BALTIMORE -- A “town hall” meeting of the Certification Commission for Healthcare Information Technology (CCHIT) at the annual Towards the Electronic Patient Record (TEPR) conference here this week turned into a shouting match at times, as small health-IT vendors were not shy about voicing their displeasure with the new program to certify ambulatory electronic health records (EHRs).

Joe Byers, a vice president of Juno Beach, Fla.-based Document Storage Systems (DSS), vociferously argued that the certification program now in place will accelerate consolidation, leading to small companies like his being swallowed up by a handful of large vendors.

When reminded that the testing was voluntary, Byers complained that no one would buy a product without a CCHIT seal of approval. Indeed, commission member Robert Tennant, government affairs manager of the Medical Group Management Association (MGMA), said, “Our members will be looking for certification.”

Small vendors were particularly upset about Tennant’s statement that forthcoming exemptions to Medicare anti-kickback regulations and the Stark rules on physician self-referral to allow hospitals and healthcare systems to supply health-IT to affiliated doctors likely require EHRs to have CCHIT certification.

If the Stark exemption includes such a requirement, “That is, in effect, federal law,” said Bill Sivill, a health-IT consultant at the meeting. “You are the tail wagging the dog.”

Department of Health and Human Services (HHS) officials are not commenting on the content of the final rules, which are due out at any time. However, the American Health Information Community (AHIC) advisory board on May 16 recommended that HHS accept the certification process. CCHIT has a three-year, $2.7 million HHS contract to create and administer a certification program for commercial EHR products.

The commission published the new ambulatory EHR standards May 1 and took applications May 3-12 (see http://www.health-itworld.com/newsletters/2006/05/02/19877?page%3aint=-1). Commission chairman Mark Leavitt, M.D., said that his staff received more than two dozen applications during the 10-day window and that about 175 people applied to be testing jurors.

Certification testing for 2006 costs $28,000, regardless of the size of the vendor seeking approval. Of that, $23,200 goes to the actual testing process and $4,800 is the annual fee to maintain certification. Vendors may use a certification for up to three years as long as they pay the annual maintenance fee, though they may choose to re-test annually to get a current-year certification stamp.

The cost and the renewal process were key targets of vendor ire. Several vendors promised that they will raise their prices if they have to pay the $28,000 testing fee. They also worried about spending money for a full re-testing next year so as not to appear that their products were out of date with a 2006 sticker in 2007.

Leavitt tried to assuage concerns by saying that certification will help business. “If you don’t see an acceleration in the [EHR] market, then we’ve failed,” he said.

Leavitt said that feedback from the health-IT community is causing him to think about how the recertification process will work starting next year. The commission plans on revising its standards annually. Still to be determined is how much testing will be required for a 2006-certified vendor to meet updated criteria in 2007.

Leavitt added that fees could come down in subsequent years, but that depends on future funding for the commission.