This is the second post in the series of posts (see the previous ONC-ATCB Certified EHR Breakdown) looking at the EHR certification numbers put together by HITECH Answers. The following is the breakdown of EHR Certification by Certifying body:

2 Certified by Infogard
- 1 Modular Ambulatory system
- 1 Modular Inpatient system
40 Certified by Drummond
- 15 Complete Ambulatory systems
- 5 Complete Inpatient systems
- 15 Modular Ambulatory systems
- 5 Modular Inpatient systems
88 Certified by CCHIT
- 50 Complete Ambulatory systems
- 15 Complete Inpatient systems
- 11 Modular Ambulatory systems
- 12 Modular Inpatient systems

Infogard is just getting started, but CCHIT and Drummond Group are cranking them out. I’m guessing right now demand for their service is strong and they can certify them as quick as they can. It will be interesting to see what happens to these organizations post EMR Stimulus money, but they have a few years before they have to worry about that.

Of course, this is only the temporary ONC EHR Certification. ONC will have the official one and then all the EMR vendors will likely have to re-certify again. Let’s call it the EHR certifying body stimulus program.

Many people were worried that we wouldn’t have many certified EHR available for 2011. I wasn’t one of those people, but they were out there. Seems to me that this really won’t be an issue at all. There’s 130 partial or complete EHR companies on the official ONC certified EHR list. That’s a lot of software and it’s only the beginning of December. I expect we’ll have 200 or so more ONC-ATCB certified EHR software by the first quarter of 2011.

The good people at HITECH Answers have done the hard work putting together the number of systems certified. Check out the numbers:
85 Complete EHR
- 65 Ambulatory systems
- 20 Inpatient systems
45 Modular EHR
- 27 Ambulatory systems
- 18 Inpatient systems

That’s right. 65 Complete Certified Ambulatory EHR. 27 other modular certified EHR and I’m sure that many of those are just doing the modular as a stepping stone to the full certification.

ONC and HHS have finally released the official list of ONC-ATCB Certified EHR which is essential to those providers interested in the ARRA EMR stimulus money. Of course, ONC is just providing the data that Drummond Group, CCHIT and other ONC-ATCB bodies (assuming more will start certifying) are providing them. I mentioned that we could look forward to this official list in my Drummond Group ONC-ATCB EHR Certifications post and my CCHIT ONC-ATCB EHR certifications post.

Looks like quite a few more EMR vendors are now ONC-ATCB certified since those first posts. Watch for many many more (almost all) of the EMR vendors to be certified by the end of the year or early 2011.

Looks like ONC is working on a version 2 of the list. Here’s their description of the next version of the ONC-ATCB Certified EHR list:

Please note: This is Version 1.0 of the Certified Health IT Product List (CHPL). Version 2.0 is under development and is expected to provide additional information, such as a list of the Clinical Quality Measures to which a given product was tested; and additional functionality, such as different ways to query and sort the data for viewing. The later version will also provide the above-mentioned reporting number that will be accepted by CMS for purposes of attestation under the EHR (“meaningful use”) incentives programs.

That number is going to be key next year for those wanting stimulus money. I’m glad they’re making access to the reporting number needed for attestation for EHR incentives easy to find.

Only problem with the above list is that it hasn’t been updates since Nov. 1. I wonder how often they’ll update it. Although, it probably won’t matter much in the long run.

One of my regular readers, Jack, sent me the following email:

“One (actually I had many….) of the real question marks I had since 2005 about CCHIT and certification of EMR was that, “Should every vendor that applies be able to pass certification?”, or put another way, “What kind of certification is it that allows everyone who applies to pass and be certified?” My notion of certification was that not everyone who applies can make it. Why have certification if everyone passes it?”

Then, he followed up with these comments:

“In prior years, I think every vendor that paid their money passed certification. I can’t ever remember an instance of a vendor failing. If its that easy to get certified…what good is it? What benefit is there? Are we really weeding out products that just don’t cut it? If so, where are they? The ones that don’t apply?”

Of course, the sad answer to Jack’s questions are that EHR certification isn’t a benefit. At least not a benefit to the doctors. The only exception now is that it is a necessary requirement to get EMR stimulus money, so having an EMR vendor that is certified will make it possible to try and get the EMR stimulus money if you so desire. Outside of that, the certification doesn’t really provide a benefit to the doctor.

EMR vendors get some benefit as far as marketing and giving them a tool to provide a false assurance to the providers who don’t understand what EHR certification is really all about.

Back to the point of every EHR vendor that pays becoming certified, yes that does diminish the value of the certification. When CCHIT first came out, we talked about this in amazing detail on EMRUpdate.com. We discussed all sorts of options and methods for certification. One such thread discussed the idea of providing grades instead of just a straight up pass/fail certification. In fact, the grades should likely be given on a feature by feature basis.

