What is CCHIT and how this group will affect physicians by defining meaningful use of Electronic Medical Records

This is part of iMedicalApps coverage of the HIMSS 2010 Conference in Atlanta, Georgia

One of the numerous sessions today was a lunch hour “town hall” on the current status of CCHIT certification. This is one of many acronyms populating the language of health IT folks, especially recently, and stands for Certification Commission for Health Information Technology. This organization is a nonprofit, 501(c)3 organization with “the public mission of accelerating the adoption of health IT”.

Today’s presentation was headed by Mark Leavitt, MD, PhD, and the chair of the commission.  He covered a large amount of ground and the presentation was followed by some pointed questions from a very educated audience, many of whom were CIOs (Chief Information Officer) or CMIOs (Chief Medical Information Officer) of hospitals.

This commission wields immense power over the future of health information systems by deciding what features of EMR are vital and the standards for interoperability between health IT systems.  They will have a leading voice in what the CMS (Centers for Medicare & Medicaid Services) will deem to represent “meaningful use” and thus qualify physicians and hospitals for a piece of the large pot of stimulus money that is being dangled in front of providers to stimulate EHR adoption.

EHR certification1While the CCHIT has been certifying EHRs since 2006, this last year has brought an intense interest in the organizations workings since currently it’s the only entity recognized by the federal government in certifying EHRs – further solidifying its crucial role in certifying meaningful use.

This “meaningful use” definition takes on a different meaning when looking at the monetary amount at stake.  The February 2009 American Recovery and Reinvestment Act (ARRA) allocated at least $20 billion in incentive payments to hospitals and doctors if they achieve “adoption and meaningful use of certified EHR technology”. Hospitals are maximally eligible for up to $5 million in incentives while physicians are eligible for up to $44k. As Dr. Leavitt explained, adoption will be the easy part, documenting meaningful use will be far more challenging.

This is because the breadth of criteria used to denote full and meaningful use is quite broad (see below) and also includes usability and patient access to digital records. Furthermore, while the “interim final rule” on meaningful use is available, the final rule will probably not be released until the second half of 2010, a fact that led to a lot of audience questions aimed at getting Dr. Leavitt to say what the final rules will be, to which he kept answering he doesn’t know yet. In fact, HHS has not even specified what organizations will be authorized to be accrediting bodies, although CCHIT feels confident they will be among those qualified.

As an example of the breadth of specifications for meaningful use, here are some of the 25 proposed criteria for just Stage 1 of meaningful use:

  1. Use CPOE for at least 80 percent of all orders
  2. Implement drug-drug, drug-allergy, drug- formulary checks
  3. Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT® (at least 80 percent of all unique patients)
  4. Generate and transmit permissible prescriptions electronically (eRx) (at least 75 percent of all permissible prescriptions)
  5. Maintain active medication list (at least 80 percent of all unique patients)
  6. Maintain active medication allergy list (at least 80 percent of all unique patients)
  7. Record demographics.
  8. Record and chart changes in vital signs; additionally, plot growth chart for children age 2 to 20.
  9. Record smoking status for patients 13 years old or older
  10. Objective: Incorporate clinical lab-test results into EHR as structured data (at least 50 percent of all clinical lab tests)
  11. *list from healthcareitnews

We do know there will be two formats for accreditation, either a single, comprehensive audit or a “modular” option where individual components of meaningful use are accredited. It was also mentioned that CMS has received a tremendous amount of feedback saying the timeline for adoption is too aggressive.

The incentives start with Stage 1 adoption in 2011 and anticipate completion of Stage 3 adoption within 5 years. After this, the incentives dwindle to zero and start becoming penalties.  Some believe the timeline will be revised, like the HIPAA deadline of 2002, that was extended to 2005. Dr. Leavitt cautioned, however, that it would be a poor gamble to put off beginning adoption any later than 2011.

EHR certification

Author:

Felasfa Wodajo, MD

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8 Responses to What is CCHIT and how this group will affect physicians by defining meaningful use of Electronic Medical Records

  1. EMR Medical June 21, 2010 at 10:05 pm #

    Considering small doctors offices make up a large part of the healthcare in the US, that means that the EMR stimulus will do little to stimulate these doctors to start using an EMR. I could certainly make drastic recommendations about how they could change the meaningful use definition to solve this problem. However, it would require drastic changes.

    • Felasfa Wodajo June 22, 2010 at 4:08 am #

      Agree that the meaningful use guidelines may be too stringent to actually allow much stimulus funds to be disbursed kto ambulatory physicians as is. They are, however, changing the direction in which health IT is heading by bringing quality measures to the front of the burner and maybe even changing physician behavior. As it is, it appears quite likely that the final published meaningful use rules will be sharply amended to offer a more generous and modular path to accreditation.

    • Iltifat Husain June 22, 2010 at 4:57 am #

      Actually, the meaningful use definition is absolutely critical. I’m
      currently conducting a study on the stimulus funds, to see if they will be
      sufficient, and thus far in my data, I’ve found them to be more than
      sufficient to meet a small practices needs. Although groups such as the
      AAFP have complained the guidelines could be a bit rigid, they are
      absolutely essential to avoid fragmentation.

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