Certification Commission for Healthcare Information Technology

CCHIT Town Hall

Mark Leavitt, MD, PhD – ChairAlisa Ray – Executive Director

HIMSS 09 Annual Conference and ExpositionEvent 38, Room W192b Chicago, ILSunday, April 5, 9:45 AM - 11:15 AM

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Agenda

•A Look Back– Assessing our progress

•A Look Ahead– The American Recovery and Reinvestment Act (ARRA)– The evolving role of certification under ARRA

•Opportunities Today– Certification programs for 2010– Opportunities for participation

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A Look Back

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Mission and Goals

Accelerate the adoptionof robust, interoperablehealth IT by creatingan efficient, credible certification process.

• Reduce the risks of investing in health IT

• Facilitate interoperabilityof health IT

• Unlock adoption incentives and regulatory relief

• Protect the privacy of health information

Goals:Mission:

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An Open, TransparentCriteria Development Process

Inputs:* Scope Guidance from Commission* Roadmap (from previous year)* Future Directions (from previous year)* Environmental Scan:

- Use Cases from AHIC- Standards from HITSP, SDOs- Market research- More

DevelopDraft Criteria

Refine Criteriaand DevelopDraft Test Scripts

ProposedFinal Criteriaand Test Scripts

Final CriteriaTest Scriptsand Roadmapfor the Future

Public Commentperiods

Launch“09”

Certification(July 2009)

Sept2008

Dec2008

Mar2009

May2009

July2008

April2008

Pilot Test

A voluntary, consensus-based processwith multiple cycles of public vetting

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An Efficient, ReliableInspection Process

• Objective, rigorous, and reliable testing methods• 100% compliance required• “Open book” model – criteria and test scripts published in advance

• Cost-efficient – web-conferencing and other virtual presence tools; no travel expense

• Robust retesting and appeal processes

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A Mission-Focused,Nonprofit 501(c)3 Organization

Board of Trustees Board of Commissioners

Executive DirectorAlisa Ray

Administrative

Kathy Shea, DirectorMerril PragerJen Degler

Marketing & CommunicationsSue Reber, Director

John MorrisseyRick Turoczy

Certification Development

Kari Taylor Atkins, DirectorShweta Trivedi

Certification Program

Bambi Rose, DirectorAmit Trivedi

Soloman AppavuDiana Rios

Michelle Knighton

Certification Technology

Dennis Wilson, DirectorVince Van de Coevering

Ben Uphoff

CO-CHAIRS STRATEGIC LEAD WORK GROUP

Steven LaneEric Rose

Kari Taylor Atkins Ambulatory EHR

Rick ReevesKathy Scanlon

Kari Taylor Atkins Inpatient EHR

Todd RothenhausSteven Stewart

Kari Taylor Atkins Emergency Dept EHR

A. John BlairMichael Kappel

Virginia Riehl Network

Ted EytanLory Wood

Jody Pettit PHR

Memo KeswickZebulon Taintor

Kari Taylor Atkins Behavioral Health

WORK GROUP STRATEGIC LEAD CO-CHAIRS

Cardiovascular Meredith Seidel Michael MirroMichael Paquin

Child Health Bonnie Cassidy Bobbie ByrneEugenia Marcus

Interoperability Amit Trivedi David TaoAlan Zuckerman

Privacy & Compliance Bonnie Cassidy Donald BechtelCassi Brinbaum

Security Soloman Appavu Khalid Al-MaskariRick Brady

22 staff facilitating the work of over 200 volunteers

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Other Key Accomplishments

• Executed 3 year, $7.5M HHS/ONC contract• Federal recognition as a certifying body (2006)• Transitioned to independent, nonprofit 501(c)3 status (2007-2008)

• Expanded to additional specialties, settings, and populations beyond HHS contract, in response to stakeholder interest

• Strong stakeholder engagement, steady increase in volunteer commitment

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Impact of Certification

Payers/Purchasers

ProvidersIT Vendors

Beneficial effects andinteroperability assured,

unlocking incentives

Reduced risk andavailability of incentives

accelerates adoption

Growing marketattracts investment,

lowers costs

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Assessment of Impacts

Payers/Purchasers

ProvidersIT VendorsSupport of professional

societies; high awarenessamong providers

Rapid uptake;>160 products certified>75% of marketplace

Breakthrough needed:Financial incentives

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Breakthrough Achieved: Incentives for EHR Adoption

