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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.

An article by Government Health IT’s Mary Mosquera has some interesting data from ONC about the number of EHR certifying bodies there might be available to EHR vendors. Here’s the most relevant section:

So far, ONC has received six or seven completed applications out of the 30 it sent to organizations that have requested them since July 1, said Dr. David Blumenthal, the national health IT coordinator, at a meeting of the advisory Health IT Policy Committee.

ONC released in June its final rule for the temporary certification program, which lays out steps organizations must take to be authorized by ONC to both test and certify that EHRs can perform the functions required for meaningful use.

“We are optimistic that we will have a new landscape in the certification realm in which, instead of having a single certification body, there will be more opportunity, a broader pipeline for certification, hopefully more price competition and shorter waiting times to get certification,” Blumenthal said at the committee meeting July 21.

6-7 applications to certify EHR software and 24 more out there that could come in. That sure blows the initial projection of 5 EHR Certifying body applications out of the water. I’m not really sure the business model for these organization. The customer base is about 300 EMR companies. That’s a pretty small market for these organizations to share.

I imagine this is really bad news for those people at CCHIT too. Mostly because CCHIT’s only product is certifying EHR software. At least other organizations like the Drummond Group do a number of certifications. Who would have guessed that the ARRA EMR stimulus money that looked so promising for CCHIT could become the legislation that drives them to irrelevancy?

Today, I thought it would be interesting to list the meaningful use final rule comments that I know of and to invite my readers to tell me about other meaningful use final rule commentary that they know about. Just reply in the comments of this post or on the EMR and EHR contact us page and I’ll update this post with all the meaningful use final rule resources we can find.

Full Meaningful Use Final Rule, Press Conference Video and EMR and HIPAA MU Thoughts
Comparing the Preliminary Meaningful Use Rule to the Final Meaningful Use Rule Done by Inga from HISTalk and a great resource.
List of Meaningful Use Webinars – Done by EMR and HIPAA
Everything HITECH Analysis of Meaningful Use
Advice on Addressing Meaningful Use – Good advice from the Healthcare IT guy on not being in a hurry to address meaningful use.
Interview with David Blumenthal About Meaningful Use
Mr. HISTalk and John Glaser Reactions to MU (have to scroll down a bit to see the obligatory meaningful use section)
Meaningful Use and It’s Impact on Physician Productivity
HISTalk Initial Comments and Reactions to MU – Just read the comments on this one.
Summary of Meaningful Use Announcement and Rule
CMS Page on Meaningful Use
Meaningful Use Final Rules Are a Big Deal – Wm. T. Oravecz Take on Meaningful Use Final Rule on HITECH Answers
David Blumenthal’s Thoughts on Meaningful Use
John Halamka’s Summary of Meaningful Use Final Rule Changes
Halamka’s Presentation on the Meaningful Use Final Rule
Summary and Other Meaningful Use Documents – The Summary Chart that’s embedded on this is an interesting one. Too bad it’s partially cut off on my screen.
Summary of the 2 Reginas and Meaningful Use – Matthew Holt talks about the 2 Reginas that spoke about Meaningful Use of an EHR
Chilmark Research Quick Meaningful Use Analysis – An always insightful look at healthcare IT
The Fox Group’s Thoughts on Where to Go from Here

I’m sure that there are plenty more. If you know of some good ones, let me know and I’ll add them to the list.

This just came in. The wait is finally over. I guess I know what I’m doing tomorrow.

CMS AND ONC TO ISSUE FINAL RULES ON MEANINGFUL USE AND STANDARDS AND CERTIFICATION FOR ELECTRONIC HEALTH RECORDS INCENTIVE PROGRAM

WHAT: CMS and ONC will host a press briefing to announce the final rules on Meaningful Use and Standards and Certification under the HITECH Act’s Electronic Health Records (EHR) incentive program.

WHO: Kathleen Sebelius, Secretary, U.S. Department of Health and Human Services
Donald Berwick, M.D, Center for Medicare & Medicaid Services, Administrator
David Blumenthal, M.D., M.P.P., National Coordinator for Health Information Technology
Regina Benjamin, M.D., M.B.A, Surgeon General

Dial In: Call in: 800-857-6748
Verbal Passcode: HHS

To watch the webcast live visit www.hhs.gov/live

A favorite topic of this blog has been Meaningful Use and it will likely continue to be a popular topic well into the future. As such, we’re all sitting around waiting to hear the word from CMS on the final rule for Meaningful Use. Doctors are waiting for it so they can select an EMR or modify their current EMR to meet the guidelines. EMR vendors are waiting for it so they can say that their EMR software can meet the meaningful use guidelines. RECs are waiting for it so that they can help doctors reach meaningful use. We’re all just waiting to see what’s going to come out.

