Certification of EHRs has been controversial since the beginning. For the longest time, some small vendors' stance was that the Certification Commission for Healthcare Information Technology thought that the process was weighted in favor of large companies, and thus would put them out of business.
With the passage of the American Recovery and Reinvestment Act, control over certification is passing to the federal government. The Office of the National Coordinator for Health Information Technology is setting rules for criteria that support "meaningful use" of EHRs, while the Commerce Department's National Institute of Standards and Technology is developing testing procedures.
Along the way, certification has become highly detailed, with at least one unintended consequence. "[T]he certification process was in effect dictating particular work flows and distinct user interfaces. That was the point where the grumblings about lack of EHR usability and complaints of EHRs not being built with physicians and patients in mind, started gaining steam," Margalit Gur-Arie, a partner in St. Louis-based health IT consulting firm Gross Technologies, notes on her On Healthcare Technology blog.
Gur-Arie says the CCHIT process was intended to reassure buyers that the systems they were considering had the functionality to handle certain tasks. "Unfortunately, certification acted in a more simplistic way and separated the heavy from the lite, regardless of usability, value and stability," she says.
ONC changed this way of thinking, instead putting emphasis whether systems have what it takes to get providers to meaningful use. "As a result, some small uncertified vendors of very lite EHRs are expressing interest in the ONC certification, if the price is right, of course. CCHIT gracefully turned on a dime and created a much slimmer ARRA certification process. But is it possible that the slimming and trimming process is going too far," wonders Gur-Arie. She says the proposed NIST testing procedures "indicate a possibility of certifying too little."