While the quality of EMRs for ambulatory practice has certainly improved since the mid-1990s, the market has until recently been a bit, well, moribund.

“If the marketplace was well developed and vigorous, you might ask, ‘Why do we need certification?’” says Mark Leavitt, a Hillsboro, Ore., internist and CCHIT president. “But what we had was basically a stalled marketplace, and that is where the right catalytic intervention — certification — can help get things going.”

Studies seem to back that up. The National Center for Health Statistics found last July that fewer than a quarter of office-based physicians owned a full or partial EMR in 2005. Only 9.3 percent used systems that had all four of the functions that many experts consider basic to an EMR — e-prescribing, test ordering, test results reporting, and physician notes.

Leavitt, who started an EMR firm of his own in the 1980s, says a valid third-party certification process can reduce physician anxiety and costs. If more physicians buy EMR software, vendors should be able to spread their marketing and sales prospecting costs out over many more units. Ultimately, EMR prices should drop, he says.

ROI disconnect

Another roadblock to wider physician adoption of the technology has been what Leavitt calls “the ROI disconnect” — the economic benefit that health information technology mostly accrues to insurance companies, employers, and patients who can lower their costs to purchase care. Yet doctors must bear 100 percent of the cost to buy, implement, and maintain the systems.

By setting up a verifiable national certification process, Leavitt and others hope that payers will loosen up the purse strings to offer more grants or richer pay-for-performance program bonuses to qualifying practices that use certified systems.

“That’s probably the more powerful mechanism: reversing that ROI disconnect and bringing that money back across to the physician,” Leavitt says.

The response so far from the nation’s payers has been slow.

Steven E. Waldren, a family physician and director of the Center for Health Information Technology, says it may be too soon to expect a flood of new incentives and declining costs.

“The wide-scale incentives are not there yet,” says Waldren, whose center is an arm of the American Academy of Family Physicians, a primary backer of CCHIT. Payers might just be waiting for broader EMR adoption by physicians before offering more significant incentives, he says.

Certify, schmertify

While Leavitt and others see the certification process leading to broader acceptance of EMRs and ultimately lower costs, others see it as the hand of big government and big industry squeezing out smaller vendors. Where that path leads, say critics, is not a level playing field where vendors large and small offer affordable, functional EMR products. Instead, says Jonathan Bertman, a Saunderstown, R.I., family physician and CEO of Amazing Charts, the growing menu of certification requirements will make systems more complex, less user-friendly, and more expensive.

“I’m all for standardizing what an EMR does,” says Bertman, whose firm targets small physician practices for its low-cost software. “I like the concept of certification. Interoperability is crucial. But [certification] is micromanaging and adding requirements, feature after feature, that may not make sense.”

Bradley also worries that certification standards may have unintended consequences.