44 new EHR incentive programs

21 states with health IT programs

54 EHR rollouts (157 hospitals) using Stark safe harbor

Health plans with P4P incentive for certified EHR 11.3% ►25.8%

2006-2007First 2 years of certificationTotal new incentives: ~$700 Million

Liability insurance discounts

2008Additional incentives: ~$2 Billion

MIPPA incentive for ePrescribing

2009 - 2014Total incentives: ~$34 Billion

American Recovery and Reinvestment Act

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A Look Ahead

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The American Recovery and Reinvestment Act (ARRA)

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A Historical Comparison

Apollo Program ARRA/Health IT

National goal Manned spaceflight to the moon Electronic health records for every American

Level of leadership Presidential:John F Kennedy

Presidential:Barack Obama

Timeframe 1961 – 1969 (8 years) 2009 – 2014 (5 years)

Driver Scientific exploration +National security

Enabler of health reform + Economic stimulus

Total government funding $22B (1969 dollars) $34B (total incentives; $19B net expenditure after savings)

Management NASA (gov’t agency) HHS/ONC (gov’t agency)

Execution Multiple contractors (private sector)

Multiple contractors and grantees (private sector)

Major challenges • Developing completely new technologies• Safety of astronaut lives

• Accelerating deployment and advancing existing technologies• Transforming care delivery to improve quality and reduce costs

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ARRA Certification Language

• “The National Coordinator, in consultation with the Director of the National Institute of Standards and Technology, shall keep or recognize a program or programs for the voluntary certification of health information technology as being in compliance with applicable certification criteria adopted under this subtitle.”

• To be eligible for the Medicare or Medicaid incentives, a professional must be a “meaningful EHR user” and satisfy each of the following requirements:

– “using certified EHR technology in a meaningful manner, which shall include the use of electronic prescribing”

– “electronic exchange of health information to improve the qualityof health care”

– “reporting on measures using EHR”

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We Are Already Seeingthe Stimulus Effect of ARRA

EHR Certification Applications

Received(per Month)

ARRA signedFeb 17, 2009

Month

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A Record Number ofNew Applications, New Vendors

• 08 Ambulatory EHR applications– 64 total applications– 39% are NEW vendors– 40% also applied for Child Health certification– 17% also applied for Cardiovascular certification

• 08 Emergency Department EHR– New domain for 08; approximately 10 vendors in market– 7 applications received

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EHR Market RemainsDiverse and Competitive

Annual Revenueof Ambulatory EHR Vendors

1 2-5 6-15 16-50 >50

Practice Sizes Servedby Vendors Applying

Number of Physicians in Practice

25%

50%

75%

$1-$10 million

37%

< $1 million

25%

$11-$20 million

13%

$21-$100 million

9%

> $100 million

7%N/A7%

Revenue and Size data from application data of certified Ambulatory EHR 08 vendors as of March 2009; N=77; response rate 100%

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Stepping Up to Meet Higher Expectations under ARRA

Attribute Before ARRA After ARRA

Scale Expand to new domains as resources permit

Expand to all domains with incentives; scale up

for increased volume

Transparency Sufficient to earn trust of health IT stakeholders

Earn public trust as guardian of $34B

taxpayer investment

AccountabilityCertify health IT product; not company, training,

support, usability

Broader responsibility for all prerequisites to

meaningful use

OutcomesResults of EHR

implementations not part of certification

Measure and compare EHRs by effects on quality, safety, cost

Speed Pace of progress limited by market acceptance

Powerful incentives provide leverage to drive

faster progress

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Rating System Concept

10

150

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Ensuring the Flow of Innovation

• Continue to monitor vendor mix– Small vs large, new vs established, alternative deployment

models, price points

• Ensure EHR certification is accessible to all corners of the market

– Commercial– Open-source – Self-developed– Modular

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Certification Life Cycle Concept

Green zone (new domains)Certification focus: Define basic functionality, security, interoperability

Blue zone (active development period)Certification focus: Drive rapid progress in interoperability

Certification life cycle of a domain

Yellow zone (maturity)Certification focus: Maintain compliance as standards are updated

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Planning for the Recognition of Certification Criteria by HHS/ONC

CCHIT 09 Criteriathat are recognized

Existingcriteria

that maybe omittedfrom the

recognizedset

New criteriathat mustbe added

to therecognized

set

09 CCHIT Criteria(Published May 2009)

HHS/ONC RecognizedCertification Criteria

(late 2009?)Offering alternatives to the

Health IT Standards Committee:

– 08, 09, or 10 criteria set may be chosen

– Advanced certifications in interoperability, quality, clinical decision support, security may or may not be required

