Feds Recommend 'Preliminary Certification' for EHRs

WASHINGTON — Electronic health records systems should be precertified to comply with Recovery Act requirements even before the government issues its final certification rules, a federal advisory panel recommends.

Because the final rules may not go into effect until next year, “the suggestion is to establish something called preliminary certification based on the assumption that vendors would be willing to take a reasonable risk that what has been proposed in the regulatory process is probably pretty close to what is going to come out the other side,” Paul Egerman, cochair of the certification/adoption workgroup of the Health and Human Services Department's Health Information Technology (HIT) Policy Committee, said at a meeting of the committee.

That way, vendors could start certifying based on the proposed criteria, “and when the regulatory process is completed, hopefully there's only a very small adjustment that we can tack on” before the software becomes HHS-certified, he added.

Whether and when HHS will adopt its committee's recommendation is uncertain at this point, according to Dr. David Blumenthal, the committee's chair and national HIT coordinator at HHS.

“We'll have to do this in a deliberate way that includes public comment and takes the necessary steps within the department and in the federal government generally,” he said during a conference call. “I think the rule-making process we have to go through will make it very difficult to react in that time frame.”

Despite Dr. Blumenthal's cautious response, the Certification Commission for Health Information Technology (CCHIT)—currently the only federally approved certification body for EHR—is moving ahead. During a Sept. 3 conference call, CCHIT officials announced that they were going to publish criteria at the end of September for EHR vendors to meet in order to “precertify” one or more components of their EHR systems. The organization planned to begin accepting precertification applications on Oct. 7. Once certification requirements, slated for spring publication, are final, CCHIT will revise its criteria accordingly and perform any additional testing needed to make sure the precertified systems conform to the final regulations.

Under the Recovery Act, formally known as the American Recovery and Reinvestment Act, $19 billion has been set aside to encourage HIT adoption, including electronic health records. The money includes up to $44,000 in financial incentives for each physician who purchases a certified EHR system and makes “meaningful use” of it by 2011; physicians who adopt EHRs later will also get an incentive, but the amount will diminish gradually over several years and disappear completely after 2014. Providers who have not adopted EHRs by 2015 will see reductions in their Medicare reimbursement.

Right now, only CCHIT can certify an EHR; certification/adoption workgroup members emphasized the need for more than one certifying organization and recommended that any certifying groups be distinct from those that set the certification criteria.

To help physicians and hospitals get ready to implement EHRs, the Obama administration is making $598 million in Recovery Act funds available now to establish 70 HIT “extension centers” that will provide hospitals and clinicians with hands-on technical assistance in the selection, acquisition, implementation, and meaningful use of certified EHRs. The extension center grants will be awarded on a rolling basis, with the first being issued in fiscal year 2010, which began on Oct. 1.

Another $564 million is also being made available in fiscal 2010 to states and state-designated groups to implement health information exchange.

HHS also will provide assistance to health care providers through the HIT Research Center, which will disseminate relevant information on effective practices and help the extension centers collaborate with one another and share best practices on EHR use.

In other business at the meeting, the committee also refined its proposed definition of certification. The new definition reads, “HHS certification means that a system is able to support the achievement of privacy and interoperability, and that the system is able to support the achievement of the meaningful use results that the government expects.”

The workgroup on the definition of meaningful use outlined its plans, which included a meeting to address gaps in meaningful use criteria. Specifically, the group planned to meet in October to hear from specialist physicians about how to make the criteria relevant to them.

They also wanted to address the needs of smaller practices and hospitals, and of safety net providers.

Committee member Gayle Harrell of Stuart, Fla., a former member of the Florida state legislature and the wife of a retired ob.gyn., said she was happy to hear that the workgroup was focusing on specialists.

“I'm delighted that you're going to be meeting with the specialties and understanding the impact of meaningful use criteria on them,” she said.

The committee also discussed barriers to widespread EHR adoption. Committee member Judith Faulkner of Epic Systems Corp. in Verona, Wis., said cost was not the biggest issue for many of the providers with whom she had spoken. “It doesn't matter what the incentive money is,” she said.

Ms. Harrell agreed, noting, “The real barrier is legal concerns. Our customers are not jumping on [EHRs] because lawyers and their other advisers are much more [concerned] about legal issues, and I don't think the money matters as much.”

