Software Certification for Electronic Health Records: The Certification Commission for Healthcare Information Technology (CCHIT) James J. Cimino, M.D. Columbia University, New York For the Health Information Management Systems Society (HIMSS)

CCHIT Topics Motivation for Certification Origins of CCHIT Overview of CCHIT work plan Workgroups Scenarios Future

Providers HIT Vendors Payers/Purchasers HIT Adoption The HIT Adoption Deadlock Hesitant to buy HIT until costs and risks are lower and/or incentives higher Can’t bring down costs until provider adoption accelerates Can’t offer incentives unless benefits and interoperability of EHRs are assured

Providers HIT Vendors Payers/Purchasers Breaking the Deadlock Reduced risk and availability of incentives accelerates adoption Growing market attracts investment, lowers costs Beneficial effects and interoperability assured, unlocking incentives HIT Adoption

Brief History of CCHIT July 2004: Certification of HIT products a key action in US Health and Hospitals Service (HHS) Strategic Framework Sept 2004: AHIMA, HIMSS, and the Alliance fund and launch CCHIT June 2005: Eight more nonprofit organizations add $325k funding support July 2005: HHS announces Health IT Strategy; RFP ONCHIT-2 released Sept, : ONCHIT-2 contract award to be announced

Mission of CCHIT To accelerate the adoption of HIT by creating a mechanism for the certification that is - efficient - credible - sustainable To reduce the risk of HIT investment by providers To ensure interoperability with local and national health information infrastructures To enhance the use of incentives from public and private payers

Motivation Healthcare payers offer financial incentives for HIT But –must be robust enough to deliver benefits Uncertainties faced by HIT buyers: product suitability, quality, interoperability, data portability – all difficult to judge Certification can act as a catalyst Certification must deliver value for all stakeholders Certification process must be efficient (no net cost) Certification muse operate in credible, objective, transparent manner

Key Points to Clarify Product Certification is different from: –Organizational Accreditation –Professional Certification Certification is binary, i.e. “pass/fail” –Not a subjective, comparative rating system Voluntary process

CCHIT Organization CCHIT Commissioners Business Operations Committee Program Management Team Work Group: Functionality Work Group: Inter- operability Work Group: Security & Reliability Work Group: Certification Process Advisory Councils and Liaisons: - Vendor Associations - Provider Organizations - Payer/Purchaser Organizations - Standards Development Organizations - Others Work Group: Use Case and Test Plan

Description of Project Phases Phase I – Data Gathering Phase I Public Comment period Phase II – Draft requirements Phase II Public Comment period Finalize requirements and begin pilot test Publish final requirements and roadmap Launch product certification

Use Cases Ensure that strategic initiatives deliver real- world improvements in the quality, safety, and efficiency Synchronize the work of the multiple HHS Health IT Contractors toward common goals Define end results expected from the “interoperability” of health IT systems For CCHIT: provide a framework for thorough, credible, yet realistic and cost- effective certification testing

Functionality Work Group Spreadsheet MORE

Use Cases: Interoperability Workgroup Receive Results Refer or transfer clinical care of patient Send electronic prescriptions Query and receive formulary benefits Report patient immunizations Enable patient and user identity correlation Quality improvement reporting Revenue cycle related transactions

Test Scenario Example: Routine Well- Child Visit to Primary Care Physician Summary: This “Clinical Test Scenario” involves a routine well- child visit to his Primary Care Physician for immunization, examination and prescription renewal. History of possible TB exposure is identified and PPD given. Positive response to PPD results in additional treatment. In addition, a Security Test Scenario, presented at the end of this document, uses data from this scenario. Key features of this Scenario are: Well Child visit with immunizations Preventive Health Anticipatory Guidance Lab Reporting Communicable Disease a) Treatment b) Reporting (needs to be added to case)

Certification Process Step 1: Application process Step 2: Vendor and product data collection Step 3: Testing process Step 4: Dissemination of certification results Step 5: Recertification and revocation of certification

CCHIT Future Year 1 (Oct 05 – Sep 06) –Certification of Ambulatory EHR products Year 2 (Oct 06 – Sep 07) –Certification of inpatient EHR products Year 3 (Oct 07 – Sep 08) –Certification of infrastructure components through which EHRs interoperate

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