Open-Source Community Welcomes New EHR Certification Possibilities

While big-picture health reform efforts on Capitol Hill are getting most of the mainstream media attention this month, another more focused kind of reform also is under way a few blocks down the road.

Last week, a subcommittee of the newly formed Health IT Policy Committee recommended an end to a five-year monopoly on certifying electronic health record systems.

Since 2004, the Certification Commission for Healthcare IT has been the only government-recognized organization to put its stamp of approval on EHRs. If the Policy Committee follows the recommendation of its certification and adoption work group, that exclusive role will end.

The Policy Committee meets next month in Washington, D.C., and plans to accept public comment on certification, as well as issues related to privacy, security, interoperability, open-source programs and other flexible software sources.

If CCHIT's exclusive role ends as expected, the door will open wider to smaller, simpler, less expensive EHR systems, according to some industry experts.

At its most basic level, the change could be construed as a move from an industry-driven system to a consumer-driven system. In that scenario, the consumer could be defined as the hospital or physician group purchasing an EHR system.

At a political level, the change could be construed as a shift from Bush-era let-the-market-lead-the-way philosophy to Obama's government-led drive toward a digital health care system.

'Not Just About Economics'

Edmund Billings—chief medical officer for Medsphere Systems, a leading purveyor of open-source health IT—was the lone representative of the open-source community invited to speak to the certification and adoption work group last week.

He said low-cost, easily adaptable systems such as those based on the Department of Veterans Affairs' VistA EHR system offer an appealing alternative to most of the systems CCHIT certifies.

"A lot of mainstream hospitals and physicians organizations look at these products certified by CCHIT, and they're just too much—too big, too complex, too expensive," Billings said.

"It's clearly not just about economics—something else is going on here when you see only about 2% of the hospitals and doc groups in this country have adopted these systems," Billings said.

Open-source software companies hope the work group's recommendations will lead to wider acceptance of open source.

"We're very optimistic about their posture in regards to how they asked questions and their overall response to the idea of open source," Billings said.

Open source is a catch-all phrase encompassing a philosophy of developing source code for software in an open, accessible manner, essentially creating a public collaboration to design, improve and customize software.

"Open source has grown significantly in other industries but health care has been a little slower to adapt to changes, as it has in so many facets of information technology," Billings said.

The code language that governs open-source software is out in the open and available for change. Proprietary software, in contrast, keeps source code private and unchangeable except by the company that designed and sold it. Most EHR systems certified by CCHIT so far are proprietary systems.

Proponents of open-source software say it is the only way to achieve true interoperability of health information software because only when the source code can be manipulated by users will EHRs be accessible by different software.

HIMSS on Other Side of Issue

On the other side of the certification debate is the Healthcare Information and Management Systems Society, the industry trade group that has been the de facto leader of health IT over the past decade, in accordance with the Bush administration (and to a certain degree, Clinton's as well) let-industry-lead stance. HIMSS was a co-founder of CCHIT and remains its biggest proponent.

In a letter to the Policy Committee work group, the HIMSS Electronic Health Record Association wrote:

"Given time constraints and CCHIT's experience in certifying EHRs, the Association supports CCHIT as the single certifying entity to avoid duplication of effort, unnecessary expense and confusion in the market. To avoid market confusion and enhance consistency, we prefer that there be one single certifying body."

The recommendation to move away from CCHIT's monopoly marks a change in HIMSS' significant influence in the industry.

At the request of David Brailer, the first head of the Office of the National Coordinator for Health IT at HHS, CCHIT was established in 2004 by HIMSS, the American Health Information Management Association and National Alliance for Health Information Technology.

CCHIT, which receives funding through a $7.5 million HHS contract, is run by Mark Leavitt, a former HIMSS executive. Until last year, HIMSS paid Leavitt's salary, according to Internal Revenue Service tax documents. Although CCHIT reimbursed HIMSS, the cozy relationship between the two organizations did not sit well with some members of the Policy Committee and the certification work group.

"One of the loudest messages that kept coming through during those two days (of testimony last week), was a challenge to what was perceived as a conflict of interest with CCHIT's close ties to the industry and being the only certifying body," Billings said.