08 EHR Certification Application

Welcome!

Welcome to the CCHIT Certified® 08 Program. This online application is used to apply for any of the CCHIT Certified 08 programs and options.

The application window for the Ambulatory, Inpatient and Emergency Department 08 programs are now open through March 31, 2009. The Ambulatory 08 certification program includes options for additional certification for Child Health and Cardiovascular Medicine. If you have any questions regarding the CCHIT Certified 08 programs, please refer to the CCHIT 08 Certification Handbook on our public web site at www.CCHIT.org.

If during the entry of information in this application process you wish to save your information and resume completion at a later date, please click the “Save my Progress and Resume Later” link located in the top right corner of the page.

Once you have completed entry of all information, click the “Submit” button. A confirmation page will display. Please be sure to carefully review and revise all entries. Click “Confirm” button to submit your application. You will not be able to change any of the information on the form after this step. You will receive a confirmation and next steps via email.

Applicant and Contact Information

Applicant and Contact Information is used for both publishing your product information in the CCHIT directory of Certified EHRs, and contacting you regarding maintenance and support for your Certification.

Applicant Information

Organization Name: *

Enter the name of the company or organization submitting a product for certification.

Organization Address

Street: *

City: *

State: *

Zip Code: *

Primary Contact

First Name: *

Last Name: *

Title:

Email: *

Telephone: *

Fax:

Street:

Enter mailing address (if different than Organization address)

City:

State

Zip Code:

Secondary Contact

First Name: *

Last Name: *

Title:

Email: *

Telephone: *

Fax:

Street:

Enter mailing address (if different than Organization address)

City:

State

Zip Code:

Billing Contact

First Name: *

Last Name: *

Title:

Email: *

Telephone: *

Fax:

Street:

Enter mailing address (if different than Organization address)

City:

State

Zip Code:

Marketing Contact

First Name: *

Last Name: *

Title:

Email: *

Telephone: *

Fax:

Street:

Enter mailing address (if different than Organization address)

City:

State

Zip Code:

Certification Information

Selecting the Type of Certification

The four main types of EHR Certifications are:

Ambulatory
Inpatient
Emergency Department
Enterprise (apply after successful completion of Ambulatory, Inpatient, and Emergency Department Certifications)

There are two options for an Ambulatory EHR Certification:

Child Health
Cardiology

You can apply for these two additional options only if you:

Are applying for a 2008 Ambulatory Certification
Or, have already obtained a 2008 Ambulatory Certification

First, select the main type of EHR Certification (if any). If you have already achieved 2008 Ambulatory Certification, and only want to for additional options then select "Ambulatory Options Only" for your primary EHR certification.

Select any options you want to obtain in conjunction with your Ambulatory EHR Certification: Child HealthCardiology

Select options to obtain for an existing 2008 Ambulatory Certification: * Child HealthCardiology

Total Application Fees:$

Total Maintenance Fees:$

Total Fees:$

e-Prescribing Readiness

You must have basic e-Prescribing transaction certification from SureScripts/RxHub completed, or have a certified 3rd party e-Prescribing product integrated into your EHR, before CCHIT will schedule your inspection. Please be aware the SureScripts/RxHub certification process can take from 1 to 5 months to complete.

Refer to the CCHIT Certification Handbook (http://www.cchit.org/handbook/materials/), or contact us for more information.

Do you have basic e-Prescribing transaction certification from SureScripts/RxHub, or a certified 3rd party e-Prescribing product integrated into your EHR? * Yes
No

Enterprise Certification Readiness

Before applying for an 08 Enterprise Certification you should have already obtained, or have already applied for Ambulatory, Inpatient, and Emergency 08 Certifications.

Refer to the CCHIT Certification Handbook (http://www.cchit.org/handbook/materials/), or contact us for more information.

Have you already received, or applied for Ambulatory, Inpatient and Emergency 08 Certifications? * Yes
No

You should already have obtained, or applied for Ambulatory, Inpatient and Emergency Certifications before applying for an Enterprise certification.

Production or Pre-Market Certification

Production Certification

Select this option if your EHR product is currently used in production environments. CCHIT will verify production use by contacting a reference site.

Pre-Market Conditional Certification

Select this option if you are seeking certification for an EHR product prepared for certification but is not yet installed in a production environment. If this product successfully passes CCHIT Certification, it will receive a conditional CCHIT Certification until its use in a production environment can be validated.

Select if applying for Production or Pre-Market Conditional Certification: * Production
Pre-Market

Commercial or Internal Use

EHR Product Developed for Commercial Use

For CCHIT, a commercial EHR product is one that was developed for the primary purpose of being installed and used in sites other than that of the developer. (Most products seeking CCHIT Certification fall into this category.)

EHR Product Developed for Internal Use

For CCHIT, an internally developed EHR product is one that was primarily developed for a specific organization’s internal use.

