Certified EMR / EHR (updated 10/13/2009)

If you are considering an EMR the next questions is what kind of an EMR. Do you want one that includes a practice management system? What about e-Prescribing? Well, you have to have one that is certified, right?

Well the first two questions are really just preferences, what will work for your practice best is what you should go with. But the answer to the third question, certified or not, is still up in the air, not that your EMR needs to be certified, but rather by whom? We know that to get federal stimulus money (if you accept medicare or in some instances 30% of your patients are medicaid patients) you need to have a certified EMR, but the decision has not been made yet as to whether or not CCHIT is in fact going to be the certifying body or simply one of the certifying bodies.

(A recent article states that CCHIT is the only certifing body - for now.(Click here to read the article wirtten by Carrie Vaughan, senior editor with HealthLeaders magazine.) But even the CCHIT organization can not guarantee that this will continue. On October 5, 2009 the Preliminary ARRA 2011 Certification Handbook was issued. In the welcome secion of the handbook is a letter from Mark Leavitt, MD, PhD Chair of CCHIT and co-signed by Alisa Ray, Executive Director of CCHIT, they state:

"CCHIT is currently an HHS recognized certification body, and expects to continue that status under the accreditation process yet to be developed by HHS/ONC; however we are unable to guarantee that outcome."

On October 7, 2009 CCHIT opened the the certification process up to EMR/EHR for certification for CCHIT Certified® 2011 & Preliminary ARRA 2011.

Preliminary ARRA 2011 certified technology is only inspected to meet applicable proposed Federal standards for certified EHR technology to support the 2011-2012 incentives under the American Recovery and Reinvestment Act of 2009 (ARRA).  The Certification Facts™ label describes which meaningful use objectives are supported by the technology.

The ARRA certification component of both programs is considered Preliminary because the definitions of meaningful use, criteria, and standards have been proposed but not yet finalized by the US Department of Health and Human services (HHS). 

Well, most people will say that you should get a system that is already certified and ready to go today a one stop shop for everything. A certified system will provide the physician with the ability to see patients and go through their clinic day with relative ease and get the extra benefit of the stimulus funds, both the PM and The EMR/EHR will communicate with each other, and work seamlessly. Right? Well, not necessarily. Just because a software product is certified (we will refer certified as a CCHIT certified product) doesn't mean that the EMR/EHR is a responsive and useable software program.

If we say that the goal of a Certification is about increasing the successful adoption of EMR/EHR systems, and thereby cut down on cost and increase the productivity of the healthcare system. Sadly, certification has not been shown to decrease EMR/EHR implementation failures. In fact, some people have argued that it may in fact increase the number of EMR/EHR implementation failures. The fact is that certification does nothing to ensure the USABILITY of an EMR/EHR.

Brian Klepper an analyst, consultant, columnist and speaker who is focused on the policy and market dynamics of US health care's deepest problems, recently stated the commission charged with certifying health information technology is unduly influenced by legacy vendors whose concern for their own welfare is threatening the success of the national HIT initiative. To read the article click here.

A certified system is what is required to qualify for the stimulus funds and at this point it is, although the list of certifying bodies and requirements have not been specified, but are expected to be available by December 31, 2009. The total amount of incentive is up to forty-four thousand dollars (depending on adoption date) with a 10% increase for physicians in rural/underserved areas. This incentive will be paid out over a 5 year period of time, starting 1 year from the first year of implementation. So if you take the total incentive, divide by 5 that will give you the yearly amount of the incentive, which is $8,800 or about $176 a week based on a fifty week year. If a certified EMR/EHR does not allow you to see the same number of patients you are currently seeing on paper, even to the tune of TWO patients per week, the system is costing your practice money. If a system that is certified slows you down or takes more than 10 additional minutes per day, that is 2 patients at the end of the week. For a dermatology practice that could be a net loss of $3700 per year. (average visit $125 X 2 = $250 - $176= 74 X 50 = $3700).

It is true that CCHIT does seem to instill some confidence, even if it is false, in doctors selecting an EMR/EHR. The question is what level of certification will make you most productive and allow you to be certified?

To read more about these topic there are a number of sources, below are a list of sources (we do not endorse any, nor is ZipChart affiliated with any of these blog's or discussion groups)