Technology: Should Your EMR Be Certified?

Still waiting to buy an EMR? A recently formed nonprofit organization thinks it’s come up with a way to help you sort the technological wheat from the chaff.

But does the stamp-of-approval process devised by the Certification Commission for Healthcare Information Technology (CCHIT) really make life easier for busy practices — or does it, as some say, provide you with misleading information while unfairly excluding vendors whose products might be perfect for you?

The commission’s certification process aims to remove the risk that a newly purchased EMR won’t be able to perform all the functions the sales rep promised. It also hopes to guide physicians to systems that are capable of measuring and reporting quality indicators for pay-for-performance incentive programs.

Though launched in 2004 with seed money from several associations, CCHIT is private, and the certification process is voluntary. An EMR system earns certification only after a team of experts, each including at least one practicing physician, puts the software through its paces. In its first year, the commission has certified more than 80 products.

In 2007, software is deemed certified after 247 criteria are inspected in 315 test steps for functionality, interoperability, and security. In the functionality area, ambulatory EMR systems approved in 2007 must be able to complete tasks in 40 categories (see below). CCHIT revises and updates its test criteria annually. Standards and required functions are based on input from practicing physicians, vendors, payers, and technology experts. You can visit CCHIT’s Web site for a list of the ambulatory electronic health record products certified by CCHIT thus far.

What the Commission Tests The Certification Commission for Healthcare Information Technology judges ambulatory EMR systems’ abilities to complete tasks in these 40 categories of functionality: Identify and maintain the patient record Manage patient demographics Manage problem lists Manage medication lists Manage allergy and adverse reaction lists Manage patient histories Summarize health records Manage clinical documents and notes Capture external clinical documents Generate and record patient-specific instructions Order medications Order diagnostic tests Manage order sets Manage results Manage consents and authorizations Manage patient advance directives Support standard care plans, guidelines, and protocols Capture variances from standard care plans, guidelines, and protocols Support drug interactions lists Support medication or immunization administration or supply Support non-medication ordering (referrals, care management) Provide alerts for disease management, preventive services, and wellness Provide notifications and reminders for disease management, preventive services, and wellness Provide clinical task assignment and routing Support inter-provider communication Enable pharmacy communication Present provider demographics Provide scheduling information Possess report generation features Manage health record output Support encounter management Provide rules-driven financial and administrative coding assistance Provide eligibility verification and determination of coverage Manage practitioner/patient relationships Provide clinical decision support system guideline updates Enforce confidentiality Possess data retention, availability, and destruction capabilities Provide audit trail Extract health record information Support concurrent use The list of required functions and criteria within those functions are expected to expand in future rounds of certification. See CCHIT’s Web site for updates.

The commission next plans to outline standard functions for EMRs used in children’s health, cardiovascular specialties, emergency medicine, and other specialties. Next year it will tackle prescribed functions for interoperability of EMRs that are networked to one another.

Not the silver bullet

Should you limit your EMR search to certified products only? Not necessarily. Certification doesn’t assure that a system is user-friendly or affordable. Nor does it tell you that the company won’t go out of business next week or just has lousy customer service.

“There’s value to what the commission is trying to do, but it will not be the silver bullet that guarantees that any physician practice buying a system from a certified vendor will have no problems implementing or using that system,” says Steven Lazarus, president of Boundary Information Group in Denver. “Certification reduces the risks, but it doesn’t eliminate them.”

Adds Nantucket, Mass., family physician Craig Bradley, “The way I understand it, CCHIT certification assures you certain things will be available, but it doesn’t necessarily guarantee you that the way they got the system to meet those criteria was done very efficiently.”

In other words, you’d still be wise to do your homework before signing on the dotted line for that new EMR. But you may be able to narrow the list a little faster now.

Rationale for certification

Conscientious EMR shopping often means talking to dozens of vendors, ringing up colleagues, lurking on user groups’ listservs, and perhaps hiring a consultant. With more than 200 firms claiming they sell a fully functional EMR, the process may feel like it’s taking forever. For Bradley, it took nine years.

“I was shopping for an EMR basically from when I got out of residency in 1995 to 2004, when I finally bought one at my previous practice,” he says of his eClinicalWorks EMR. “Part of it was waiting for the products to mature. Now, what you get in terms of functionality is so much more cost-effective. But if CCHIT was around then, it would have saved me a lot of time.”