCHIT Progress: Toward EHR Adoption
Alisa Ray, Executive Director, CCHIT
Feb 15, 2007American Health Quality AssociationNew Orleans, LA
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Topics
•Objectives of Session
•Brief Update on CCHIT’s Work
•Progress of Certification Development
•Understanding the Certification Program
•Accessing the Certification Program
•Q & A
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Objectives of Session
Prepare you to: • Describe CCHIT’s strategic role and progress within the national health information technology initiatives
• Participate in CCHIT’s current development for specialty and inpatient EHRs, and in future network certification development
• Guide physician practices in how to access and use CCHIT’s current ambulatory certification program
Certification Commission for Healthcare Information Technology
Brief Update on CCHIT’s Work
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Mission and Milestones
Mission: accelerate the adoption of robust, interoperable health IT
• Reduce the risks of investing in HIT
• Facilitate interoperability of HIT products
• Enhance availability of adoption incentives and regulatory relief
• Ensure that the privacy of personal health information is protected
Milestones:• Sept 2004: AHIMA, HIMSS, and the
Alliance partner to launch CCHIT
• June 2005: AAFP, AAP, ACP and others add $325k funding support
• Sept 2005: CCHIT awarded 3-year, $7.5M HHS development contract
• May 2006: CCHIT Ambulatory EHR Criteria approved by AHIC and HHS
• July 2006: First CCHIT Certifiedsm Ambulatory EHRs released
• Oct 2006: HHS deems CCHIT a Recognized Certification Body
• Dec 2006: CCHIT becomes independent nonprofit organization
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Current Organization
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CCHIT Role withinHHS Health IT Strategy
StandardsHarmonization
ContractorCCHIT:
ComplianceCertificationContractor
Privacy/SecuritySolutionsContractor
Office of the National CoordinatorProject Officers
American Health Information CommunityChaired by HHS Secretary Mike Leavitt
NHINPrototype
Contractors
HarmonizedStandards
NetworkArchitecture
PrivacyPolicies
Governance and Consensus Process EngagingPublic and Private Sector Stakeholders
CertificationCriteria +
Inspection Processfor EHRs
and Networks
Strategic Direction +Breakthrough Use Cases
Accelerated adoption of robust,
interoperable, privacy-enhancing
Health IT
Certification Commission for Healthcare Information Technology
Progress of Certification Development
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Scope of Work Under HHS Contract
• Phase I (Oct 05 – Sep 06)– Develop, pilot test, and assess certification of
EHR products for ambulatory care settings – maintenance • Phase II (Oct 06 – Sep 07)
– Develop, pilot test, and assess certification ofEHR products for inpatient care settings
• Phase III (Oct 07 – Sep 08)– Develop, pilot test, and assess certification of infrastructure or
network componentsthrough which EHRs interoperate
• Scope Expansion (effective Oct 06)– Address specialized EHR needs
• Concurrent effort (April 06 – Sep 08)– Transition to become an independent, self-sustaining
organization
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Development Timeline
Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3
20062005 2007 2008
Develop, publish proposed criteria
Pilot test and publish report
Develop, publish proposed inspection process
Develop, publish proposed criteria
Ambulatory EHR Domain (Update for 2006-07)
Inpatient EHR Domain (New for 2006-07)
Network Domain (Starts in 2007-08)
Pilot test & publish report
Final comments, begin certification
Final comments, begin certification
Update criteria, roadmap; publish
Pilot test as needed; publish report
Update inspection process; publish
Final comments, apply updated criteria
Preliminarydata-gathering
Develop, publish proposed ins. proc.
