Whole or Part EHR to Meet Meaningful Use?

When is Certification not Certification?

The issue of what makes up complete certified EHR technology continues to amuse and confuse Eligible Professionals and Eligible Hospitals. Simply put, the issue stems from the fact that all the modules that make up a Certified Complete EHR do not inherit the certification once they are broken out by a vendor to sell or license separately. For those modules to become certified they must be taken separately through the process with an ONC-ATCB. Bill O’Toole, founder of the O’Toole Law Group  has posted a good review in this issue at HIStalk.

In the past 24 hours I have been asked the following question by two different vendors: “If a customer has my Complete Certified EHR, but doesn’t use parts of it for meaningful use and instead uses another vendor’s certified module, are they at risk for not receiving incentives?” So let’s at least answer that question once and for all. Based on CMS guidance below that scenario is fine and meets the definition of certified technology from the standpoint of the CMS EHR Incentives.

Question [9-10-014-1]: I’ve selected a certified Complete EHR [or certified EHR Module] from EHR technology developer XYZ. That being said, I prefer the certified CPOE EHR Module designed by EHR technology developer ABC over the CPOE capability included in EHR technology developer XYZ’s Complete EHR. Can I use the certified CPOE EHR Module from EHR technology developer ABC instead of the CPOE capability included in EHR technology developer XYZ’s certified Complete EHR? Alternatively, can I use both of the certified CPOE capabilities included in EHR technology developer XYZ and ABC’s EHR technologies at the same time? In other words, can I use duplicative or overlapping certified capabilities of different certified EHR technologies without jeopardizing my ability to meaningfully use Certified EHR Technology?

Answer: Meeting the definition of Certified EHR Technology can be achieved in numerous ways; including using EHR technologies that perform duplicative or overlapping capabilities (if that is what an eligible health care provider chooses to do) so long as all of the applicable certification criteria adopted by the Secretary have been met and those EHR technologies are certified. Consequently, an eligible health care provider could use both certified capabilities (e.g., CPOE) at the same time in two different sections/departments of its organization. The eligible health care provider would however be responsible for reconciling the data between those two certified capabilities for purposes of reporting to CMS or the States. Eligible health care providers who take such an approach should use ONC’s “Certified HIT Products List (CHPL)” webpage to generate a unique certification combination identification in order to accurately attest to CMS or the States the aggregate of certified EHR technologies used during the EHR reporting period.

Question [12-10-021-1]: What does it mean to “possess” Certified EHR Technology as discussed in FAQ 9-10-017 and can I still possess Certified EHR Technology without implementing or using a capability it includes?

Answer: In the first version of FAQ 9-10-017, the “question” asked whether eligible health care providers needed to “implement all of the applicable capabilities specified in the adopted certification criteria regardless of whether [they] intend to use all of those capabilities to qualify for [an] EHR incentive payment.” We did not directly address the term “implement” in our “answer” to the first version of this question. Rather, we stated at the end of our “answer,” consistent with our usage throughout our regulations, that in order to possess EHR technology that meets the definition of Certified EHR Technology, it must be tested and certified by an ONC-ATCB to all applicable certification criteria adopted by the Secretary. Since the publication of our “answer” to the first version of this question, we received more questions expressing confusion about what is required to meet the definition of Certified EHR Technology and whether the certified EHR technology in an eligible health care provider’s possession must be implemented or used in order for the definition to be met. We consider “possession” of Certified EHR Technology to be either the physical possession of medium on which a certified Complete EHR or combination of certified EHR Modules resides, or a legally enforceable right by an eligible health care provider to access and use, at its discretion, the capabilities a certified Complete EHR or combination of certified EHR Modules includes. An eligible health care provider may determine the extent to which it will implement or use these capabilities, which will not affect the provider’s “possession” of Certified EHR Technology. While we recognize that eligible health care providers may enter into various business arrangements depending on their particular needs and circumstances, we would expect that such arrangements could potentially include agreements with EHR technology developer(s) to access and use the capabilities included in Certified EHR Technology. Further, that these business arrangements could make an eligible health care provider’s payment for a particular capability contingent on its use or implementation of that capability in a production environment or the provider’s request for maintenance or technical support. If an eligible health care provider has sought testing and certification for its own “self-developed” EHR technology, we would presume that such EHR technology would be in the provider’s possession because it would possess the physical medium on which a certified Complete EHR or combination of certified EHR Modules resides.

Jim Tate is a nationally recognized expert on the CMS EHR Incentive Program, certified technology and meaningful use and author of The Incentive Roadmap® The Meaningful Use of Certified Technology: Stage 1.