Last Thursday, July 16th, the ONC Policy Committee accepted recommendations for an updated definition of "meaningful use". The major revisions include an extension for incentive funds eligibility (under the new "adoption year" scheme) and a requirement that 10% of orders be entered via CPOE. However, much confusion still festers over the how's, why's, and when's of CCHIT EHR certification. Worryingly absent were any new requirements to include certification of open source, or in-house EHR systems.

Among the HIT Policy Committee's many recommendations in the wake of the expanded "meaningful use" definition was to "Expand Certification to include a range of software sources: Open source, self-developed, etc.".

Further, the committee recommended a new definition for HHS certification:

HHS Certification means that a system is able to achieve government requirements for security, privacy, and interoperability, and that the system would enable the Meaningful Use results that the government expects.

HHS Certification is not intended to be viewed as a 'seal of approval' or an indication of the benefits of one system over another.

Their concern, apparently, is that CCHIT currently requires excessive functionalities that are not directly related to showing "meaningful use". Says the report, "...there is too much attention to specific features and functionality".

Enter the open source debate.

There has been much back and forth over the perceived pros and cons of open source, with each side demonizing the other. The cons have negatively stereo typed the open-source developer as working from his basement lair, accountable to no one. The pros have blessed open source as the messiah, pointing to Facebook and Linux, the inevitable end point of all great software development.

Is there any middle ground? Or will CCHIT continue with it's certification monopology?

The fact is, with EHR adoption, one size does not fit all. What works for a 500-bed hospital might not be the best solution for a small physician practice. This must be reflected in the certification criteria, allowing room for both the large-vendor enterprise solutions and smaller, more nimble, open-source solutions.

There needs to be more focus on interoperability and less on extraneous requirements that don't necessarily promote "meaningful use".