We are here: Final Ambulatory public comment (2/21) New Inpatient schedule Public comment on specialty roadmap Initiating data-gathering on networks
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Update: Inpatient EHR Certification Development
• Inpatient systems much more complex than ambulatory• Modular approach• First modules to be certified: CPOE and eMAR• Core HIS/CIS probably next• Interoperability requirement: functional integration to
pharmacy and Core HIS/CIS must be demonstrated– Pharmacy and Core HIS/CIS can be same vendor’s
application, other vendor’s application, or simulation– Demonstration can be at vendor’s facility or at customer
site -- vendor’s choice
• Schedule delayed ~3 months – probable launch July/Aug
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Update: Specialized EHR Certification Development
Core Criteria
Specialty A Additional
Criteria
Setting M Additional
Criteria
Population XAdditional
Criteria
• Concept:– Core Criteria with Additional Criteria
serving particular specialties, settings, or populations
– All EHRs certify to core criteria; vendors choose which additional sets to certify against
– Full transparency on CCHIT website• Status
– Environmental scan done– Commission published draft roadmap– Public comment Feb 2007– Begin development for 2-3 specialties
during 2007
Certification Commission for Healthcare Information Technology
Understanding the CertificationProgram
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Certification Program
• All requirements published well in advance:– Functionality Criteria– Interoperability Criteria– Security Criteria– Test Scripts– Interoperability Practice Test Files
• Vendors apply, complete documentation requirements, and receive an inspection date
• Multiple fail-safe mechanisms• Appeals process is available
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Certification Flowchart
= CCHIT Process
= Applicant Process
= CCHIT Decision
= Applicant Decision
On inspection date:CCHIT Proctor supervises
the Jury-Observed Demonstration
Same-day retest of noncompliant steps on
first pass
Juror votes collated -items declared
‘noncompliant’ bya majority of the jury
are identified
On inspection date: CCHIT Proctor and Security
Inspector observe demonstration
Items declared ‘noncompliant’ are identified
Passed all items?
YES
Issue Certification Document
Add to list of Certified Vendors on CCHIT Website and issue press release on next batch announcement
date
Completed in allotted time?
YES
Schedule additional test date
(fee charged) NO
NO
Applicant may request retest with new jury/
inspector (no fee charged)
If product is found noncompliant after retest with new jury/inspector, Vendor may appeal for Commission review (no
fee charged)
Commission review –concur with jury/inspector?
YES
NO
LEGEND
FUNCTIONALITYINSPECTION
SECURITYINSPECTION
Issue report on noncompliant inspection to Applicant
ENDCertification denied –Applicant may reapply
ENDCertification granted – Vendor must comply with
Maintenance requirements
CCHIT Proctor and Security Inspector review self attestation materials
Items declared ‘noncompliant’ are identified
Provide clarifications or additional information
SELF ATTESTATION INSPECTION
Same-day retest of noncompliant steps on
first pass
Information reviewed and results compiled
Verify production use
Flowchart from CCHIT Certification Handbook (available at www.cchit.org)
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Functionality Inspection:Jury-Observed Demonstration
Vendor personnel follow Test Script to demonstrate system at the vendor facility
Juror A(Practicing physician)
Juror B
Juror C
Web conferencing (gotomeeting.com)
and concurrent audio conferencing
CCHIT Proctor
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Security Inspection:Demonstration + Self-Attestation
Vendor personnel follow Test Script to demonstrate system at the vendor facility
Juror D (IT/Security Expert)
Web conferencing (gotomeeting.com)
and concurrent audio conferencing
CCHIT Proctor
Juror D (IT/Security Expert)also reviews self-attestation
material offline, calls or emails vendor as needed for
additional documentation
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Interoperability Inspection:Demonstration + Self-Attestation
Vendor importsTest Files during live
demonstration
Jurors confirm that result data appears
correctly in the record
CCHIT Proctor
Vendor self-attests to ePrescribing standards
compliance (certification by RxHub or SureScripts fulfills
requirement)
CCHIT staff reviews documentation and verifies valid certification by RxHub
or SureScripts
Vendor receives official Lab Result Test Files
as test begins
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Current Status ofCertification Program
22 Certifications Announced
May 3-12, 20061st
2006Ambulatory
EHRs
July 2007May 1-14, 20071st2007
Ambulatory EHRs
Apr 2007Feb 1-14, 20074th
25% of est. market size
Nov 1-14, 200629 Applications
3rd
11 Certifications Announced
Aug 1-14, 20062nd
AnnouncementApplication Window
Certification Quarter
Certification Year
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Evidence of Certification Impact on HIT Adoption
• Official recognition/deeming of CCHIT by HHS/AHIC• Stark and Anti-Kickback safe harbors require certification
of donated EHRs• Physician community: certification endorsed by AAFP,
AAP, ACP, MGMA, AEP, and Physicians Foundations• Evidence that communications efforts reaching physicians
in their practices and influencing buying decisions• High interest from specialties in expanding EHR
certification to their areas
Certification Commission for Healthcare Information Technology
Accessing the Certification Program
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Which Products are Certified?
