My Problem With CCHIT

I love CCHIT.  Having an independent body assess EHR functionality is a wonderful service for us buyers of that technology.  CCHIT gives the seal of approval to those vendors that that have comprehensive EHR functionality requirement.

Apparently someone involved with writing the Federal Stimulus bill loved it as well.  It is apparent to me that it is intended to be a mechanism for determining if a healthcare organization qualifies for EHR incentive payments.

However, assuming CCHIT can determine acceptable EHR functionality is based on the flawed assumption that an EHR is a single purchase from a single commercial vendor.  Organizations that have achieved EHR functionality through the use of multiple specialized applications don’t have a certified EHR in the eyes of CCHIT (and therefore in the eyes of the ARRA it appears).

Let’s say I have a vendor that meets all but one requirement, perhaps their ePrescribing is inferior.  In the past I would simply find someone with niche capabilities to fit that need.  Good for me since I don’t have to start all over just to address that one need.  Good for the start-up that saw a need and met it.

But, in the ARRA world this is no longer an option.  Instead I don’t qualify for EHR incentives because I am not using a qualified EHR technology.

This concern has reached the level of drama in the open source world.  The Open Source folks had an open forum with the CCHIT folks at HIMSS yesterday.  It kind of got ugly.  CCHIT is just tied to an old single vendor paradigm which cannot accommodate this legitimate approach.

The problem is that vendor functionality does not determine how well an EHR is implemented.  I could have a vendor that provided my organization the richest functionality one could imagine, and still implement it in a way that totally sucks.  Conversely, I could cobble together several applications, none of which could qualify on their own for CCHIT certification, but implemented in the right way create something more functional and beneficial to my patients than some CCHIT certified applications.

We should return CCHIT to a buyer’s guide and stop using it to determine government patments.  The goal is good EHRs.  Certification distracts from that more than it ensures it.

14 thoughts on “My Problem With CCHIT

  1. Legislation that inhibits startups from entering an industry… We all know that’s REALLY the way you want to drive innovation!

    It will be interesting to see how the next few years play out.

    Thanks for the post Will!

  2. Pingback: ICMCC Website - Articles » Blog Archive » My Problem With CCHIT

  3. Pingback: Hospital CIO’s Take on CCHIT | EMR (EHR) and HIPAA

  4. There is a need for standardization and CCHIT is just the beginning. Hopefully, we will see a stronger and better organization surface and take the challenge of defining certification as it’s meant to be defined.

  5. I agree with your assessment that their certification process is difficult.

    I have been working in Healthcare IT for about 12 years now. The one thing that I have to say, about the many environments I have worked in, that even if someone DOES have one of the big vendors (Cerner, Epic) on their side — it doesn’t matter. It’s not JUST the EHR software that matters — there are dozens to hundreds (depending on size) of clinical systems that would need to be interfaced into an EHR — these are the types of systems that run, say, a linear accelerator, and simply will never be replaced by an EHR — yet holds clinical information vital to the patient record. I believe these systems to be far superior than just an EHR that would easily get the certification.

    I’ve seen EHR projects that have succeeded, and I’ve seen ones that have failed. In my experience, the variable upon which success rests is not the vendor, but the implementation team.

  6. Great commentary on CCHIT.

    I think that having an external body who evaluates this technology is very important for hospitals, offices, etc. who are looking to implement EHR technology — we all know that there are too many ‘consultants’ who are really salesmen. It’s important that we have a place to turn that will give us the true ‘skinny’ on these systems.

    But, my issues with CCHIT are essentially the same as yours, especially when they are being used by the federal government.

    I’ve seen a system in the wild that would never be CCHIT certified. It is a home-grown ‘data warehouse – like’ system that is accessed by physicians through the web, and contains ALL information from ancillary systems. The database of information is built using the HL7 messages that bounce through all the systems, and enables this central point to also give ADT, results, etc. to the ancillaries. Does it work? Boy, howdy, does it – and better than some of the multi-million dollar systems I’ve seen in place. Would CCHIT ever certify it? Well, no. If the feds used CCHIT to evaluate whether or not folks are compliant with any kind of federally mandated EHR, would they be able to keep it? I guess that’s the big question in my mind.

    Look, it’s great if a solution has a stamp by CCHIT. But the fact of the matter is, they are skewed towards the larger, more hefty systems that some health systems simply can not afford. And the greater fact of the matter is, look, it’s great if you implement Epic, Cerner, whatever — but the system is useless if it’s not configured, maintained, and used properly — who are they going to get to govern THAT?

  7. PS — as for certification . . .

    I’ve been working in this field for over a decade. I do not carry any vendor specific certifications because I’m an EHR agnostic — I don’t mind whatever EHR my clients use, I’m there to help them to use it properly.

    A lot of the people I know who carry certification did so for a bump in pay and easy jump between companies. I’ve met an awful lot of people with certification who don’t know the realities of the field they face.

    Certification is NOT replacement for experience — and this is true of consultants and the EHR’s. Unfortunately, most employers DO believe that certification is ‘better’ than experience. A pity.

  8. You neglected to mention the core problem with CCHIT and it is the cozy relationship with HIMSS that I hope the new federal policy and standards committees tear apart. If we want a certification process that works, it must be independent but we need a certification process nonetheless. If you are worried about Ministry not qualifying for “meaningful use” for incentive EHR money, you could have guaranteed yourself qualification by going with a commercially well-known package/vendor with mainstream technology such as EPIC, GE Health, etc. instead of hoping for the best with an unproven legacy EHR which you negotiated on the cheap. Your CCHIT comments could be construed as being directed at your EHR vendor Marshfield Clinic and we all know that Ministry is way too far down the road with that to change at this point don’t we?

    • Ministry’s decision to use the Marshfield Clinic EHR was not to save money. It was to do what EHRs should do, make sure that the doctors and other caregivers have access to the complete information at their fingertips so they can spend the most amount of time with the patient making the best medical decisions. Our patients are best served by sharing an electronic medical record between Ministry’s 200 physicians and 15 hospitals and Marshfield Clinic’s 750 clinicians. Most of our patients see providers at both organizations.

      Had we been clairvoyant and predicted EHR incentives, we still would make the same decision. It is about the patients, not the vendors or the money.

      By the way, the Marshfield Clinic’s EHR is CCHIT certified, so you missed the boat on my motives for this post.

  9. I agree with your assessment that their certification process is difficult.

    There is a need for standardization and CCHIT is just the beginning. Hopefully, we will see a stronger and better organization surface and take the challenge of defining certification as it’s meant to be defined.

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