Fierce EMR reported that the Meaningful Use final rule will be published by July 14th. Here’s a couple quotes from that report:

FierceEMR spoke with a CMS official directly involved in writing and publishing the final regulation, and she assures us that although there’s no “official” publication date (CMS missed its own self-imposed June 30 deadline), “I would be very surprised if it’s published any later than July 14.”

Not a very firm commitment to July 14th, but it should be around that date I imagine.

“We hoped to have it out by the end of June, but it’s looking more like mid-July,” the official told us this week. “There are so many moving parts and so many people are involved. This is a long regulation.” No doubt! The proposed rule was thicker than many novels. We expect nothing less from the final reg.

That wasn’t quite the novel I was hoping to read this summer, but it will be nice to have something final.

All of this said, we may be waiting for nothing. First, because I don’t think that we’ll see any real meaningful changes to the regulation. Plus, I think the regulation will still be missing much of the meat and potatoes that will be involved in managing that regulation. There will still be a lot of practical details needed and interpretation of the regulation to be done. At least if it’s the government process that I know.

There’s a lot of interesting speculation going on right now around what HHS is going to do in regards to meaningful use. There’s no doubt that a lot of the feedback given to HHS on meaningful use surrounded the idea that it was too much and had too many objectives. The question remains, what will HHS do with this feedback?

A number of people have suggested that the meaningful use objectives will be relaxed. In this company is past healthcare IT czar, David Brailer. The interesting part of this chorus is that it includes a large number of providers that say it’s going to be relaxed. Then, they follow up that statement with something like, “If it’s not relaxed, then doctors won’t show meaningful use and will not worry about the EMR stimulus money.” Basically, it will become a failed government initiative if the meaningful use bar is too high.

Other people are suggesting that meaningful use is going to stay the same. Carol Flagg of HITECH Answers quotes the following from David Blumenthal as indication that meaningful use will not substantially change:

“Introducing change in health care is never easy. Historically, adopting our most fundamental medical technologies, from the stethoscope to the x-ray, were met with significant doubt and opposition. So it comes as no surprise that in the face of change as transformational as the adoption of health IT – even though it carries the promise of vastly improving the nation’s health care – some hospitals and providers push back….The question health care providers are facing today is whether we are pushing too hard, too fast to make this important change. I respectfully submit, no. In turn, I ask, ‘Can we make these changes expeditiously enough?… Every provider, every patient throughout our nation will benefit from the goals envisioned by the HITECH Act. Yes, this will be a challenge. While large hospital networks and smaller providers may be stretched to meet national health IT goals, it is not beyond their capacity for growth.”

Little by little I’m leaning this direction. I’m not sure exactly why, but I’m getting the feeling that HHS either can’t or won’t change the meaningful use criteria. It’s basically going to be similar to what we have now with maybe one or two items of note.

What do you think? What will happen with the MU final rule?

After noting that CCHIT had gone quiet and posting about Drummond Group’s view of the EHR certification final rule, it seems appropriate that CCHIT has finally come out with their own comments.

The CCHIT blog post was done by Alisa Ray but says it’s a statement from Karen M. Bell, MD, Chair, CCHIT. I think that’s a bad sign for those of us who like executives that blog that Karen Bell sent the blog post through Alisa Ray, but maybe Karen’s still just getting setup on the new job.

There’s nothing really all that shocking or newsworthy in the CCHIT blog post. Here’s the cliff notes version (with some of my own commentary):
-CCHIT will apply to be a “ONC Authorized Testing and Certification Body (ONC-ATCB).” – Not a surprise since EHR Certification is CCHIT’s only business model.
-CCHIT will continue their “independently developed programs.” – They used their favorite word “assurance” in correlation with their programs again. Sadly, they just assure doctors that some programmer knows how to run their test scripts before paying CCHIT $30k+ to get their EHR certification. They don’t assure that an EMR is more usable, or has a higher implementation success rate, or that it saves more lives or increases reimbursement. Nope. Those assurances would run at least $100k to certify;-)

At least in the blogosphere, there’s been a number of healthcare IT bloggers proclaiming the end of CCHIT. Sadly, I’m not one of those. I think they’ll be around for a while and there’s still A LOT more educating that needs to spread about what an EHR certification is and what it is not.

Also, Michelle at Occam PM wrote a blog post that includes some interesting word clouds of the CCHIT and Drummond Group bog posts. An interesting view of what was said.

