EHR Certification and Meaningul Use: Sorting it Out. Karen Bell, MD Chair, CCHIT REC Summit October 4, 2010 San Francisco, California

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1 EHR Certification and Meaningul Use: Sorting it Out Karen Bell, MD Chair, CCHIT REC Summit October 4, 2010 San Francisco, California

2 Topics The importance of establishing goals for EHR investment Types of certified EHR products Choosing what works for an individual physician/clinican or office

3 CCHIT in brief: Mission: accelerate the adoption of robust, interoperable health IT by creating an efficient, credible certification process Status: independent, nonprofit 501(c)3 organization More than 250 EHR products certified since 2006 Offers 12 independently developed CCHIT Certified programs Developed certification criteria and inspection processes under contract with HHS/ONC, : >300 clinical and EHR volunteer subject matter experts HHS Recognized Certifying Body (Stark safe harbor, Medicare EHR demo) One of first ONC Authorized Testing and Certification Bodies (ATCBs) announced on August 30, CCHIT Slide 3 Sept 27, 2010

4 Three Steps to the ARRA Incentive CCHIT s Role Step 1: Adopt certified EHR technology EHR is certified by an ONC-authorized testing and certification body against ONCdeveloped criteria and standards and NIST test procedures Step 2: Achieve meaningful use Hospital or Eligible Provider achieves Meaningful Use goals, objectives, and measures published by CMS Step 3: Apply for payment Hospital or Eligible Provider submits data or reports in a manner to be defined by CMS, collect payment 2010 CCHIT Slide 4 Sept 27, 2010

5 The Importance of Practice Goals Long term investment or CMS incentive payments For primary use inside in practice for patient care purposes or to engage in other activities (research, data exchange) Interest in using for limited purposes ( i.e, e- prescribing, order entry/results retrieval) or for full spectrum of clinical care What can environment sustain? ACO s in the near future? 2010 CCHIT Slide 5 Sept 27, 2010

6 Things to Consider in Choosing an EHR Architecture: Client server, ASP, Software as a Service Need for integration of data: modules that do not share data vs. a fully integrated system Level of Interoperability Level of Security Specialty specific needs Your level of comfort with health IT 2010 CCHIT Slide 6 Sept 27, 2010

7 Definitions (per Federal Legislation) Complete EHR: able to perform, at a minimum, all of the applicable capabilities required by certification criteria adopted by the Secretary, and thereby, as providing eligible professionals or eligible hospitals with the technical capabilities they need to support their achievement of meaningful use of certified EHR technology. Qualified EHR: an electronic record of health-related information on an individual that: (1) Includes patient demographic and clinical health information, such as medical history and problem lists; and (2) has the capacity: (i) to provide clinical decision support; (ii) to support physician order entry; (iii) to capture and query information relevant to health care quality; and (iv) to exchange electronic health information with, and integrate such information from other sources EHR Module: any service, component, or combination thereof that can meet the requirements of at least one certification criterion adopted by the Secretary Bundled Modules: multiple technologies addressing up to 9 criteria which are certified as a bundle, precluding each individual technology from claiming individual certification status. Certification : ONC Authorized process for complete EHRs or EHR modules required for eligibility for meaningful use incentives 2010 CCHIT Slide 7 Sept 27, 2010

8 Certification Program Comparisons

9 Current Certification Programs ONC-ATCB certified 2011/2012 A robust set of criteria with greater assurance of state of the art functionality, interoperability and security Inspects and assures integrated EHR capabilities Exceeds many of the government certification criteria for 2011/2012 Offers flexibility to assemble an EHR from a mix of technologies meeting federal minimum technical requirements for Meaningful Use Inspects Complete EHRs or EHR Modules, integration not required Limited to government requirements for 2011/ CCHIT Slide 9 Sept 27, 2010

10 Comparing the Programs Criteria independently developed by CCHIT s broad stakeholder work groups to meet provider needs Certification locked down for set period of time Multiple domains: Ambulatory, Inpatient, ED, Long Term & Post Acute Care, Behavioral Health Specialty specific certifications available for growing number of specialties ONC-ATCB certified 2011/2012 Criteria and testing tools developed by the government Specific to each stage of Meaningful Use but criteria and testing process can be modified at any time Two domains: Eligible Provider (ambulatory) and Hospital All EHRs and modules tested to the same set of criteria (oriented to general medicine for EP) 2010 CCHIT Slide 10 Sept 27, 2010