The challenge with giving grades for EHR is that it’s quite subjective. Plus, which subjective viewpoint do you use. Do you give it an F for specialists and an A for general medicine? At that point, you’re becoming so granular that it’s just not able to scale in any reasonable manner.

What’s the solution? If I knew, I’d probably be doing it. What is clear is that EHR certification wasn’t meant to help doctors.

In case you missed the announcements on Thursday and Friday, Drummond Group announced the first ONC-ATCB certified EHR (3 of them) and CCHIT announced their first set of ONC-ATCB certified EHR (21 full ONC-ATCB EHR). I also got word today that HHS finally updated their website with the Drummond Group ONC-ATCB.

Of course, we have a few hundred more EHR software out there that are going to be announced. It’s just a matter of how quickly the ONC-ATCB are going to be able to pump out the certifications. Not to mention the EMR vendors completing the list of requirements.

As one EMR vendor told me this weekend. We could have easily rolled out the features that the EHR certification requires to become certified. However, that wouldn’t have been very useful for our users. Then, he went on to say that he’d rather spend an extra month or two to make the certified EHR requirements part of a really nice and useful dashboard than to just roll out some shoddy features that satisfy the EHR certification requirements, but don’t make sense to doctors.

Makes you wonder about these first EHR vendors that have been certified. Just because the EMR is an official ONC-ATCB doesn’t mean you will actually want to use that EMR software.

InfoGard Laboratories, the nation’s first accredited IT security testing laboratory, is approved by the Health and Human Services, Office of the National Coordinator for Health IT as an ONC-Authorized Testing and Certification Body (ONC-ATCB) for the certification of Complete EHRs and EHR Modules for both ambulatory and inpatient settings. -Source

And now there are three official ONC-ATCB for EMR vendors looking to get their EHR software certified. Looks like InfoGard has been doing NIST certifications for a long time now and EHR certification will just be another certification for them.

Info Gard will be the third officially approved ONC-ATCB alongside Drummond Group and CCHIT which were announced previously. There’s also been rumors that Weno Healthcare is trying to become an ONC-ATCB as well.

Maybe I’m just missing it, but I wasn’t able to find other details on InfoGard’s EHR certification plans, pricing, and timeline. If someone else finds it, please let me know. It’s a little disappointing that their press release didn’t include a link to this type of information like Drummond Group and CCHIT did.

Drummond Group has recently published an FAQ about EHR certification. I’m guessing that the FAQ will continue to grow over time. They do cover some important topics. Here’s one of the FAQ that I found particularly interesting (and pretty sad too).

Q: My software is developed for a specialty practice (e.g. dental, etc.) and some criteria are not relevant for my customers. To be a Complete EHR, do I still need to certify over all the criteria?

A: There is not a specialized criteria set beyond the general categories of ambulatory or inpatient, and thus specialized software are required to satisfy the same criteria as general EHRs. The concept is that even if a user will not utilize all the features of a certified EHR that the certified EHR must still have this functionality present within it. Regarding criteria that do not fit a specialty’s typical use, ONC address this type of situation in their Standards and Certification Criteria Final Rule. They talk more of the situation with ED/inpatient settings and comments that growth charts are not needed. Here are the relevant sections that show the aggregated comments they received and their response.

Comments.  A few commenters noted this certification criterion applies more

directly to specialties that predominantly treat children.  For other specialties, this criterion would add unnecessary cost and complexity to many HIT products that they would use.  Many commenters suggested that a growth chart component should not be required for EHR technology designed for an inpatient setting, as it is not feasible to track this data in a meaningful way over a long enough period of time in an inpatient setting (which is typically of a short and infrequent duration).  A couple of commenters suggested that non-traditional forms of growth charts should be accepted.  One commenter suggested that the certification criterion establish a baseline, but should not limit the expansion of this capability to other ages.  Other commenters made specific suggestions for different age ranges, such as including children under the age of two and lowering the upper age to ages less than 20 years old (e.g., 18).

Response.  As we stated above with respect to the calculation of BMI, we believe

that Certified EHR Technology should be capable of performing this capability

regardless of the setting for which it is designed.  Moreover, with respect to whether growth charts should be applicable to Complete EHRs and EHR Modules designed for an inpatient setting, we remind commenters that children’s hospitals qualify as eligible hospitals under the Medicaid EHR incentive program and will also need to demonstrate meaningful use of Certified EHR Technology.  We do not preclude Complete EHR and EHR Module developers from designing novel approaches to displaying growth charts.  Finally, we concur with the commenter that suggested this certification criterion should be a baseline.  We reiterate that this certification criterion establishes a floor, not a ceiling, and we encourage Complete EHR and EHR Module developers to include additional functionality where it will enhance the quality of care that eligible professionals and eligible hospitals can provide.

