1. Certification Commission
for Healthcare
Information Technology
CCHIT Town Hall
Mark Leavitt, MD, PhD – Chair
Alisa Ray – Executive Director
HIMSS 09 Annual Conference and Exposition
Event 38, Room W192b
Chicago, IL
Sunday, April 5, 9:45 AM - 11:15 AM

2. 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
© 2009 | Slide 2 | April 5, 2009

3. A Look Back
© 2009 | Slide 3 | April 5, 2009

4. Mission and Goals
Goals:
Mission:
• Reduce the risks of
Accelerate the adoption
investing in health IT
of robust, interoperable
health IT by creating • Facilitate interoperability
an efficient, credible of health IT
certification process.
• Unlock adoption incentives
and regulatory relief
• Protect the privacy of
health information
© 2009 | Slide 4 | April 5, 2009

5. An Open, Transparent
Criteria Development Process
Inputs:
* Scope Guidance from Commission
Public Comment
* Roadmap (from previous year)
periods
* Future Directions (from previous year)
* Environmental Scan:
- Use Cases from AHIC
- Standards from HITSP, SDOs
- Market research
- More
Final Criteria
Refine Criteria Proposed Launch
Develop Test Scripts
and Develop Final Criteria “09”
April Draft Criteria and Roadmap
Draft Test Scripts and Test Scripts Certification
2008 for the Future
(July 2009)
May
July Sept Mar
Dec
2009
2008 2008 2009
2008
Pilot Test
A voluntary, consensus-based process
with multiple cycles of public vetting
© 2009 | Slide 5 | April 5, 2009

6. An Efficient, Reliable
Inspection 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
© 2009 | Slide 6 | April 5, 2009

7. A Mission-Focused,
Nonprofit 501(c)3 Organization
Board of Trustees Board of Commissioners
Executive Director
Alisa Ray
Administrative Marketing & Communications Certification Development Certification Program Certification Technology
Sue Reber, Director
Kathy Shea, Director Kari Taylor Atkins, Director Bambi Rose, Director Dennis Wilson, Director
John Morrissey
Merril Prager Shweta Trivedi Amit Trivedi Vince Van de Coevering
Rick Turoczy
Jen Degler Soloman Appavu Ben Uphoff
Diana Rios
Michelle Knighton
CO-CHAIRS STRATEGIC LEAD WORK GROUP WORK GROUP STRATEGIC LEAD CO-CHAIRS
Steven Lane Kari Taylor Atkins Meredith Seidel Michael Mirro
Ambulatory EHR Cardiovascular
Eric Rose Michael Paquin
Rick Reeves Kari Taylor Atkins Bonnie Cassidy Bobbie Byrne
Inpatient EHR Child Health
Kathy Scanlon Eugenia Marcus
Todd Rothenhaus Kari Taylor Atkins Amit Trivedi David Tao
Emergency Dept EHR Interoperability
Steven Stewart Alan Zuckerman
A. John Blair Virginia Riehl Bonnie Cassidy Donald Bechtel
Network Privacy & Compliance
Michael Kappel Cassi Brinbaum
Ted Eytan Jody Pettit Soloman Appavu Khalid Al-Maskari
PHR Security
Lory Wood Rick Brady
Memo Keswick Kari Taylor Atkins Behavioral Health
Zebulon Taintor
22 staff facilitating the work of over 200 volunteers
© 2009 | Slide 7 | April 5, 2009

8. 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
© 2009 | Slide 8 | April 5, 2009

9. Impact of Certification
Beneficial effects and
interoperability assured,
unlocking incentives
Payers/Purchasers
Providers
IT Vendors
Reduced risk and
Growing market
availability of incentives
attracts investment,
accelerates adoption
lowers costs
© 2009 | Slide 9 | April 5, 2009

10. Assessment of Impacts
Breakthrough needed:
Financial incentives
Payers/Purchasers
Providers
IT Vendors
Rapid uptake; Support of professional
>160 products certified societies; high awareness
>75% of marketplace among providers
© 2009 | Slide 10 | April 5, 2009

11. Breakthrough Achieved:
Incentives for EHR Adoption
2006-2007 44 new EHR incentive programs
First 2 years of certification
Total new incentives: ~$700 Million 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%
Liability insurance discounts
2008 MIPPA incentive for ePrescribing
Additional incentives: ~$2 Billion
2009 - 2014 American Recovery and
Reinvestment Act
Total incentives: ~$34 Billion
© 2009 | Slide 11 | April 5, 2009

12. A Look Ahead
© 2009 | Slide 12 | April 5, 2009

13. The American Recovery
and Reinvestment Act
(ARRA)
© 2009 | Slide 13 | April 5, 2009

14. 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: Presidential:
John F Kennedy Barack Obama
Timeframe 1961 – 1969 (8 years) 2009 – 2014 (5 years)
Driver Scientific exploration + Enabler of health reform +
National security 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 Multiple contractors and grantees
sector) (private sector)
• Developing completely new • Accelerating deployment and
Major challenges
technologies advancing existing technologies
• Safety of astronaut lives • Transforming care delivery to
improve quality and reduce costs
© 2009 | Slide 14 | April 5, 2009

15. 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 quality
of health care”
– “reporting on measures using EHR”
© 2009 | Slide 15 | April 5, 2009

