1. Special Topics in Vendor-Specific Systems Quality Certification of Commercial EHRs This material (Comp14_Unit2) was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 1U24OC000003.

2. Quality Certification of Commercial EHRs Learning Objectives 2 1. Describe the Certification Commission for Health Information Technology (CCHIT) 2.Describe examples illustrating how CCHIT criteria are used for certification of EHR systems 3.Identify the benefits of ‘meaningful use’ of EHRs and identify examples of ‘meaningful use’ of EHRs in given scenarios 4.Identify the three stages of implementation requirements for ‘meaningful use’ of EHRs 5.Identify the role of governing bodies certifying commercial EHRs, including FDA oversight, the Joint Commission and National Patient Safety Goals Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor-Specific Systems Quality of Certification of EHRs

3. Overview 3 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor-Specific Systems Quality of Certification of EHRs Introduction to certificationCertification Commission for Health Information Technology (CCHIT)Meaningful UseJoint CommissionNational Patient Safety GoalsSafety and FDA oversight

4. Why Certify? 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor-Specific Systems Quality of Certification of EHRs Foster collaboration, communication, information exchange Support high quality patient care and clinical decision making Support quality assurance and efficiency measures To evaluate if a specific EHR meets criteria to help … Expanding rapidly Many stakeholders Scientific studies to real life applications EHR Development: Patient safety Clinician workflow Acceptance and adoption by clinicians Information reuse Health information exchange Return on investment Quality of an EHR impacts:

5. Why Certification Is Important Koppen, R., Metlay, J.P., et al. (2005). 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor-Specific Systems Quality of Certification of EHRs

6. Who Certifies? 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor-Specific Systems Quality of Certification of EHRs Volunteer certifications Verifies EHR system meets requirements for managing patient information Certification Commission for Health Information Technology (CCHIT) Verifies health care organization is using EHR correctly in providing patient care Joint Commission

7. CCHIT Certified® Program 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor-Specific Systems Quality of Certification of EHRs Independent, non-profit founded in 2004 Recognized Certification Body by ONC (Office of National Coordinator for Health Information Technology) Expert work groups develop criteriaFinanced by industry partners American Health Information Management Association (AHIMA)\ Healthcare Information and Management Systems society (HIMSS) National Alliance for Health Information Technology (Alliance) American Academy of Pediatrics (AAP) American College of Physicians (ACP)

8. CCHIT Certified® Program (cont.) 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor-Specific Systems Quality of Certification of EHRs Ambulatory, Inpatient, and Emergency Department Three criteria areas derived from existing standards: –Functionality (e.g., CPOE) –Security (e.g., authorized access, encrypt and decrypt information exchange) –Interoperability e.g., (HL7) Domain specific topics –e.g., cardiovascular health, child health, diabetes System vendors are provided with a certification handbook and test-scripts for self-evaluation Ambulatory, Inpatient, and Emergency Department Three criteria areas derived from existing standards: Functionality (e.g., CPOE) Security (e.g., authorized access, encrypt and decrypt information exchange) Interoperability e.g., (HL7) Domain specific topics e.g., cardiovascular health, child health, diabetes System vendors are provided with a certification handbook and test-scripts for self-evaluation

9. CCHIT and the American Recovery and Reinvestment Act (ARRA) 2009 9 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor-Specific Systems Quality of Certification of EHRs Certification voluntary CCHIT Health Information Technology for Economic and Clinical Health (HITECH) Act: Hospitals and health care professionals required to become meaningful users of certified EHR technology Incentive payments under Medicare or Medicaid Avoid financial penalties down the road Using a certified system does not mean you are a meaningful user ARRA – a.k.a. the “Stimulus Bill”

10. CCHIT and the ARRA (cont.) Meaningful Use 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor-Specific Systems Quality of Certification of EHRs Incentives to healthcare providers Adoption and Meaningful use of certified EHRs Within the next 10 years $32 billion available Automatic certification as meeting or exceeding the preliminary ARRA 2011 requirements CCHIT 2011 comprehensive certification

11. Meaningful Use (cont.) 11 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor-Specific Systems Quality of Certification of EHRs Defined meaningful use of EHRs Center for Medicare and Medicaid Services Defined certification standards for EHR technology Office of the National Coordinator http://healthit.hhs.gov/portal/server.pt To prevent computerizing administrative functions and not useful health care information

