By CHRIS THORMAN

For nearly four years, the Certification Commission for Health Information Technology (CCHIT) has been the lone entity recognized by the federal government to certify electronic health record systems. Since being named a recognized certifying body by Health and Human Services (HHS) in 2006, CCHIT has awarded certifications to nearly 200 EHR software products based on CCHIT’s standards of functionality, interoperability, usability and security.

However, CCHIT’s role in the EHR market is changing. The Office of the National Coordinator of Health IT (ONC) and the Center for Medicare & Medicaid Services (CMS) announced in early March 2010 that they would name more than one organization to certify EHR software, countering previous claims that CCHIT would become the sole certifying body. The certification requirements are in accordance with 2009’s Health Information Technology for Economic and Clinical Health (HITECH) Act.

As this news swirled around, one doctor called Software Advice and asked: “Is CCHIT dead?”

Dead? No. But it appears that the organization’s influence is waning.

In the spirit of point counterpoint, here are three reasons why CCHIT could become less relevant in the EHR industry:

• Competition with other certifying entities;
• Influence of regional extension centers; and,
• Diminishing need for certification.

And here are three reasons why CCHIT could continue to remain relevant:

• Institutional knowledge;
• CCHIT products are a bridge to HITECH incentives; and,
• Need for alternatives to government certification.

Why CCHIT Will Become Less Relevant
CCHIT became a recognized certifying body (RCB) in 2006 so that hospitals could donate IT systems, equipment and training to physicians and other healthcare providers without fear of violating anti-kickback laws. If the equipment donated by the hospitals was approved by an RCB, then it was perfectly legal. CCHIT was the only organization, and still is, to earn the RCB designation.

Fast forward to 2010 and you’ll see how CCHIT has outgrown this role. Even though we think that CCHIT has considerable staying power in the EHR software market, the organization’s fight to remain relevant includes numerous obstacles as the U.S. healthcare system enters the “HITECH era.”

Competition with other certifying bodies. In a recommendation released in August 2009, the Health IT Policy Committee, an advisory group to the National Coordinator for Health IT, said that it would be in the best interest of the healthcare industry to have multiple entities certifying EHR software.

This recommendation by the Health IT Policy Committee effectively ends CCHIT’s “monopoly” on certifying EHR software. Other groups, such as The Drummond Group, are beginning to step into the certification space. This company “has tested over a thousand international software products used in vertical industries such as automotive, consumer product goods, healthcare, energy, financial services, government, petroleum, pharmaceutical and retail.” While The Drummond Group hasn’t specifically certified EHR software before, they obviously feel comfortable enough with the government’s certification requirements to move forward with their application.

Private entitites aren’t the only groups involved in certifying EHRs. The National Institute of Standards and Technology, a government entity, is collaborating “with health IT stakeholders such as vendors, implementers, standards organizations and certification bodies to establish a testing infrastructure.” Essentially, the institute will monitor the organizations that become official certifying bodies and ensure they’re held to national data standards.

In short, there is now competition and oversight in a space where previously there was none. This alone reduces CCHIT’s influence and relevance. Organizations that become RCBs will have the opportunity to attack CCHIT’s perceived weak spots, such as evaluating more specialty-specific EHR software and offering certification programs with less stringent requirements.

RECs may not choose CCHIT-certified products. The HITECH Act established approximately 60 regional education centers (REC) whose goal is to “offer technical assistance, guidance, and information to support and accelerate health care providers’ efforts to become meaningful users of Electronic Health Records.” Spread throughout the country, RECs are tasked with getting approximately 100,000 phy

sicians up to speed as meaningful users of EHR software over the next two years.

The RECs not only will help physicians implement EHR software but also will choose “preferred” EHR vendors to work with. For example, the NYEC Regional Extension Center, which serves New York state except for New York City, recently chose eClinicalWorks, Eclipsys, Greenway, NextGen and Sage as “preferred vendors.”

How does this affect CCHIT? Each REC can choose their own preferred EHR software vendors, CCHIT-certified or not. If RECs choose to promote vendors that don’t offer CCHIT-certified EHR software, then CCHIT is effectively cut out of that region’s REC physician pool. The more software vendors RECs choose that are not CCHIT-certified, the less influence the commission will have. Conversely, if RECs choose CCHIT-certified software or make CCHIT certification part of their preferred vendor selection process, the commission stands to actually increase their influence in the EHR arena.

Certification may become less important to new vendors. The list of EHR software providers that are currently CCHIT-certified leans heavily towards larger, more established software vendors. While some may take this as an indication of CCHIT bias towards larger vendors, others may argue that smaller or less established vendors may not choose to have their products CCHIT-certified because of the cost involved.

Whether or not new competition drives down CCHIT’s certification fees remains to be seen. If their certification costs remain high, it’s plausible that more EHR vendors without interest in CCHIT certification will emerge. The emergence of cloud computing and Software as a Service (SaaS) applications is bringing software development and maintenance costs down. A lower barrier of entry to the market means more niche vendors will emerge, filling in gaps that CCHIT-certified software doesn’t fill.

Why CCHIT Will Become More Relevant
CCHIT has been entrenched in the EHR certification game for too long to just disappear. In fact, there’s an argument that CCHIT stands a good chance of becoming a permanent certifying body in the EHR software industry. Here are a few reasons why CCHIT will continue to remain relevant to providers searching for EHR software.

Experience counts. In the world of EHR certification, CCHIT is currently “it.” They’ve been carrying the torch of EHR certification since the organization was created in 2004. No other U.S. organization has been more thoroughly involved in testing and certifying EHR software than CCHIT. They’ve certified nearly 200 products since 2006.

With experience like that, it’s unlikely that CCHIT will be left out in the cold once Health & Human Services chooses certification bodies. CCHIT already has applied to become an official certification body under the program and created a preliminary EHR certification program designed to meet the proposed HITECH standards. Even if CCHIT isn’t the best choice to become an official certifying body, it’s tough to argue against including them as at least one of the options.

The bottom line: No other organization is as prepared as CCHIT is to begin certifying EHR software for the government.

CCHIT products are the “best bet.” Many providers and hospitals are waiting on the certification requirements of the HITECH Act to become final before they choose an EHR software system. At the same time, a provider needs to demonstrate meaningful use for 90 consecutive business days in the year 2011 to earn up to $18,000 in incentive payments for the 2011 calendar year.

So, providers need to have an EHR up and running relatively quickly but they’re still not sure what EHR systems are going to be certified. What can they do? Currently, CCHIT offers a Preliminary 2011 ARRA certification in addition to its it’s full 2011 EHR certification. CCHIT’s ARRA certification is “simpler and more flexible” than the normal CCHIT certification and is “designed to demonstrate that a developer’s technology is well-prepared to be certified once ONC-accredited testing and certification becomes available.”

It’s likely that in this time of uncertainty, many providers and even RECs are turning to CCHIT-certified products to guide them.

Alternatives to government certification are needed. The HITECH Act’s success is not guaranteed. And in the event that the government-sponsored EHR certification program doesn’t succeed or loses relevance, the market will need to fill a void. Some authority on EHR software will be needed and CCHIT is one of the best positioned organizations to become that authority.

Even if the HITECH Act is a rousing success, the EHR market will still have a need for an organization akin to what CCHIT and others do now – evaluate the functionality of EHR systems.