Understanding EHR certification

Selecting an EHR system for your practice involves sorting through vendors touting the certification of their products.

Selecting an EHR system for your practice involves sorting through vendors touting the certification of their products. While certification is extremely important, it does not guarantee that you will get a system that will qualify you for meaningful use incentive dollars, or even that the system will do exactly what it needs to.

Certification is a benchmark that provides a level of confidence regarding specific EHR functions. Not all certifications test the same features or functions, nor do they represent the same bar that the technology must meet.

There are two main types of EHR certification, CCHIT and ONC-ATCB. Think of them like the LSAT or the MCAT; they are both tests, but would assess different aspects of the same person. CCHIT is useful in that it is a more comprehensive test, whereas the ONC-ATCB test is narrowly targeted to the meaningful measures and thus does not test all of the things that an EHR system will need to do to function well in a practice.

Further, ONC-ATCB certifications are open and can be administered by any of the approved testing bodies, whereas the CCHIT certification tests are proprietary and can only be administered by CCHIT. (The CCHIT itself is an approved test administrator for ONC-ATCB standards.)

CCHIT certification. The Certification Commission for Health Information Technology (CCHIT) uses test scripts to evaluate an EHR system's programming code. These scripts have been developed by experts to test whether an EHR system can accomplish tasks that most users expect. The rigor of certifications has increased progressively since 2006, thus it is important to pay attention to the year the product was certified. CCHIT certification may mean the product can perform to a certain level overall, but it does not mean it will qualify a practice to receive meaningful use incentive payments.

ONC-ATCB certification. Office of the National Coordinator for Health Information Technology Authorized Testing and Certification Bodies (ONC-ATCB) certification was developed by the federal government to certify that an EHR system meets the technical requirements needed for a clinician to meet meaningful use criteria. Test scripts are very specific to EHR criteria that qualified clinicians must meet in order to participate in the government incentive program. This type of certification may attest that the product can do specific things for meaningful use, but the product may not be able to do things that you need in your practice.

There are two types of ONC-ATCB certification:

  1. 1. Complete EHR certification means that the EHR product has met all 33 criteria for Stage 1 Meaningful Use.
  2. 2. EHR module certification means that the product meets at least nine of the 33 criteria tested. (This article originally stated in error that only one was needed. However, even if someone is certifying a module for a single function, they must also certify it for privacy and security.)

Some pros and cons regarding both complete EHRs and EHR modules include the following.

Complete EHRs


  • Less hassle with updates/upgrades,
  • Better user interfaces, and
  • Simpler interfacing with labs and hospitals.


  • Less customizable and may not meet the needs of all the clinicians in your office,
  • Can't be used to supplement an existing EHR system that may not have complete EHR certification, and
  • Up-front cost may be higher.

EHR modules


  • More flexible,
  • Allow practices with existing software to add new functionality without changing the rest of the system,
  • Allow purchased certified EHR technology to be mixed with self-developed technology, and
  • May have a lower up-front cost.


  • High level of technical expertise required for assembly of a module-based EHR, and
  • Require purchasers to evaluate the companies offering the technology as well as assemble and interface enough modules to support all meaningful use objectives

Optimally, a practice would want a product that is CCHIT certified for functionality purposes and is also ONC-ATCB certified, both for functionality purposes and to qualify for meaningful use payments. Look into products that qualify for both certifications. You can find out more about CCHIT and ONC-ATCB certification on the AmericanEHR Partners website.