More on EHRs (June 2006): The future of CCHIT, EHR adoption

With its first phase of certification rolling, the Certification Commission for Healthcare Information Technology (CCHIT) will concentrate on maintaining its momentum while moving to the realm of inpatient electronic health records (EHRs) in its second certification phase, followed by the evolving EHR network infrastructure in phase three.

"The inpatient domain is orders of magnitude more complicated-there are more systems, more institutions, and the systems are adopted already, so looking at evolving them or adapting them and getting the right units of what we're looking at will be a challenge for our workgroups and our commission," says Alisa Ray, CCHIT's executive director. "As for the networks, those are really just being defined."

Despite the challenges ahead, Mark Leavitt, MD, PhD, and chairman of CCHIT, thinks the commission will be able to meet a goal from President George W. Bush to have the majority of Americans served by EHR systems by 2014.

"The industry wants to see this happen, so we've had support from all quarters, but we've got a lot of work ahead of us."

According to a survey earlier this year by the Healthcare Information and Management Systems Society (HIMSS), only 24% out of 3,000 respondents had a fully operational EHR system in place, while 40% of the respondents are in the process of installing or signing a contract to get an EHR system.

"Those adoption figures from HIMSS are actually the high end of the scale reflecting the larger organizations," says Dr. Leavitt, who is on leave as HIMSS' chief medical officer while serving as CCHIT's chair. "We think we can impact those figures positively, but we'll have the most leverage where the adoption gap is-at the office and the small office end of the scale where they don't really have the ability to sort through 100 products and vet them before purchasing."

One of the specific barriers to widespread EHR adoption is the cost to physicians, and the federal government, among other payers, likely will have to help pay for the systems.

"We're expecting one stakeholder, basically the provider, to front the entire cost of the technology; so incentives could really help, and if the major payers, with the biggest payer in the country being the federal government, take even a moderate step toward that, that would really drive the marketplace," Dr. Leavitt says.

According to Joel Brill, MD, chief medical officer of Predictive Health LLC and an advisory board member for Managed Healthcare Executive, possible federal solutions could include a combination of enterprise grants, tax-free loans, and/or subsidies to encourage more rapid adoption.

From a primary-care perspective, Richard J. Baron, MD, FACP, Greenhouse Internists in Philadelphia, suggests that a one-time payment for moving information from paper to electronic could be effective for a FFS model to reimburse the time and monetary costs to the provider. In capitated contracts, or those with quality bonuses, he believes that payers' adding premium dollars to practices that utilize EHR systems, in particular CCHIT certified products, could speed adoption through auditing utilization/implementation.