The Bigger Picture: Absolutely Certifiable

For potential buyers intimidated by the high prices and dizzying array of EMRs on the market, a certification process is supposed to make life easier. Paul Edge, director of product management for Misys, one of those with a certified program, says of the purchasing process that it would “eliminate some heavy lifting” if practices could “simply select from certified vendors.”

The Certification Commission for Healthcare Information Technology (CCHIT) is a nongovernmental organization set up to evaluate EMRs, granting its stamp of approval to those systems that meet its criteria. The idea is that more physicians will buy EMRs if the shopping process is a made a little easier and there is some assurance that what you get is going to work. But while the idea is terrific, I’m skeptical of the certification process. For now, I’d advise physicians shopping for an EMR to take CCHIT certification somewhat lightly.

Most vendors decided not to submit applications to CCHIT on this first go ’round. Why not?

For one thing, the $28,000 application fee had many vendors balking. “It is a burden,” acknowledges Andrew Ury, a physician and the CEO of Practice Partner, who nevertheless paid the tab and got his product certified.

No doubt the review process is time-intensive and expensive and, relative to other costs, $28,000 isn’t that much. Still, if you are objectively judging consumer products, should you expect and ask to be paid for your services? There’s a reason Consumer Reports doesn’t take advertising.

Second, the process was a bit rushed. Justin Barnes, vice president of marketing and government affairs at Greenway Medical Technologies, explains that when CCHIT first tested its certification process, all six vendors involved failed. But CCHIT took an amended process live anyway without further testing.

“It had never been retested after all the companies failed, and there were no incentives for physicians,” Barnes says. “Why would Greenway do it? Our system is already doctor-certified. We’ve got thousands and thousands of physicians using our system today very happily.”

Barnes is also skeptical of the fact that CCHIT does not test usability. It evaluates only functionality (whether the system has a certain set of features and functions), interoperability, and security.

“Technically, if you had a screen with all these bells and whistles, you could pass CCHIT,” says Barnes. “It’s not usable, but it would be certified.”

Finally, some claim the CCHIT process is unfair to specialty-focused EMRs. “No one is trying to do everything,” says Frank Rhie, founder of Alteer, which creates its products solely for specialties like gastroenterology. “There is so much waste in redoing what is already available in the marketplace.”

In Rhie’s view, CCHIT’s process is one-size-fits-all. And since certification is all or nothing - you either get it or you don’t - there is no way for consumers to know that a product performs well for what they need it to do, even if it doesn’t do so well performing tasks the practice doesn’t care about anyway.

CCHIT will be reviewing products and posting its certification results quarterly. That means its list of certified products (see the first group at www.cchit.org/certified/products.htm) will grow. CCHIT is also exploring ways to accommodate specialized EMR products.

A year from now, it might be wise to look into certified EMRs only. But for now, it’s important to understand what “certified” really means.

This article originally appeared in the October 2006 issue of Physicians Practice.