Today we got news of the new ONC-ATCB EHR certifying bodies: CCHIT and Drummond Group. However, this is really just the start of the EHR certifying bodies. ONC released that “Applications for additional ONC-ATCBs are also under review.”

One of those possible additional ONC-ATCB EHR certifying bodies is Weno Healthcare. This EMR Daily News guest blog post (Thanks Michelle for pointing it out) asserts that Weno Healthcare has submitted their application to be an ONC-ATCB EHR Certifying body. They also offer this interesting insight:

Until recently, only one body was promoted to do this testing and certification. Because of no competition, their prices were out of the ballpark for smaller technology companies who may have built the better and cheaper mouse trap for doctors and hospitals, but could not afford the fees for certification. The technology companies that certified their products earlier are not considered certified by the new rules today, so all technology vendors must go through an ONC-ATCB in order to be re-tested and certified, if they choose to do so.

If Weno is approved as an ONC-ATCB, more technology vendors can afford the testing and certification fees. Weno savings can be as much as $19,000 for complete EHRs. These savings will certainly provide physicians and hospitals with more cost effective certified technology options to choose from. Again, competition is a good thing because it brings prices down and quality up.

Comparing the Weno Healthcare EHR certification price above with the CCHIT and Drummond Group EHR Certification prices, it’s going to be really interesting. That puts the costs of EHR certification (not counting software development costs) at:
Weno Healthcare: $14,000-18,000
Drummond Group: $19,500
CCHIT: $33,000

Of course, this assumes that Weno Healthcare becomes an ONC-ATCB and that the prices don’t change. I won’t be surprised if they do change. Plus, there could be other EHR certifying bodies.

If you’ve read this blog and/or EMR and HIPAA, you’re quite familiar with my feelings about CCHIT. I just don’t see the value that they add for doctors. If they could show me how they help doctors and not just EMR vendors who want a third party validation to sell more product, then I’d be willing to change my mind. But I digress…

Looks like with the new head of CCHIT Karen Bell taking the reigns, the CCHIT blog has mostly gone quiet. Mark Leavitt did post a good bye on his last day. Sadly, not a single person commented on that blog post saying thank you, best of luck, or anything. So much for 1723 readers subscribed to their blog. I honestly feel a little bad that no one commented. While I disagreed with many opinions that Mark and CCHIT represented, Mark always seemed like a very sincere guy that did care.

Besides that, there’s a post about preparing for the EMR stimulus, but it just links to an outside article. Maybe they should link to some of my articles or even my EMR selection e-Book. I bet they’d like that.

I can imagine how frustrating the EMR stimulus must be to them. Not to mention HHS’s inability to finalize the details of EHR certification bodies and meaningful use. They are kind of in a wait and see pattern until HHS finishes their work.

CCHIT did put out a new search tool. I’m just glad they’re not developing EMR software. Their search tool is one of the most confusing things I’ve seen. At least the lists were easy to understand (once I found them).

We’ll see if CCHIT starts blogging again once HHS gives us some meaningful details.

In case you missed it, I posted on my other site about the NIST EHR Certification testing website. I still haven’t had much time to dig deep into what’s available, but one of my readers sent me the following (excuse the lack of form since they probably didn’t intend it to be published):

Boy, I don’t know what to think. Much of this seems to be piles of words referring to zillions of links.

However, I did find a place where it talks about the “Draft Test Procedures.” Under that heading it lists the “Draft Test Method” for a category such as Maintain Active Medication List. It shows, for instance, that you must be able to enter something like:

RxNormCode Medication Brand Name (generic name) Dose Form Route Frequency DateStarted DateStopped
205875 Diabeta (glyburide) 2.5 mg Tablet By mouth(po) every morning 9/16/09
617314 Lipitor (atorvastatin calcium) 10 mg Tablet By mouth(po) daily 5/5/08

and then modify, and later list. So, I guess if a system didn’t have the ability to enter “route” then does this mean the system fails? Or, does allowing an improper form of “route” for the med make it fail? Unclear. On the other hand, because you can enter and modify all of the above, does it “pass”? What is missing, from my opinion, is the useability factor. My docs, for instance, like to see the history of dispensing of a given medication. Knowing and being able to easily see the various dispensings of amoxicillin is key to practicing good medicine. The Draft does not address that and is, in my opinion, a major missing point. One can have a system where doing anything takes lots of clicks and typing, or common things can be done in a few steps.

The rest of the Draft Test Methods are the same. Enter this, change that, make a list.

It would be nice if someone could tell me what it is I’m missing.

Does anyone else get the feeling that this certification stuff is going to be a mess and add little value for doctors?