Just because HHS designated the Certification Commission for Healthcare
Information Technology a "recognized certification body" last week and
this designation -- according to theory -- makes its certification
evidence of an electronic health record's interoperability, it doesn't
necessarily mean that CCHIT-certified EHRs can actually "talk to each
CCHIT Chairman Mark Leavitt acknowledged as much, noting that the
industry started at a point where there was virtually no ability for
two entities to exchange health information and that it will take time
to establish data-transmission standards and then build those standards
"We're starting at zero," Leavitt said. "We can't go from zero to 100
Nevertheless, he added that the vehicles the health IT industry is
riding are getting capable of achieving faster and faster speeds.
Leavitt explained that he used to say EHRs were in the "Model T" stage,
referring to the early Ford automobile that was made until the late
'20s and was said to have "put America on wheels." Now, he compares
EHRs to the cars of the 1930s.
"Cars actually ran pretty reliably back then," Leavitt said. "They
looked clumsy, but they got people places better than horses did, and
you weren't a nut if you bought one."
He added that waiting is no longer the right decision for physicians to
make regarding EHRs.
Last September, CCHIT was awarded a $2.7 million HHS contract to
develop a sustainable process to certify health IT products'
functionality, security and interoperability -- first for the outpatient
setting, and then for inpatient and hospital EHRs. In order to get
certified, vendors need to pay a $28,000 fee, and their products need
to score 100% on CCHIT's 200-item test and, so far, 33 ambulatory EHR
products have done so. But Leavitt acknowledged that, for now at least,
criteria on the interoperability side of the certification equation are
CCHIT is still waiting for standard-setting bodies to finish their
tasks so, for 2006, the only interoperability requirement needed for
certification was the ability to receive laboratory-test results
electronically. Starting in May 2007, EHRs will need to be able to
electronically transmit prescriptions in order to be certified. And, in
2007, Leavitt said they will need to be able to electronically transfer
"We're going to get more interoperability criteria every year," he
said, adding that last week's announcement by HHS that CCHIT was a
recognized certification body will also serve to promote more
interoperability between EHRs because it opened the door for more
hospitals, health systems and health plans to donate EHR hardware and
software to their affiliated physicians.
These donations will be allowed under the new exceptions to physician
self-referral prohibitions published by HHS in August as well as by
anti-kickback safe-harbor provisions declared at the same
One of the conditions of the new exceptions is that the products be
interoperable and, according to a CCHIT news release, "EHR software
will be deemed interoperable under both rules if it has been certified
within 12 months prior to the donation by a certification body
recognized by the Secretary of Health and Human Services."
This 12-month requirement, Leavitt said, will motivate vendors -- who are
typically upgrading their products every 12 to 16 months anyway -- to
keep current with their certifications as the products to be donated
will have to meet the latest standards. "Vendors won't want to be left
behind," he said. "Vendors are not interested in just selling to new
customers; they want existing customers to buy upgrades."
The rule change "guarantees that vendors will keep upgrading" the
interoperability of their EHRs, Leavitt added. "Using normal market
mechanisms, we'll be able to carry everyone along to take
interoperability to the level we eventually want to get to."
Leavitt also acknowledged that there has been little interest on the
part of hospitals, systems and plans to make these donations to their
affiliated physicians and whether the rule change will promote more of
these "is the question on everyone's lips now."
As for himself, Leavitt is optimistic that selling EHRs to hospitals
that then pass them on to physicians in their community makes sense on
many levels because of economies of scale, and he thinks vendors will
start considering this path as an important part of their marketing
The typical hospital has several hundred physicians who are not its
employees but have admitting privileges and, currently, these doctors
are all individually exploring their IT investments independently of
what the hospital is doing, he explained.
"It's very natural and economical for all those physicians to make a
group purchase or have a single source of support," Leavitt said. "It
will make this less risky for doctors. It will make them more
successful with implementation. … It pushes all the right
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