Select if EHR product is developed for Commercial or Internal use: * Commercial Use
Internal Use

Single or Joint Applicants

Single Comprehensive Product Application

Choose this option for individual comprehensive EHR products that meet, or can assign, all CCHIT required criteria without the assistance of additional products.

Joint Certification (Single Applicant)

For EHR systems where multiple products from the same Applicant are needed to meet the certification criteria. The Applicant must list here: each product name, version, release/version number and release date.

Joint Certification (Multiple Applicants)

For EHR systems where multiple products are needed to meet the certification criteria and together, multiple Applicants seek joint certification, one Applicant must serve as prime on the application below. Other co-applicants must be also listed.

Select the type of application: * Single Comprehensive Product
Joint Certification (Single Applicant)
Joint Certification (Multiple Applicants)

Product Information

Product Information is used to maintain CCHIT Certification records, and to publish an online directory of certified products.

NOTE: All release dates provided in this section should be the date the specific product seeking certification (product and version number) became available for production use. If the product is pursuing pre-market certification, please indicate the estimated release date.

Product Information

Product Name *

Product Version Number *

Product Release Date *

NOTE: The release date should be the date the specific product seeking certification (product and version number) became available for production use. If the product is pursuing pre-market certification, please indicate the estimated release date.

Primary Product Information

Primary Product Name *

Primary Product Version Number *

Primary Product Release Date *

NOTE: The release date should be the date the specific product seeking certification (product and version number) became available for production use. If the product is pursuing pre-market certification, please indicate the estimated release date.

Additional Product Information

List all the products packaged together under this single application for Certification. Use the "Click here to add product" link to open additional form sections.

Additional Product Company Name *

Enter your product name here.

Additional Product Name *

Name of this additional product

Additional Product Version Number *

Additional Product Release Date *

NOTE: The release date should be the date the specific product seeking certification (product and version number) became available for production use. If the product is pursuing pre-market certification, please indicate the estimated release date.

Click here to add another product

Co-Applicant Product Information

Co-Applicant Company Name *

Enter co-applicant company name here.

Co-Applicant Product Name *

Enter co-applicant product name here.

Co-Applicant Product Version Number *

Co-Applicant Product Release Date *

NOTE: The release date should be the date the specific product seeking certification (product and version number) became available for production use. If the product is pursuing pre-market certification, please indicate the estimated release date.

Reference Site Information

Reference site information is only required for production systems. This information will be used to confirm that the system seeking certification has been in production use at a live site for a minimum of 45 calendar days.

If you cannot supply Reference site information, then go back to the Certification Information section of this form and select "Pre-Market" for the type of certification. Production systems without references are still eligible for Pre-Market Conditional Certification.

Important: For Inpatient Certifications the reference site provided must be using bar code medication administration

Reference Site Name: *

Reference Site Address

Street: *

City: *

State: *

Zip Code: *

Reference Site Contact Name: *

Reference Site Contact Email: *

Reference Site Contact Phone: *

Reference Site Contact Fax:

Reference Site Installation Date: *

Product Configuration Information

The CCHIT inspection process requires the applicant to define the product seeking certification. The applicant must identity all of its components including hardware, software, operating system, communication method, configuration information, delivery model, etc., which are needed to satisfy CCHIT’s certification criteria. CCHIT’s Security Criteria and test scripts require the examination of this information to determine the product’s compliance with CCHIT’s criteria and test scripts.

Product Configuration Information is also used to accurately identify the certified EHR product to purchasers, and is listed in the CCHIT’s Certified Product Directory. Refer to the Certification Handbook for more details about this disclosure process, and how you can list Additional Configurations of your Certified Product. The Product Configuration Information you supply with this application (entered below) should exactly match the configuration to be tested in the inspection process.

Organization Information

CCHIT is collecting the following for program assessment purposes only. CCHIT will manage this information as confidential and will only release this information in aggregate form without company identification.

What are the annual revenues generated by your CCHIT Certified EHR product and its related services? * < $1 million
$1 million to $10 million
$11 million to $20 million
$21 million to $100 million
Greater than $100 million
Not Applicable

Key Company and Product Metrics

Company and Product Metrics are used by CCHIT to create listings in the CCHIT EHR Product Directory, an online resource for buyers of EHR products.

Having your product listed in this catalog is optional, and you have the ability to opt-in or opt-out at any time.

Publish Key Company and Product Metrics

CCHIT publishes a directory of Certified EHR products, with information organized to help purchasers determine which EHR products best match their requirements.

You can choose whether you want this Key Company and Product Metrics information just provided to be published in the directory. You can change this preference later by contacting CCHIT.

Do you want your Key Company and Product Metrics published in the CCHIT EHR Product Directory? * YesNo