16. We Are Already Seeing
the Stimulus Effect of ARRA
EHR
Certification
Applications
Received
(per Month)
ARRA signed
Feb 17, 2009
Month
© 2009 | Slide 16 | April 5, 2009

17. A Record Number of
New 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
© 2009 | Slide 17 | April 5, 2009

18. EHR Market Remains
Diverse and Competitive
Annual Revenue Practice Sizes Served
of Ambulatory EHR Vendors by Vendors Applying
> $100 million N/A
75%
7% 7%
< $1 million
25% 50%
$21-$100 million
9%
25%
$11-$20 million
13% $1-$10 million
37% 1 2-5 6-15 16-50 >50
Number of Physicians in Practice
© 2009 | Slide 18 | April 5, 2009
Revenue and Size data from application data of certified Ambulatory EHR
08 vendors as of March 2009; N=77; response rate 100%

19. Stepping Up to Meet Higher
Expectations under ARRA
Attribute Before ARRA After ARRA
Earn public trust as
Sufficient to earn trust of
Transparency guardian of $34B
health IT stakeholders
taxpayer investment
Certify health IT product; Broader responsibility for
Accountability not company, training, all prerequisites to
support, usability meaningful use
Results of EHR Measure and compare
Outcomes implementations not part EHRs by effects on
of certification quality, safety, cost
Expand to all domains
Expand to new domains
Scale with incentives; scale up
as resources permit
for increased volume
Powerful incentives
Pace of progress limited
Speed provide leverage to drive
by market acceptance
faster progress
© 2009 | Slide 19 | April 5, 2009

20. Rating System Concept
10
150
© 2009 | Slide 20 | April 5, 2009

21. 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
© 2009 | Slide 21 | April 5, 2009

22. 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
Yellow zone (maturity)
Certification focus: Maintain
compliance as standards are updated
Certification life cycle of a domain
© 2009 | Slide 22 | April 5, 2009

23. Planning for the Recognition of
Certification Criteria by HHS/ONC
HHS/ONC Recognized
Offering alternatives to the Certification Criteria
Health IT Standards (late 2009?)
Committee:
– 08, 09, or 10 criteria set
may be chosen
– Advanced certifications in Existing
New criteria
interoperability, quality, criteria
that must
clinical decision support, that may CCHIT 09 Criteria
be added
be omitted that are recognized
security may or may not to the
from the
recognized
be required recognized
set
set
– Committee may request
omission of some criteria
– Committee may request
addition of criteria
09 CCHIT Criteria
(Published May 2009)
© 2009 | Slide 23 | April 5, 2009

24. Certification Commission
for Healthcare
Information Technology
Opportunities
Today

25. 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 © 2009 | Slide 25 | April 5, 2009

26. Help Update Existing Programs
Base Domain Certification Options 06 07 08 09
(Add-on to Base Domain)
L
Ambulatory EHR*
Ambulatory L
Child Health
Ambulatory L
Cardiovascular Medicine
L
Inpatient EHR*
L
Emergency Dept
Amb+Inpt+ED L
Enterprise
L
HIE*
L
PHR
L
Stand-alone ePrescribing
Legend: L = Launch
*Original HHS Contract (all other programs represent voluntary expansion)
© 2009 | Slide 26 | April 5, 2009

27. Or Help Develop New Ones
Base Domain Certification Options 09 10 11 12
(Add-on to Base Domain)
Ambulatory EHR
D L
Behavioral Health (as add-on)
D L
Behavioral Health (as stand-alone)
D L
Clinical Research
D L
Dermatology
R D L
Eye Care
R D L
Oncology
D L
Advanced Interoperability
D L
Advanced Quality
D L
Advanced Security
D L
Advanced Clinical Decision Support
D L
Long Term Care Spectrum
R D L
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)
© 2009 | Slide 27 | April 5, 2009

28. Volunteer Workgroup Organization
For Development of ’10 (launch 2010) Criteria
Develop
Behavioral
Cardiovascular Clinical Advanced
Criteria for Dermatology Advanced
Child Health
Health
Medicine Research Inter-
Optional Work Group Quality
Work Group
Work Group
Work Group Work Group operability
(DER) (AQ)
Additional (CH)
(BH)
(CV) (CR) (AIO)
Certifications
Advanced
Advanced Clinical
Contribute Inter-
Security Privacy Security Decision
Criteria for operability
Work Group Work Group (AS) Support
Work Group
Specific
(Sec) (PRI) (ACDS)
(IO)
Attributes
New Work Groups and
Panels being formed
Stand-alone
Identify
ePrescribing
Criteria for
Work Group
Modular
(eRx)
Applications
Long Term
Emerg Dept
Ambulatory Inpatient
Care
Develop Base PHR HIE
EHR
EHR EHR
Spectrum
Work Group Work Group
Criteria for a
Work Group
Work Group Work Group
Work Group
(PHR) (HIE)
Domain
(ED)
(Amb) (IP)
(LTC)
© 2009 | Slide 28 | April 5, 2009

29. 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
© 2009 | Slide 29 | April 5, 2009

30. 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!
© 2009 | Slide 30 | April 5, 2009

31. Technical Roundtables
on 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
© 2009 | Slide 31 | April 5, 2009

32. Discussion and
Q&A
For more information:
www.cchit.org