If anybody was doubting that Drummond Group was ready to be a player in the EHR certification rule, I think this blog post should make them think twice. You can tell from the tone of the post that Drummond Group had been waiting for HHS to issue the final rule so they could get moving.

In the same blog post, Drummond Group provides a short summary of some of the major changes to the rule after the comments:

* Waiving of the 30-day delay in the effective rule. This is by far the most significant “change” in terms of how it impacts vendors, providers and hospitals. Typical procedure for Final Rules is to have 30-day delay after it is on the Federal Register before it becomes “effective”, but this can be waived in certain situations. What this means practically is that once the Final Rule goes into the Federal Register, say around July 1, the Temporary Certification Program will be active and ONC can begin processing applications from organizations like ourselves intending to be ATCBs. ONC does give themselves 30 days to process and approve the application so you still may not see an ATCB officially testing until possibly August.

* Temporary Certification Sunsets No Earlier than 12/31/11. The NPRM had stated that the Temporary Program ends (and the Permanent Program begins) when there is an accredited ONC-ACB. Now, the Temporary Program is given a clear window of operation through the end of 2011, and it may be extended if an ONC-ACB is not found by then. This gives more stability to the Temporary Program.

* All ATCBs Must Support Remote Testing. The NPRM had previously only required support of testing at the local ATCB facility. Now, remote testing is required for all ATCBs. Remote testing can be done either at the development site (vendor) or deployment site (provider or hospital implementation). Based on our DGI surveys, remote testing was by far the preferred method, and ONC also received the same feedback.

Drummond Group also suggests that ONC really did listen to the comments that were given. I don’t doubt this actually. The people I’ve met from ONC really do seem like good people that are trying to do their best within the government limitations. It’s just unfortunate that the government limitations are so onerous.

Now the real fun begins as the various EHR certifying bodies start to appear and EMR vendors get to decide which body they should use.

HHS has put up an interesting new part of their website called “Health IT Journey: Stories from the road.” Here’s their description:

Have you, your practice, or your organization been through a health IT implementation? We’d like you to share your story with us. After internal review, your story may be published to inspire other providers and organizations to become meaningful users of Electronic Health Records (EHRs). Let’s learn together.

Of course, it also comes with the following disclaimer:

Disclaimer
Posting of the articles on this Web site does not necessarily constitute HHS or ONC endorsement of the procedures followed; vendors, products and services named; or overall performance of the facility’s delivery of care. We do hope you find these narratives insightful and useful in your efforts to adopt health information technology and improve patient care.

It seems like ONC is mostly looking for stories that have been published somewhere. They link to 3 articles already, but only one of those is actually available without paying for the service or signing up. This was an article about using an EHR to quantify the number of patients you’re seeing in the New England Journal of Medicine (NEJM).

Of course, you can probably imagine how high the bar is to get your story shared in the NEJM. With that said, I’m always interested in posting interesting stories on this site about people’s use of an EMR or experiences with the EMR selection and implementation processes. So, if you have a story you want to share, just send it to me on the EMR and EHR Contact form. It will be interesting to see how HHS/ONC will look at publications on blogs like this one, but they’ve been pretty open to bloggers in the past.

It will be really interesting to see what other stories are submitted, approved and published by ONC. I do applaud their efforts to try and spread the stories of EMR success. That’s a very good thing. It’s just too bad they’re promoting these stories that are stuck behind a pay wall. That’s not the way to spread good stories of HIT success.

A really interesting comment about the REC EHR selection process was made over on EMR and HIPAA:

It is beyond me how any REC could have already selected EHR vendors since no EHRs have yet gone through the HHS certification process. CCHIT certification in prior years simply isn’t relevant now. I bet ONC would be horrified to hear what people in this comment string are saying…or at least, I hope they would be horrified!

What ONC needs to do is establish a standardized and TRANSPARENT process by which the RECs select vendors. The RECs are supported by taxpayer dollars, so we all have a right to know how this vendor selection is going down.

I really love the idea of ONC requiring an open and transparent EHR selection process by the RECs that are getting millions of dollars from them. Remember, each of these RECs are non profit organizations that are suppose to be helping doctors show meaningful use of an EHR. Why wouldn’t they want to have a transparent EHR selection process? What are they trying to hide?

My fear is that many of the RECs are so worried about the short timelines they’ve been given that they’re just throwing darts at the wall instead of really involving people in the process. I’m a HUGE proponent of what’s been called crowd sourcing. It’s really amazing the type of information you can get to make a better decision when you involve a large group of people in the process. I hope the RECs will do just that and be transparent in their EHR selection process.

Side Note: We’re getting a lot of the RECs and their websites listed on this list of EHR Regional Extension Centers wiki page. Please add any others that you might know about.