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Initial recommendations of the federal HIT Policy Committee's certification/adoption workgroup could spell the end of the Certification Commission for Healthcare Information Technology's monopoly on certifying electronic health records systems. But the group leaves the door open to having existing systems certified under CCHIT criteria deemed certified in 2011. That's when Medicare/Medicaid incentives authorized under the American Recovery and Reinvestment Act start.

The workgroup recommends that multiple organizations be allowed to perform "HHS Certification" testing and provide certification. HHS Certification means a certifying process that is limited to the minimum set of criteria necessary to meet functional requirements of ARRA and achieve the law's meaningful use objectives.

More comprehensive certification of EHRs, such as what CCHIT now offers, should continue if the market demands it, but not be a requirement for Medicare and Medicaid incentive payments, according to the workgroup.

The group's proposed definition of HHS Certification is:

"HHS Certification means that a system is able to achieve government requirements for security, privacy and interoperability, and that the system would enable the Meaningful Use results that the government expects. HHS Certification is not intended to be viewed as a 'seal of approval' or an indication of the benefits of one system over another."

Under the proposal, EHR vendors would only need to get certification from one accredited certifying organization. Updates should occur no more frequently than every other year and be done in time to enable vendors and providers "sufficient time for effective implementation."

The workgroup recommends the Office of the National Coordinator for Health Information Technology define HHS Certification criteria and that the process be separated from organizations that perform certification testing.

There is a feeling in the industry that CCHIT's current certification process is "excessively detailed," according to the recommendations. "There is too much attention to specific features and functionality." But the workgroup praised CCHIT for transparent discussion of requirements and a fair process of testing and certifying EHRs.

In addition to focusing certification on meaningful use requirements and setting up a new certification process, other workgroup recommendations address privacy, security and interoperability issues; flexible software sources such as open source or in-house developed; and a short-term transition plan.

Under the transition plan, for instance, ONC would look at gaps in existing CCHIT criteria to address meaningful use objectives, such as public health reporting; and revise existing criteria, such as e-prescribing, to meet meaningful use objectives. "Subject to completing a special meaningful use gap certification, existing certified products should be deemed certified for 2011," according to the recommendations.

The workgroup on certification/adoption presented its initial recommendations to the HIT Policy Committee on July 16. It will continue to accept comments and refine the recommendations. The initial recommendations are available at http://healthit.hhs.gov. Click on Public-Private Initiatives, then Health IT Policy Committee.

--Joseph Goedert