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EHRs: Certification is extending to specialty EHRs


EHRs can be as specialized as the doctors who use them. That's why the CCHIT will begin putting its stamp of approval on programs geared toward child health and cardiovascular disease.

EHRs can be as specialized as the doctors who use them. That’s why the Certification Commission for Healthcare Information Technology will begin putting its stamp of approval on programs geared toward child health and cardiovasculardisease.

The US Department of Health and Human Services contracts with CCHIT, a private group, to certify EHR programs-inpatient and outpatient-that can perform essential tasks such as displaying a problem list, transmitting a prescription to a pharmacy, or exchanging information with other EHRs. Right now, CCHIT certifies all-purpose ambulatory EHRs, but many doctors use programs tailored to their specialty and work routines. Case in point: EHRs designed for pediatricians can display growth charts. Many all-purpose EHRs do that, too, but CCHIT has never made that capability a requirement for certification. After all, internists shopping for an EHR don’t need a growth chart for a 50-year-old male,unless they are tracking belly fat.

EHR certification is becoming more fine-tuned, however. This year, CCHIT will begin certifying EHRs used in treating children and patients with cardiovascular problems. To win child-health certification, EHR vendors initially will have to demonstrate that their program can do three things--capture patient-growth parameters such as weight, height, head circumferences and vital signs as discrete data elements; display growth charts based on this data, and use “age-specific and/or height-specific normative data for a vital sign.” In subsequent years, CCHIT will add more criteria, such as the ability to compute appropriatedrug doses based on a patient’s body survey area and ideal body weight.

Likewise, CCHIT has initially set forth 23 criteria for cardiovascular certification, among them the ability to import reports of studies and procedures from other computer systems and display ECG tracings and their interpretations. In 2009, CCHT will expect such EHRs to graphically display ejection fraction resultsfrom multiple studies in one view. 

To receive either of these two specialized certifications, an EHR must also satisfy the criteria for an all-purpose ambulatory EHR. Each year, CCHIT issues a new and expanded set. The latest batch raises the bar on the ability of EHRs to “talk” to other computer systems. According to the recently released 2008 criteria, EHRs must be able to send and receive patient-chartsummaries, which would include basics like problem and medication lists.

CCHIT plans to certify other kinds of specialized EHRs after 2008. Programs for behavioral healthcare are slated for 2009, along with personal health records. CCHIT chairperson and internist Mark Leavitt says his organization anticipated certifying PHRs possibly by 2010, but the debut of PHRs from pace-setting players like Google and Microsoft has sped up its timetable. Certification for EHRs used in long-term-care settings is tentatively setfor in 2010.

While some niche certifications apply strictly to medical specialties such as cardiology, others are based on certain patient populations. One example is child-health certification, which applies to EHRs used by pediatricians as well as family physicians who treat children. The setting for care-suchas a nursing home-is a third certification category.

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Jennifer N. Lee, MD, FAAFP
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