Raising the bar or playing favorites?

Despite critiques that the CCHIT favors only large healthcare IT vendors, CCHIT Marketing Director Reber says all criteria are set through a “consensus-driven process” that is open to any interested parties. “There’s any number of ways to participate in that process,” according to Reber.

Although a board of commissioners ultimately approves all testing criteria, standards really are developed by volunteer workgroups that represent the gamut of healthcare IT stakeholders, Reber says. CCHIT publishes the minutes from its workgroup meetings and also invites public comment prior to finalizing any proposed standards.

Standards have evolved since testing started in 2006. In 2008, for example, the criteria expanded to require ambulatory EHRs to demonstrate “advanced” electronic prescribing functionality and the ability to send and receive Continuity of Care Document patient summaries. That was also the first year the commission offered optional testing for specialty-specific features.

“Every year we have been moving the bar up,” Reber says.

That strategy hardly placates critics, though.

“CCHIT has moved in a direction that I don’t think is optimizing care,” says Hayward Zwerling, MD, a Chelmsford, and Mass., endocrinologist who also sells an EHR under the ComChart Medical Software name. ComChart does not have CCHIT certification. “I didn’t believe it added any value to my product,” Zwerling says, citing the cost of testing.

Certification of ambulatory EHRs currently costs $35,000, including an application and testing fee of $29,000 and annual maintenance costs of $6,000. Each 12-month certification can be renewed twice by paying the maintenance fee. The fees cover technical testing, a commission review of self-reported information and demonstration in front of a jury composed of physicians, other provider representatives and security inspectors.

Zwerling says the true cost of certification, including making the necessary software changes to meet the testing requirements, is more in the range of $100,000 to $200,000. He believes CCHIT actually stifles innovation because smaller companies must put some of their scant resources into testing compliance rather than software advancement like the Web portal that ComChart offers.
Reber dismisses any talk of favoritism toward the largest software companies. “There’s no goal to drive vendors out of the marketplace,” she says.