Look for the official certification seal on
the product, documentation, or
marketing literatureFind latest list at www.cchit.org website
Or...
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How Certification Helps
• An EHR is a major, long-term investment for a practice.
• Take advantage of the work CCHIT has done in evaluating Ambulatory EHR products – then combine it with due diligence.
• Look for the seal – be sure it’s CCHIT Certifiedsm
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Download the Guide to Certification from www.cchit.org
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Frequently asked questions
• For certified products, can practices skip all the pre-purchase evaluation steps previously performed?
– No, but they can probably spend evaluation time more efficiently.
– They can use CCHIT certification to narrow the initial field of vendors.
– They can also use CCHIT certification to assure basic functionality, letting them focus their evaluation more on any special or unusual needs of their practice
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Frequently asked questions
• Are the certification criteria universally applicable to all practices?
– CCHIT developed criteria that provide a broad foundation of required capabilities in typical ambulatory care settings.
– However, some specialties may not need all of the functionality required by CCHIT, while others may need additional specialized capabilities. Take this into account when evaluating products and their certification status.
– CCHIT has begun to evaluate program expansions to specialty practice, special settings and special populations.
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Frequently asked questions
• Does CCHIT evaluate the vendor’s support capabilities?– No, CCHIT tests only the product and does not evaluate
service aspects of the company. Practices should perform this due diligence themselves.
• Can CCHIT eliminate concerns about vendor financial viability?
– No, CCHIT only evaluates products, not vendor financial status. Practices must continue to perform this due diligence.
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Frequently asked questions
• Can certification guarantee compatibility with other IT systems?
– In health IT, interoperability is at an early stage. CCHIT criteria are just beginning to establish requirements for interoperability. Choosing a certified product does increase the likelihood that a system can interoperate with others now and in the future, but the problem will take years to completely solve.
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Frequently asked questions
• Is CCHIT controlled by a particular set of interests?– CCHIT’s decisions involve many stakeholders –
physicians, health IT vendors, payers, and others. CCHIT strives to find fair and balanced solutions that deliver value for all stakeholders. CCHIT leadership and volunteers must disclose all conflicts of interest, and multiple protections are in place to reduce the possibility of undue influence by any one group.
• Is CCHIT a government agency?– No, CCHIT is a private sector organization, currently
transitioning to nonprofit, self-sustaining status. In 2005, CCHIT was awarded a 3-year, $7.5M government contract to develop certification criteria and an inspection process
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Frequently asked questions
• Vendor sometimes claim to be “CCHIT-compliant”. Is this the same as being certified?
– No, look for the CCHIT seal on the product or marketing literature. It tells you not only that the vendor is certified, but which year’s criteria it was tested against. Criteria are updated every year in May.
– To be certain, visit the CCHIT website (www.cchit.org) for the list of currently certified products.
– Report any deceptive misrepresentations to [email protected]
Certification Commission for Healthcare Information Technology
Summing Up
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Summary
• An independent, nonprofit initiative to accelerate the adoption of robust, interoperable HIT
• Building a reputation for transparency, credibility, integrity• Successful launch of Ambulatory EHR certification• Officially recognized by HHS; certification required for
EHR donations under Stark/AKA safe harbor• Next challenges:
– Deliver on our commitment to launch inpatient EHR certification in 2007
– Expand certification to specialties / special settings– Establish relationships with emerging networks, learn their
challenges, and determine how CCHIT can deliver value
Thank You!Q & A
For more information:www.cchit.org
