The Certification Commission for Healthcare Information Technology last week announced the final 30 electronic health-record systems for the ambulatory-care environment to receive certification under its initial set of criteria, a small milestone in the long march toward healthcare IT adoption in the U.S.
With the newly anointed systems, there are now 89 companies offering 81 CCHIT-certified products suited for use in physician offices. There are more companies than products because some companies have entered into marketing arrangements where they will sell a re-branded version of an EHR developed by another company.
"We'd like to think it means we're doing the right thing," CCHIT Chairman Mark Leavitt said of the vendor turnout thus far, despite the not-for-profit charging all vendors $28,000 to take the certification test. "There were concerns raised in the midyear: would this shut out smaller vendors. That's something that we wanted to see—that certification was not distorting the market. I think—I hope—that has been completely laid to rest.
"We did a survey in January that (found) one in six (small vendors) was under $1 million in revenues," Leavitt said. With the latest batch of systems being certified, a record number, "I don’t believe the percentage of small vendors is going to go down."
One of those small vendors is Polaris Medical Management, a service organization based in Cranston, R.I.
For physician Albert Puerini Jr., president of the 165-physician Rhode Island Primary Care Physicians Corp., certification is a significant achievement. In 2002, the group decided to develop its own EHR system through its affiliated practice-management service provider, Polaris, which already was doing electronic billing for the group. Its EHR software, launched in 2003 and called EpiChart, is being used by about 100 physicians.
"CCHIT does not make this distinction easy," Puerini said. "We were judged over a three-week period with a final seven-hour test that verifies criteria for functionality."
"We're a very small company and we built this ourselves," Puerini said, using a development group of four doctors and three IT people. "When CCHIT first came out, we said, 'Nah, we're not going to do that. Twenty-eight thousand dollars is ridiculous. Why should a little company like ours pay that?' But we got by that when it came down the pipe that Medicare was going to require it and Blue Cross was going to require it."
Meeting all of the testing criteria was tough, Puerini said, "Because they measure in three different ways, the functionality, the interoperability and the security. The first two, the simulation, where they throw a patient at you, we flew through that, and the interoperability, I think, we were ahead of the game. For 2007, they want e-prescribing; we already had that."
But, Puerini said, "When they came up with the security, we thought we were there, and they really, really nitpicked. We thought they overplayed that. I think the security aspect was very, very rigid. It required a lot of rewriting of the software from what we have. But at the end of it, we've got a much better system because of the recommendations of CCHIT."
Polaris officials got the call from CCHIT April 27. The software had passed, "to our delight," Puerini said. Now, Puerini is something of a CCHIT certification booster.
"It's kind of a David-and-Goliath thing," he said. "This little company has the same certification as those giant IT companies. It does level the field if people are going to put a lot of stock in CCHIT certification. It really helps our confidence. It's obviously going to help our marketing. And what I like about it is the standardization, of the … (certified systems), at some level, we all have the same criteria. I think it's a good thing. People have a large list of vendors that they can be confident in."
Two of the biggest winners in this round of certification were clinical IT systems developed by the Defense Department and, tangentially, by the Veterans Affairs Department.
The Defense Department's Military Health System itself submitted its AHLTA clinical IT system for testing and received certification.
And two private-sector organizations submitted and received certification for their adaptations of the VA's VistA system. They were Document Storage Systems, Juno Beach, Fla., a for-profit company with a long history of work as a VistA subcontractor for the VA, which received certification for its vxVistA; and the not-for-profit WorldVistA, with its open-source WorldVistA EHR VOE/1.0, which was developed under a grant from the CMS to provide a low-cost EHR for physicians in solo practice and small group practices where IT penetration rates remain chronically low.
Fred Trotter, developer of an open-source billing system, FreeB, said with the first CCHIT certification of an open-source EHR, "the entire rules have turned upside down" in healthcare IT.
"Free and open-source software can do the same things that proprietary software can do," Trotter said. "All of the sudden the landscape is all about services. The age of the proprietary EHR vendor is over."
VistA pioneer Norman Dodd worked for 33 years with the VA and led a team of programmers working under the Pacific Telehealth & Technology Hui in Honolulu developing an open-source version of the VA's VistA system. Retired from the VA, Dodd now works with a small company called Blue Cliff in Honolulu, which is developing a version of VistA for the hospital market as well as a vendor for World VistA EHR VOE. Dodd and his Blue Cliff colleagues also helped develop a laboratory interface for VOE.
"As a vendor implementing VOE, the certification was really good news," Dodd said. "I feel that if the DoD's product got certified, the VA will follow with certification. This means that vendors will not have to worry about certification of VistA, as the VA may do it for us."
In April, three of the WorldVistA leaders were among 22 winners of a 2007
Wired magazine Rave award. Other winners included California Gov. Arnold Schwarzenegger for politics; Arianna Huffington, founder of the liberal political blog the Huffington Post, under the category of "renegade"; and the Allen Brain Atlas, which is developing a genetic map of the brains of mice, under science.
Maury Pepper, WorldVistA chairman and director, said certification "just means more legitimacy," but added, for the not-for-profit that aims to continue distributing the software as an open-source product, "in some sense, it makes it a little more complicated.
"Part of certification means controlling the name," Pepper said. "The certified version may have to be packaged a little differently." With open source, "people are making copies and making modifications. It has to be made clear what is certified."
How that is to be accomplished is unclear, Pepper said. WorldVistA is a volunteer organization and members had been so focused on getting the product ready for CCHIT testing, they haven’t had much time to focus on the distribution issues that certification and open source create.
"There is some uncertainty there that we're talking about," Pepper said.
Winning the
Wired award and CCHIT certification is "kind of like we had a couple of home runs in one inning," Pepper said. "There has been very little time to sort it all out and plan our future."
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