Bush's order: the end for non-certified systems?

Most media coverage of President Bush's executive order of Aug. 22 has focused on the Administration's effort to promote "transparency" in health care. But the order also requires federal agencies and their contracting health care providers, when they acquire or upgrade information systems, to choose ones that can communicate with each another. This interoperability requirement—unaccompanied by funding, of course—may be the beginning of the end for EHRs that aren't certified by the Certification Commission for Health Information Technology (CCHIT).

While no EHRs were tested for interoperability in the first round of certifications, this capability is on CCHIT's "roadmap" for next year. Moreover, Health and Human Services Secretary Mike Leavitt has stated that his department would view certification as a proxy for interoperability. This is important because, under the recently announced changes in the Stark rules, the EHRs that hospitals can help physicians acquire have to be interoperable.

Erica Drazen, a Boston-based consultant with the First Consulting Group, regards this part of the executive order as the government's attempt to reinforce the importance of CCHIT certification. "They want to prevent people from selling products that are specifically designed not to interoperate, which is what the standards prevent you from doing."

Janet Marchibroda, CEO of the e-Health Initiative, a Washington, DC-based organization that promotes health information technology, notes that no systems have yet been certified in this area. But she predicts, "At some point in the future, certification will mean interoperability."

Overall, Marchibroda says, Bush's order "will further accelerate the use of standards in healthcare IT. It symbolically says, 'We're going to move towards standards-based health care systems, and we're going to put the government's buying power behind that.'" This will not only encourage the adoption of EHRs, she avers, but will also benefit the regional health information organizations that are starting up across the country.