12. Meaningful Use: Non-hospital based incentives 12 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor-Specific Systems Quality of Certification of EHRs Eligible to receive $44,000 in incentive payments through Medicare over 5 years (2011 - 2015) In 2011, providers deemed to be "meaningful users" of EHR systems 2013 maximum $39,000 2014 maximum $24,000 After 2014 – no incentive payments available Incentives decrease for joining late Are 75% of the amount billed to Medicare Payments to providers Medicare reimbursement penalized by 1% per year up to 3% reduction in 2017 The law as written allows up to 5% reduction “Eligible Professionals” who do not demonstrate meaningful use of an EHR by 2015:

13. Meaningful Use: Phasing in 3 Stages Now – 2015 13 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor-Specific Systems Quality of Certification of EHRs Stage 1 Collecting electronic health data in coded formats Implementing clinical decision support tools Reporting clinical quality measures and public health data Using EHR data to track conditions and coordinate care Providers submit at least 80% of their orders electronically Hospitals submit at least 10% of orders electronically Providers use EHRs to check for drug interactions Required to provide electronic copies of patients’ medical records within 48 hours

14. Meaningful Use: Phasing in 3 Stages Now – 2015 14 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor-Specific Systems Quality of Certification of EHRs Stage 2 criteria Data exchange & quality improvement The Stage 3 criteria Advanced decision support & population health Joining in 2011 2 years to achieve each stage Joining after 2011 a consecutive stage has been phased in 1 year to achieve next stage

15. Joint Commission 15 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor-Specific Systems Quality of Certification of EHRs Oldest Independent Not-for-profit Patient safety and quality health services accreditation and certification Licensing and Medicare reimbursement eligibility On-site survey every 3 years HIPAA requirements Information mgt., EHR mgt. & Personal Health Information mgt. Voluntary, yet required by many states

16. National Patient Safety Goals and EHRs 16 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor-Specific Systems Quality of Certification of EHRs Identify patients correctly Improve communication among caregivers Improve the safety of using medications Accurately reconcile medications

17. Patient Safety and FDA Oversight 17 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor-Specific Systems Quality of Certification of EHRs Development of a national program to monitor patient safety problems in health IT systems May be FDA, but responsible agency not yet named Potential role of FDA Collaboration about certification criteria Focus on EHR implementation in areas with safety risks

18. FDA Oversight of EHRs 18 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor-Specific Systems Quality of Certification of EHRs FDA focus on serious injuries and death Yet, EHRs may cause unsafe conditions and hazards versus actual injuries May extend safety of EHR systemsMay stifle innovation and increase costs

19. Stay Current EHR Certification and Meaningful Use Policy and Criteria are continuously evolving Office of National Coordinator for Health Information Technology (ONC) website: –http://healthit.hhs.gov/portal/server.pthttp://healthit.hhs.gov/portal/server.pt 19 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor-Specific Systems Quality of Certification of EHRs

20. Quality Certification of Commercial EHRs Summary CCHIT certification requirements Meaningful Use –Financial incentives through the ARRA –providers that use a certified HER –Requirements for each stage Stage 3 still development EHRs and Joint Commission National Patient Safety Goals –Potential for FDA oversight Stay up to date –Programs and requirements are new and are quickly evolving 20 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor-Specific Systems Quality of Certification of EHRs

21. Quality Certification of Commercial EHRs References References: 1.Retrieved June 15, 2010 from http://healthit.hhs.gov/portal/server.pthttp://healthit.hhs.gov/portal/server.pt 2.Retrieved June 15, 2010 from http://www.cchit.orghttp://www.cchit.org 3.Retrieved June 15, 2010 from http://www.jointcommission.orghttp://www.jointcommission.org 4.Office of the National Coordinator for Health Information Technology, Department of 5.Health and Human Services. (2010). Establishment of the temporary certification program for health information technology: Department of Health and Human Services. Retrieved June 15, 2010 from http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__home/1204 http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__home/1204 6.Egerman P, Probst M. (2010). Adoption-Certification Letter HIT Safety: HIT Policy 7.Committee to the National Coordinator for Health IT. Retrieved June 15, 2010 from http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__policy_recommendations/1815 http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__policy_recommendations/1815 Images: Slide 5: Koppel, R., Metlay, J.P., Cohen, A., Abaluck, B., Localio, A.R., Kimmel, S.E., Strom, B.L. (2005). Role of computerized physician order entry systems in facilitating medication errors. JAMA, vol293, n10, p.1197- 1203. 21 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor-Specific Systems Quality of Certification of EHRs