When urologist John C. Lin of Gilbert, AZ, was shopping for an EHR last year, he wanted a product that had the Certification Commission for Healthcare Information Technology (CCHIT)'s stamp of approval. Because certification costs a lot and "takes a commitment," he says, it implies that a software company will be around for a while. It also means that the product has a set of functions that experts deem desirable in an electronic health system.

Still, certification is only one of a number of criteria he used to evaluate EHRs, stresses Lin, who's happy with the certified Allscripts HealthMatics system he bought in September 2006. For example, he wouldn't look at any company that hadn't been in business for at least six or seven years.

George G. Ellis Jr., an internist in Youngstown, OH, also looked only at certified products when he was searching for an EHR last year. But, unlike Lin, Ellis is very dissatisfied with the integrated EHR and practice management system he purchased. He's been unable to send out any bills since the system was installed in June, and the visit-note templates are so generic that they're practically unusable, he says. To make matters worse, it's hard to customize the templates, so he has to have the vendor do it for him—an extremely time-consuming process.

In fact, CCHIT's imprimatur should be seen as only the first step on the long road to find-ing the right product—a fact that many doctors may not realize. Indeed, EHR certification is so new that most physicians don't know what it means, say observers, yet many of them want certified products because they've been told that it's important. (For more information on what certification means, visit the CCHIT website at http://www.cchit.org/files/CCHITPhysiciansGuide2007.pdf).

As CCHIT raises the bar for certification and branches out into specialty areas, as well as hospital and network certification, its importance will continue to grow. So if you're planning to buy an EHR or upgrade to a better system, you'll need to be familiar with what the Commission is doing and how your peers are reacting to those moves. You'll also need to be aware of other key factors, such as the reputation and integrity of the vendor, the utility of the EHR in a practice of your size and specialty, and the EHR's ability to help with P4P and quality data reporting.

High number of certified vendors raises questions

A private, not-for-profit organization formed by three health IT trade and advocacy associations, CCHIT certified EHRs from 81 vendors in its first certification year, which extended from May 1, 2006 to April 30, 2007. (Certification is good for three years, but vendors have the option of applying for recertification annually.) Overall, the Commission certified products from about 40 percent of the 200 vendors it estimates are in the ambulatory care market.

To Mark Anderson, a Montgomery, TX-based health IT consultant whose firm publishes an annual EHR survey, the large number of certified products indicates that CCHIT's criteria weren't very rigorous. Now, however, CCHIT has made it tougher. Among its new criteria for certification are the ability to send prescriptions and refills to pharmacies electronically and to receive lab results online. As a result, Anderson and other observers doubt that more than 40 vendors will have their products certified during the current certification year.