Understanding EHR Certification – What is a Modular EHR System?

What do you need to know about EHR Certification in order to select an EHR that is appropriate for use in your practice? How can you ensure that the system you select will allow you to qualify for Meaningful Use federal incentive payments? Should you select a Complete EHR system or a Modular system? These are some of the questions you will need to answer whether you are converting from a paper-based practice or use an existing EHR, but wish to upgrade to a new system.

The Centers for Medicare & Medicaid Services (CMS) Overview of  EHR Incentive Programs provides detailed information on Meaningful Use certification and timelines.

As you embark upon the task of selecting an EHR system for your practice you will quickly be bombarded by EHR vendors telling you what types of certification they have for their product(s).  While this is extremely important information for anyone looking to purchase an EHR system, the numbers and types of certifications and EHR certifiers makes this information difficult to understand.

EHR certifications are important because they are one of the few benchmark measures that provide a level of confidence regarding specific EHR functions that you are paying for.  All EHR certifications do not test the same features or functions nor do they represent the same bar that the technology must meet. There are essentially two main types of EHR certification displayed by EHR companies; one is CCHIT certification, and the other ONC-ATCB certification (Meaningful Use certification).

CCHIT certifications are based upon test scripts that are used to evaluate an EHR system’s programming code. These scripts have been developed by expert workgroups to test whether an EHR system can accomplish the tasks that most users will expect.  However CCHIT has issued several different certifications since they were founded in 2004. CCHIT 2006, CCHIT 2007, CCHIT 2008, CCHIT 2011 for both ambulatory and inpatient EHR systems along with an array of specialty certifications.  The rigor of certifications has increased progressively since 2006. As such it is important to pay attention to the year in which the product was certified.  So, why should you be interested in CCHIT certifications rather than or in addition to ONC-ATCB certification?  Basically, they provide certification of a wider range of functions that you and your practice may need to use on a regular basis and which the ONC-ATCB certification test scripts do not cover. You can find out more about CCHIT certification on AmericanEHR Partners or visit the CCHIT website. An important and potentially confusing factor is that CCHIT is also an ONC-ATCB.

ONC-ATCB certification has been developed by the federal government to certify that an EHR system meets the technical requirements needed for a provider to become a meaningful user of an EHR system. The use of an ONC-ATCB certified product is required to receive any federal government incentive money for the use of an EHR system. The ONC-ATCB certification test script is very specific to EHR criteria that qualified providers must meet in order to participate in the government incentive program. ONC-ATCB criteria do not extend to other EHR functions such as the ability to record notes during a phone call with a patient.  ONC-ATCB certification can be issued by any organization that has been approved by the Office of the National Coordinator for Health Information Technology. View a list of ONC-ATCB certified EHR products.

There are two types of ONC-ATCB certification; one for Complete EHRs and one for EHR Modules.  A Complete EHR certification for Stage 1 Meaningful Use means that the EHR product has met all 33 criteria tested.  Whereas an EHR Module certification means that the product meet at least one of the 33 criteria tested.

These two types of certification were created to allow flexibility for both EHR vendors and Eligible Providers and Hospitals in order to meet the meaningful use requirements.  A provider can use any combination of certified EHR Modules to achieve the same as a Complete EHR and thus qualify for the incentive program.

This flexibility also raises the question of which option is best, a Complete EHR or multiple EHR Modules? The simple answer is that it depends on your type of practice, your practice or hospital’s level of IT support and expertise, and whether you have an existing system in place.

Some generic pros and cons regarding both Complete EHRs and EHR Modules are outlined below:

Pros – Complete EHRs

  • No finger pointing as to which module is not working;
  • Less hassle with software and hardware updates/upgrades;
  • Relatively seamless user interface. (Features within the EHR system work with the same look and feel rather than constantly switching between different programs). An extreme example of a disjointed user interface would be the need to switch between a PC and a Mac computer when charting different parts of a patient note;
  • Simpler to interface with labs and hospitals (Interfaces should not break when the EHR is updated).

Cons – Complete EHRs

  • Less customizable. May not meet the needs of all the providers in your office;
  • Existing EHR system may not have complete EHR certification;
  • Up-front cost may be more expensive.

Pros – EHR Modules

  • More flexible;
  • Can allow practices with existing software to add new functionality without needing to change the rest of the system;
  • Can be a good choice for those who want the flexibility of mixing purchased certified EHR technology with self-developed technology;
  • May have a lower upfront cost.

Cons – EHR Modules

  • A high level of technical expertise may be required in order to assemble a Module-based EHR;
  • Purchasers are responsible for evaluating the companies offering the technology as well as assembling and interfacing a sufficient set of modules to support all meaningful use objectives.

Add your thoughts by clicking on the Comments link below.

This post is the personal opinion of the author and does not necessarily reflect the official policy or position of the American College of Physicians (ACP). ACP does not endorse a specific EHR brand or product and ACP makes no representations, warranties, or assurances as to the accuracy or completeness of the information provided herein.


4 responses to "Understanding EHR Certification – What is a Modular EHR System?"
  • September 13, 2011
    Abed Ali

    Great summary of the pros and cons…I’m trying to learn more about this option. Does anyone know what percent of physicians using EHR have used the modularization option?

  • September 13, 2011
    Alan Brookstone, MD

    Abed, it is very difficult to determine this data. The majority of physicians appear to be selecting the complete EHR certification option. Assembling modular components requires a greater level of expertise and at this time, I am unaware of the percentages. This is an area that we are looking at through AmericanEHR as users provide feedback and satisfaction ratings on their systems, but we do not have sufficient data to present at this time.

  • September 13, 2011
    Abed Ali

    Thanks so much for the response Dr. Brookstone. Another question, should you have the time: how large are the federal incentive payments for meaningful use of certified EHR systems?

  • September 13, 2011
    Alan Brookstone, MD

    Take a look at the following section on AmericanEHR. There are links to a number of resources on Meaningful Use incentives.


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