WASHINGTON — Electronic health records systems should be precertified to comply with Recovery Act requirements even before the government issues its final certification rules, a federal advisory panel recommends.

Because the final rules may not go into effect until next year, “the suggestion is to establish something called preliminary certification based on the assumption that vendors would be willing to take a reasonable risk that what has been proposed in the regulatory process is probably pretty close to what is going to come out the other side,” Paul Egerman, cochair of the certification/adoption workgroup of the Health and Human Services Department's Health Information Technology (HIT) Policy Committee, said at a meeting of the committee.

That way, vendors could start certifying based on the proposed criteria, “and when the regulatory process is completed, hopefully there's only a very small adjustment that we can tack on” before the software becomes HHS-certified, he added.

Whether and when HHS will adopt its committee's recommendation is uncertain at this point, according to Dr. David Blumenthal, the committee's chair and national HIT coordinator at HHS.

“We'll have to do this in a deliberate way that includes public comment and takes the necessary steps within the department and in the federal government generally,” he said during a conference call. “I think the rule-making process we have to go through will make it very difficult to react in that time frame.”

Despite Dr. Blumenthal's cautious response, the Certification Commission for Health Information Technology (CCHIT)—currently the only federally approved certification body for EHR—is moving ahead. During a Sept. 3 conference call, CCHIT officials announced that they were going to publish criteria at the end of September for EHR vendors to meet in order to “precertify” one or more components of their EHR systems. The organization planned to begin accepting precertification applications on Oct. 7. Once certification requirements, slated for spring publication, are final, CCHIT will revise its criteria accordingly and perform any additional testing needed to make sure the precertified systems conform to the final regulations.

Under the Recovery Act, formally known as the American Recovery and Reinvestment Act, $19 billion has been set aside to encourage HIT adoption, including electronic health records. The money includes up to $44,000 in financial incentives for each physician who purchases a certified EHR system and makes “meaningful use” of it by 2011; physicians who adopt EHRs later will also get an incentive, but the amount will diminish gradually over several years and disappear completely after 2014. Providers who have not adopted EHRs by 2015 will see reductions in their Medicare reimbursement.

Right now, only CCHIT can certify an EHR; certification/adoption workgroup members emphasized the need for more than one certifying organization and recommended that any certifying groups be distinct from those that set the certification criteria.

To help physicians and hospitals get ready to implement EHRs, the Obama administration is making $598 million in Recovery Act funds available now to establish 70 HIT “extension centers” that will provide hospitals and clinicians with hands-on technical assistance in the selection, acquisition, implementation, and meaningful use of certified EHRs. The extension center grants will be awarded on a rolling basis, with the first being issued in fiscal year 2010, which began on Oct. 1.

Another $564 million is also being made available in fiscal 2010 to states and state-designated groups to implement health information exchange.

HHS also will provide assistance to health care providers through the HIT Research Center, which will disseminate relevant information on effective practices and help the extension centers collaborate with one another and share best practices on EHR use.

In other business at the meeting, the committee also refined its proposed definition of certification. The new definition reads, “HHS certification means that a system is able to support the achievement of privacy and interoperability, and that the system is able to support the achievement of the meaningful use results that the government expects.”

The workgroup on the definition of meaningful use outlined its plans, which included a meeting to address gaps in meaningful use criteria. Specifically, the group planned to meet in October to hear from specialist physicians about how to make the criteria relevant to them.

They also wanted to address the needs of smaller practices and hospitals, and of safety net providers.

Committee member Gayle Harrell of Stuart, Fla., a former member of the Florida state legislature and the wife of a retired ob.gyn., said she was happy to hear that the workgroup was focusing on specialists.

“I'm delighted that you're going to be meeting with the specialties and understanding the impact of meaningful use criteria on them,” she said.

The committee also discussed barriers to widespread EHR adoption. Committee member Judith Faulkner of Epic Systems Corp. in Verona, Wis., said cost was not the biggest issue for many of the providers with whom she had spoken. “It doesn't matter what the incentive money is,” she said.

Ms. Harrell agreed, noting, “The real barrier is legal concerns. Our customers are not jumping on [EHRs] because lawyers and their other advisers are much more [concerned] about legal issues, and I don't think the money matters as much.”

