Big Fat Liars, CCHIT and the ARRA EMR Incentives

We had the pleasure of attending a trade show recently, our ZipChart EMR booth was in a room with other vendors, including four other EMR vendors. Of those four EMR/EHR products, three had a CCHIT certification of some kind. ZipChart is not CCHIT certified for a good number of reasons, the major one being that the certification had little real world relevance to our specialty oriented software.

We listened to potential clients ask us why the other vendors were stating that ZipChart is not a “Certified” EMR and that a medical practice selecting us as their EMR would not be able to collect any of the ARRA HITECH funds that are being made available from CMS (Centers for Medicare & Medicaid Services) for providers that are demonstrating meaningful use of a certified EMR. That statement is patently false, and we assume was being made by people who know it’s false. Besides being rude it’s an extremely distasteful business practice to compare one’s software product with another on anything besides the merits of the application and the support thereof.

It should be noted that currently there is NO CCHIT certification that qualifies any EMR / EHR to collect ARRA HITECH funds. If, as a potential buyer of an electronic medical records product, you have been informed that a CCHIT certification qualifies software for ARRA funding, you have been misinformed either deliberately or simply by a vendor undereducated in the regulations affecting their industry.

How is that possible? The US Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) is responsible for the standards that need to be meet for ARRA certification. CMS has not yet issued those standards and the current timeline is December 31, 2009.

So why are there so many EMR companies stating that they are CCHIT certified and already certified to enable practices to collect ARRA funds using their EMR? Part of it is marketing hype and outright lying of course, but the balance is possibly a lack of understanding regarding the certification process.

The CCHIT organization has recently (October 7, 2009) opened the process for EMR vendors to become certified for CCHIT 2011 and Preliminary ARRA 2011 Certification even though the final standards have yet to be published by CMS. The CCHIT organization feels confident that, upon reading the recommendations that were presented to CMS by HHS and ONC (The Office of the National Coordinator for Health Information Technology), they have all the required items in their Preliminary ARRA 2011 certification program, and as such have begun offering EMR companies the opportunity to get certified. If they find the final standards CMS decides upon is different then what CCHIT anticipated, they will retest EMR software at no additional cost to the vendor and that vendor will be placed first in the queue to get the ARRA 2011 certification. There has been significant resistance to the CCHIT organization within the EMR industry and within the Federal government sanctioning bodies, so their certifications may be rendered moot. Even if the CCHIT certification stands, the price remains (in our opinion) exhorbitant.

If the EMR vendor opts to certify for the CCHIT 2011 Certification, which is more costly than the Preliminary ARRA 2011 certification, CCHIT is confident that those EMRs will meet all the standards required for ARRA incentives.

Well what does all of that mean? Well for ZipChart, it means at least two rounds of certification.

Why not opt to become a CCHIT 2011 Certified product and only go through one round of certification? While that may seem like the path that would be prudent, one only has to look at the numerous EMRs that have been CCHIT certified over the years and have been found by providers to be unusable, unintuitive and costly. EMRs that have proven to be inefficient and unproductive actually cost physicians more then the incentive money that is being offered by CMS for HIT adoption. The CCHIT standards are designed to shift clinical decision making from the hands of the physician to the hands of the software developer and, in the process, present software that is cumbersome and considerably more ‘click heavy’ than a clinician should have to deal with. One of the problems with these software packages is that, when being demonstrated by an expert, the actual effort required to complete a patient encounter is NOT obvious. So, the medical practice will invest a great deal of money and effort in a system that is guaranteed to slow down the most expensive person in the office, the physician. 

One other thing to consider for EMR companies that has not had much discussion, but is addressed in a letter in the welcome section of the CCHIT’s Preliminary ARRA 2011 Certification Handbook published on October 5, 2009 is that CCHIT may not continue to be the certifying body. Mark Leavitt, MD, PhD Chair of CCHIT and co-signed by Alisa Ray, Executive Director of CCHIT, state:
“CCHIT is currently an HHS recognized certification body, and expects to continue that status under the accreditation process yet to be developed by HHS/ONC; however we are unable to guarantee that outcome.”.

If you are even more confused now, just know this; HHS and the ONC have sent a list of recommendations to CMS for the ARRA certification. Any EMR company that intends to remain in business is paying a great deal of attention to the details of these recommendations. ZipChart has been closely following the recommendations, and as such has already implemented many of the items that have been recommended for ARRA certification. If you would like to read what CMS has stated about the HITECH ARRA act, including their timelines, click here. When the final standards have been published and certifying body (or bodies) have been decided upon, ZipChart will move toward becoming certified in a way that does NOT hinder a physicians productivity and have an negative impact on a practices’ bottom line.

Remember the incentive money is nice to get, provided it doesn’t cost you more by having an inefficient, unusable system.


  1. Elizabeth Curtman says:

    I really enjoyed your comments and insight as an EMR company, but more importantly as someone who understands what works and doesn’t work in a clinical setting.
    An EMR is great, hey if the government wants to pay me for using one even better, but not if I have to see fewer patients daily, or if my staff is overwhelmed by nonfunctioning technology.
    I can’t tell you how many hours my staff has been on hold with our practice management software provider. If it were our EMR we would not be able to run clinic!

  2. Michael Warren says:

    CCHIT is a joke. How many providers have installed emrs that were CCHIT and they were disasters!

    Many of my co-works will not go to a CCHIT certified EMR unless there is no other option!