HHS Certification vs. CCHIT

Electronic Health Record (EHR) certification has undergone a fundamental change, as a result of the Health IT Policy Committee developing a national health IT framework based on “Meaningful Use.” Unlike approaches to certification in the past, created by the vendor industry to codify features that “seemed like a good idea at the time,” the HHS approach is more methodical. It started from a high level deliberative process, which identified a set of national priorities to help focus performance improvement efforts in healthcare delivery. From there, “meaningful use” definitions were elaborated, and are the basis of a new type of certification, called HHS Certification.

Prior to the creation of this new certification approach, the sole certification pathway for EHRs was through CCHIT, a private non-profit certification organization that was created by a vendor-industry organization (HIMSS) and spun off as a stand-alone. CCHIT had an exclusive contract to be the only certification pathway for EHRs, and had a progressively-expanding set of criteria (around 500 line items) that had been criticized by numerous observers as being too feature-focused and centered around large, legacy, fully-integrated client/server systems (which was the forefront of software development in the 1990s).

Does CCHIT certification automatically mean HHS Certification? No. The HHS Certification criteria have considerably more specificity in certain areas (like security and privacy), and the expectation is that a “short-term certification transition plan” would need to be developed for EHRs that are certified in 2008 (i.e. CCHIT certified). It is HHS Certification that determines access to HITECH stimulus money – not CCHIT certification.

So what value is there in CCHIT certification? CCHIT has recently taken a new tack in response to the development of HHS Certification, and is intending to build a two-path process: one for CCHIT-mediated Preliminary HHS Certification, and one for “full” CCHIT certification. They are hosting a “town call” meeting around the HHS Certification venture on Sept 3. This still leaves the question of what value will remain in traditional “full” CCHIT certification – since HHS Certification is what determines access to stimulus moneys. CCHIT has hoped that “full certification” will confer some kind of “gold seal” for EHR systems “beyond” HHS Certification, but given the kinds of criteria in their pre-HITECH approach, it is likely to mean simply “conforming to large, legacy, self-contained, integrated client/server applications.”

Multiple other organizations are expected to also develop certification pathways. It is suggested that some 10 or 12 organizations (beyond just CCHIT) will have certification pathways, addressing different kinds of HHS-Certified products – like hosted, web-based SaaS services (e.g. Practice Fusion), or open source approaches, or home-grown solutions, or certified “pieces” of stand-alone software (e.g. ePrescribing-only systems) that might be assembled together into a unified dashboard, etc.

It is important to recognize the sea-change at hand. Many organizations (medical groups, hospitals and consortiums, payors, etc.) have required their health IT selection committees only to consider CCHIT Certified EHRs. With the change in certification brought on by this new era, such a requirement should be re-evaluated. HHS Certification is what counts, by whichever certifying body that is appropriate for the type of technology at hand.

As for Practice Fusion, we continue to participate actively in the emerging HHS Certification process, keeping our eye closely on the Meaningful Use criteria, as they and the subordinate certification criteria become finalized over the course of this and next year. Our commitment is to be an early, leading HHS Certified EHR which allows all our users full access to HITECH stimulus funds.

Robert Rowley MD – Chief Medical Officer, Practice Fusion, Inc.