WASHINGTON — Electronic health records systems should be precertified to comply with Recovery Act requirements even before the government issues its final certification rules, a federal advisory panel recommends.

Because the final rules may not go into effect until next year, “the suggestion is to establish something called preliminary certification based on the assumption that vendors would be willing to take a reasonable risk that what has been proposed in the regulatory process is probably pretty close to what is going to come out the other side,” Paul Egerman, cochair of the certification/adoption workgroup of the Health and Human Services Department's Health Information Technology (HIT) Policy Committee, said at a meeting of the committee.

That way, vendors could start certifying based on the proposed criteria, “and when the regulatory process is completed, hopefully there's only a very small adjustment that we can tack on” before the software becomes HHS-certified, he added.

Whether and when HHS will adopt its committee's recommendation is uncertain at this point, according to Dr. David Blumenthal, the committee's chair and national HIT coordinator at HHS.

“We'll have to do this in a deliberate way that includes public comment and takes the necessary steps within the department and in the federal government generally,” he said during a conference call. “I think the rule-making process we have to go through will make it very difficult to react in that time frame.”

Despite Dr. Blumenthal's cautious response, the Certification Commission for Health Information Technology (CCHIT)—currently the only federally approved certification body for EHR—is moving ahead. During a Sept. 3 conference call, CCHIT officials announced that they were going to publish criteria at the end of September for EHR vendors to meet in order to “precertify” one or more components of their EHR systems. The organization planned to begin accepting precertification applications on Oct. 7. Once certification requirements, slated for spring publication, are final, CCHIT will revise its criteria accordingly and perform any additional testing needed to make sure the precertified systems conform to the final regulations.

Under the Recovery Act, formally known as the American Recovery and Reinvestment Act, $19 billion has been set aside to encourage HIT adoption, including electronic health records. The money includes up to $44,000 in financial incentives for each physician who purchases a certified EHR system and makes “meaningful use” of it by 2011; physicians who adopt EHRs later will also get an incentive, but the amount will diminish gradually over several years and disappear completely after 2014. Providers who have not adopted EHRs by 2015 will see reductions in their Medicare reimbursement.

Right now, only CCHIT can certify an EHR; certification/adoption workgroup members emphasized the need for more than one certifying organization and recommended that any certifying groups be distinct from those that set the certification criteria.

To help physicians and hospitals get ready to implement EHRs, the Obama administration is making $598 million in Recovery Act funds available now to establish 70 HIT “extension centers” that will provide hospitals and clinicians with hands-on technical assistance in the selection, acquisition, implementation, and meaningful use of certified EHRs. The extension center grants will be awarded on a rolling basis, with the first being issued in fiscal year 2010, which began on Oct. 1.

Another $564 million is also being made available in fiscal 2010 to states and state-designated groups to implement health information exchange.

HHS also will provide assistance to health care providers through the HIT Research Center, which will disseminate relevant information on effective practices and help the extension centers collaborate with one another and share best practices on EHR use.

In other business at the meeting, the committee also refined its proposed definition of certification. The new definition reads, “HHS certification means that a system is able to support the achievement of privacy and interoperability, and that the system is able to support the achievement of the meaningful use results that the government expects.”

The workgroup on the definition of meaningful use outlined its plans, which included a meeting to address gaps in meaningful use criteria. Specifically, the group planned to meet in October to hear from specialist physicians about how to make the criteria relevant to them.

They also wanted to address the needs of smaller practices and hospitals, and of safety net providers.

Committee member Gayle Harrell of Stuart, Fla., a former member of the Florida state legislature and the wife of a retired ob.gyn., said she was happy to hear that the workgroup was focusing on specialists.

“I'm delighted that you're going to be meeting with the specialties and understanding the impact of meaningful use criteria on them,” she said.

The committee also discussed barriers to widespread EHR adoption. Committee member Judith Faulkner of Epic Systems Corp. in Verona, Wis., said cost was not the biggest issue for many of the providers with whom she had spoken. “It doesn't matter what the incentive money is,” she said.

Ms. Harrell agreed, noting, “The real barrier is legal concerns. Our customers are not jumping on [EHRs] because lawyers and their other advisers are much more [concerned] about legal issues, and I don't think the money matters as much.”