11 CCHIT Certified Program Domains Available or in Development Base Domain Certification Options (Add-on to Base Domain) Year Launched [or Planned] Available Ambulatory EHR 2006 Yes Child Health 2008 Yes Cardiovascular Medicine 2008 Yes Behavioral Health (add-on) 2010 Yes Dermatology 2010 Yes Clinical Research 2010 Ready Oncology 2011 Spring 2011 Women s Health (OB) 2011 Spring 2011 Inpatient EHR 2007 Yes Emergency Dept 2008 Yes Enterprise 2008 Yes 2010 CCHIT Slide 11 Sept 27, 2010

12 CCHIT Certified Program Domains Available or in Development Base Domain Certification Options (Add-on to Base Domain) Year Launched [or Planned] Available Now eprescribing (stand-alone) 2009 Yes Behavioral Health (stand-alone) 2010 Yes Long Term and Post-Acute Care 2010 Yes Skilled Nursing Facility 2010 Yes Home Health 2010 Yes 2010 CCHIT Slide 12 Sept 27, 2010

13 Understanding the Differences Usability tested and rated (Ambulatory) Live usage at multiple sites verified Vendor characteristics published Provider assurance that all advertised functions, security and interoperability criteria are tested and will meet expectations for a fully integrated, stable product ONC-ATCB certified 2011/2012 No usability testing, live site assessment, or information on vendors available Provider responsibility for integration of modules, vendor implementation experience, usability, and changes made to system Criteria much less robust than CCHIT Certified, but includes: CCR display, CDC s smoking status, and quality measures calculation and reporting 2010 CCHIT Slide 13 Sept 27, 2010

14 3 Criteria to Watch and Consider Public Health Surveillance wrong implementation guide specified in the Final Rule; options are for vendors to Test a Complete EHR with the guide specified in the Rule Return for testing when the correct guide is specified in a Rule update E-Prescribing Rule allows for two implementation guides: EDI and XML NIST testing procedure only available for EDI Quality Measures EHRs certifying to the Hospital criteria must test all 15 EHRs certifying to the Eligible Provider criteria must test against a minimum of 9 of the 44 measures Minimum: 6 core measures and 3 additional chosen measures Vendors may elect to demonstrate any of the remaining measures later 2010 CCHIT Slide 14 Sept 27, 2010

15 Which certified product(s) might work best for you? ONC ATCB 2011/2012 only: Don t intend to use all modules beyond the minimum for supporting Meaningful Use at this point Experienced in health IT, or have your own ambulatory self developed system and just need to pass minimum requirements Desirous of a niche product or other technology for which there is not a CCHIT Certified program at present Short term plan in place to maximize incentive revenue 2010 CCHIT Slide 15 Sept 27, 2010

16 Which certified product(s) might work best for you? CCHIT Certified only: (relatively unusual, since most vendors will certify to both programs at no additional charge) Physicians for whom 2011/12 incentives will not provide the necessary short term ROI and who want a stable foundation for long term EHR use Specific specialty physicians for whom MU many not be important Dual Certification: Just about everyone else! (Most tech-savvy docs were early adoptors) Those specialists who want available specialty certification and meaningful use incentive payments 2010 CCHIT Slide 16 Sept 27, 2010

17 Info on ONC-ATBC Certified Products ONC s Certified HIT Products List (CHPL) Web Page (tbd) All certified Complete EHRs and EHR Modules that could be used to meet the definition of Certified EHR Technology (from all ONC-ATCBs) Other pertinent information ONC-ATCBs are required to report to ONC Providers electing to combine certified EHR Modules use the CHPL Web page to validate whether the EHR Modules they have selected satisfy all of the applicable certification criteria that are necessary to meet the definition of Certified EHR Technology CCHIT s Find Products Web Page (currently available) An aggregate, cross-indexed product listing with a faceted search capability to help providers find products that meet their needs An individual product page with Certification Facts that will include all of the ONC reporting requirements and some additional company information CCHIT inspected products only 2010 CCHIT Slide 17 Sept 27, 2010

18 In Summary CCHIT experienced in EHR certification on many levels CCHIT offers two separate testing processes, with no cross dependencies between the CCHIT Certified and ONC-ATCB 2011/2012 certification programs Announced first batch of 33 ONC-ATCB certified products: see our website We have immediate capacity and are actively taking applications, performing testing and issuing certifications in all of our programs Providers must assess their goals and environments before investing in EHR technology and choose those that are certified to best meet their needs: CCHIT Certified, ONC-ATCB 2011/2011 certified, or both 2010 CCHIT Slide 18 Sept 27, 2010

19 Final Thought Patient Care has dual meaning PROVIDING care: diagnosis and treatment of symptoms and disease processes Caring ABOUT one s patients: in the context of their lives and socio-emotional situations HIT must support both aspects 2010 CCHIT Slide 19 Mar 18, 2010

20 Thank You! For more information:

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