Open source healthcare IT solutions have been gaining popularity with the federal government ever since Democratic Representative from California, Pete Stark promoted open source as a low-cost and viable approach to EHRs in a proposed bill back in September. The government has also pointed to the success it has had in making its VA EHR solution, VistA available as Open Source Software (OSS) in helping rural communities implement EHRs. 

More recently West Virginia Democratic Senator, Jay Rockefeller in his proposed Health Information Technology Public Utility Act, echoed the clarion call to OSS for EHR implementation. But OSS has presented a bit of a problem to CCHIT, currently the primary certifying body for EHRs. CCHIT’s current standards do not accommodate OSS based EHRs, which by their very nature are not set in stone solutions, but are often made up of disparate components from different vendors, that constantly evolve to meet user needs. CCHIT has also been criticized for establishing criteria that are more concerned with functionality and “bells and whistles” than practical usability. 

CCHIT has responded to the OSS community and such criticisms by announcing a plan to offer three different pathways to certification, EHR-C, EHR-M, and EHR-S.

EHR-C, or EHR Comprehensive, would provide certification of comprehensive EHR solutions that exceed minimal federal standards. The process for obtaining EHR-C certification is most similar to CCHIT’s current certification process and standards.
EHR-M, or EHR Module will be designed to offer a more flexible option for vendors with EHR products that are tailored to specific medical practices, and therefore may not need nor have all of the functions of an EHR-C system.
EHR-S, or EHR Site, is targeting health providers who create their own EHR systems from a variety of non-certified components. This is the path to certification that is most directly in response to proponents of OSS. 

CCHIT Chair Mark Leavitt believes it was time to offer the three different ways to obtain certification. There were too many members of the EHR marketplace that felt they were being excluded from the ability to gain certification and access to Stimulus money for EHR implementations.

Leavitt added that any component that breaks off from an EHR-M, or EHR-S certified system, will retain that certification. This move has broad appeal to OSS developers, who often change and modify components. Under current certification requirements once they performs such modifications, they have to incur the cost of re-certification.

Perhaps the greatest appeal of the proposal is that gaining CCHIT certification will now be accessible to a much broader base. EHR-C certification will cost a vendor around $50,000.00, about the same as the current CCHIT certification. EHR-M certification however, will only cost from $5000.00 –$35,000.00, and EHR-S certification could be obtained under the proposal for as little as $150.00.