– Committee may request omission of some criteria

– Committee may request addition of criteria

Certification Commission for Healthcare Information Technology

OpportunitiesToday

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Schedule of Participation Opportunities

• Public comment periods– Comments on Proposed Final 09 now open through April 28– Next cycle (10): Sept 2009, Dec 2009, April 2010, May 2010

• Volunteer work group members and co-chairs– Applications now open through April 20– Term: 1 year, July 1, 2009 – June 30, 2010– More details on slides to follow

• Board of Commissioners– Applications will open in July– Term: 2 years, Sept 2009 – Sept 2011

• Board of Trustees– Applications will open in October– Term: 3 years, Jan 2010 – Jan 2013

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Help Update Existing Programs

Base Domain Certification Options(Add-on to Base Domain)

06 07 08 09

L

L

L

L

L

L

L

L

Ambulatory EHR* L

Ambulatory Child Health

Ambulatory Cardiovascular Medicine

Inpatient EHR*

Emergency Dept

Amb+Inpt+ED Enterprise

PHR

Stand-alone ePrescribing

HIE*

Legend: L = Launch

*Original HHS Contract (all other programs represent voluntary expansion)

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Or Help Develop New OnesBase Domain Certification Options

(Add-on to Base Domain)09 10 11 12

Behavioral Health (as add-on) D L

Behavioral Health (as stand-alone) D L

Long Term Care Spectrum D L

Eye Care R D L

Oncology R D L

Advanced Interoperability D L

Advanced Quality D L

Advanced Security D L

Advanced Clinical Decision Support D L

LD

L

L

R

Ambulatory EHR

Clinical Research D

Dermatology D

Obstetrics/Gynecology

Note: scheduling of all areas will remain flexible so the Commission can respond to the emerging requirements of the American Recovery and Reinvestment Act.

Legend: R = Research (staff level); D = Start Development; L = Launch (tentative)

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Volunteer Workgroup OrganizationFor Development of ’10 (launch 2010) Criteria

InpatientEHR

Work Group(IP)

AmbulatoryEHR

Work Group(Amb)

Emerg DeptEHR

Work Group(ED)

CardiovascularMedicine

Work Group(CV)

Stand-aloneePrescribingWork Group

(eRx)

Child HealthWork Group

(CH)

HIEWork Group

(HIE)

SecurityWork Group

(Sec)

Inter-operability

Work Group(IO)

PrivacyWork Group

(PRI)

PHRWork Group

(PHR)

Long TermCare

SpectrumWork Group

(LTC)

Develop Base Criteria for a

Domain

Contribute Criteria for

Specific Attributes

Develop Criteria for

Optional Additional

Certifications

BehavioralHealth

Work Group(BH)

ClinicalResearch

Work Group(CR)

DermatologyWork Group

(DER)

AdvancedQuality(AQ)

AdvancedInter-

operability(AIO)

New Work Groups and Panels being formed

AdvancedClinical

DecisionSupport(ACDS)

AdvancedSecurity

(AS)

Identify Criteria for

Modular Applications

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Volunteer Application Process and Schedule

• Application process– Applications accepted March 26 to April 20, 2009– Applications only accepted online: find link at www.cchit.org– Indicate all positions you are interested in – member and/or co-

chair roles– Existing volunteers must re-apply and supply updated resume– Notifications in late May

• Strengthened conflict of interest policy– Applicants must disclose any financial relationship with a

vendor of certified or certifiable technology; if so, they are assigned to Vendor stakeholder group

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What to Expect

• Term of service is July 1, 2009 to June 30, 2010• Meetings may be weekly, biweekly, or less frequently,

depending on the group -- more information at the time of application

• Face-to-face kickoff July 15-16 in Chicago – airport area hotel location to be announced

• Volunteers may also be invited to serve on various Panels or Task Forces during the course of the year

• We are in a dynamic new environment – expect changes!

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Technical Roundtableson Monday, April 6

• Session 1: Interoperability 09 and Beyond: a look at CCHIT’s roadmap for the future

– 1:00 – 2:00 PM CDT

• Session #2: Open Source Forum: a dialogue on certification for open source EHRs

– 2:00 – 3:00 PM CDT

• To attend in person:– Room 10d, Hyatt Hotel at McCormick Conference Center– Registration not required to attend

• To participate from offsite:– Register at: https://www1.gotomeeting.com/register/429901059– Dial in to (877) 313-5342, ID # 91945091

Discussion and

Q & A

For more information:www.cchit.org