CCHIT Is Ready For The Uncertainty Ahead

My experience as a rookie volunteer on the Certification Commission for Health Information Technology's new Clinical Research Workgroup has been surprisingly positive. I applied for this position because I wanted to get more involved in the national IT scene at an exciting time for clinical informatics. So far, I haven't been disappointed.CCHIT, a non-governmental, nonprofit, was formed five years ago to define what encompasses an electronic health records system and establish certification criteria. It's been certifying systems for the past three years.

As a physician and faculty member in family medicine at the University of North Carolina at Chapel Hill, I've been working on a large data warehousing project in consultation with IBM Global Business Services for the past year. I expect this experience will serve as good background for contributing to the CCHIT workgroup.

CCHIT volunteers generally do most of their work via teleconferences. But for our first meeting, all 259 of us gathered in Chicago for two days in mid-July. It was an impressive, diverse group. My own workgroup has representatives from Dana Farber Cancer Institute, Palo Alto Medical Foundation, Duke, Eli Lilly, Kansas University, Allscripts, Epic, MD Anderson, and North Carolina's Division of Mental Health among others.

One of the first issues up was vendor representation, clearly a potential point of controversy. Mark Leavitt, CCHIT CEO, addressed the issue directly, noting that vendors can only make up one-third of total membership. Dr. Leavitt is quite proud of the diversity of the workgroups and openness of the criteria development and testing process.

The only more controversial issue was the pronunciation of CCHIT. We were admonished at least three times against using the "Sea-Chit" pronunciation, and instead say C-C-H-I-T. While it conserves syllables and allows for more rapid discourse, "Sea-Chit" has led to some unfortunate mispronunciations (intentional or not) and apparently also to some embarrassing moments for the marketing department.

Signing the nine-page confidentiality agreement was a daunting part of my CCHIT experience. I understand the need to protect the intellectual property of software under review, but I've never seen such a detailed confidentiality document in all my 23 years working in academic medicine. However, I am impressed by the staff's transparent approach to communications: we're allowed to discuss our impressions freely as long as we state who we were, that we aren't speaking for CCHIT, and that our comments reflect the need to maintain a level playing field by not revealing inside information that might benefit one group over another. The Bigger Picture Overall, I'm also impressed with CCHIT's flexibility. Leavitt noted that the federal stimulus legislation "changes everything." And it already has. In June, CCHIT announced two new paths to certification, adding module and site certifications to the existing comprehensive one. This move aligns CCHIT more closely with work being done by the U.S. Department of Health and Human Services' Office of the National Coordinator of Health Information Technology (ONC) to define the "meaningful use" of healthcare IT as required by the legislation.

During the second day of our meeting, on July 16, the ONC's Health IT Policy Committee came out with yet another revision of "meaningful use," and one of its workgroups released a report criticizing CCHIT. The report noted that CCHIT's certification process is "excessively detailed" and identified a possible conflict in that CCHIT both sets certification criteria and does the testing. It went on to point out the potential benefit of an alternative certification approach, the so-called "HHS certification"--government-defined criteria, more directly aligned with HHS's "meaningful use" definition. The report advises that multiple organizations should be allowed to perform HHS certification testing and provide certification.

If implemented, the report has the potential to require even bigger changes from CCHIT. Whether it becomes a testing-only organization, adapts its certification to mirror the still-ambiguous HHS certification, or becomes one in a field of certification groups remains to be seen. However, CCHIT impressed me as a nimble, responsive organization despite, or maybe even because of, the criticism it has received.

One thing is certain, CCHIT has the most experience in an open process of criteria development for and certification of electronic health record systems. With billions of stimulus dollars at stake and the timeline set, CCHIT will continue to play an important role, and I anticipate volunteers such as myself will be needed for CCHIT workgroups for the foreseeable future.

Dr. Donald Spencer is the associate director of Medical Informatics at UNC Health Care at the University of North Carolina, Chapel Hill. He's also a professor of Family Medicine at the UNC School of Medicine and holds an MBA in Management from the University of Missouri-Columbia.