09 HIE Certification Application

Welcome!

Welcome to the CCHIT Certified® 09 Program. This online application is used to apply for the CCHIT Certified Health Information Exchange (HIE) 09 program. The application deadline has been extended. Please contact CCHIT for the new timeline. If you have any questions regarding the CCHIT Certified 09 programs, please refer to the CCHIT Handbook on our public web site at www.CCHIT.org.

If during the entry of information you wish to save your information and resume at a later date, please click the “Save my Progress and Resume Later” link at the top right of the page. You can then resume your previously saved session at a later date to resume entry.

Once you have completed entry of all required information, click the “Submit” button. A confirmation page will appear. Please carefully review all entries and revise if necessary. Clicking the “Confirm” button submits your application. After confirming, you cannot change any information on the form.

Once your application has been accepted, you will receive a confirmation email describing the next steps.

Who is Eligible to Apply

CCHIT certification will be offered to organizations that are legally responsible for the oversight, management, and delivery of services for the exchange of health information. These organizations may contract with third parties to provide the software, hardware, network, and actual exchange services.

Whether the applicant organization provides services directly or through 3rd parties the applicant is responsible for demonstrating compliance with the certification criteria, making certification payments, coordinating with CCHIT on the submission of documentation, live testing, and ongoing reporting and attestation of continued compliance with certification criteria. At this point in time CCHIT is not certifying organizations that provide software, hardware, network, and other services to health information exchanges.

Applicant and Contact Information

Applicant and Contact Information is used for publishing your information in the CCHIT Directory of Certified HIEs, and for contacting you regarding maintenance and support for your Certification.

Applicant Information

Organization Name: *

Enter the name of the 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:

Technical Contact

First Name: *

Technical Contact is the person who will be responsible for interfacing the transaction testing tools to your HIE network.

Last Name: *

Title:

Email: *

Telephone: *

Fax:

Street:

Enter mailing address (if different than Organization address)

City:

State

Zip Code:

Certification Information

Selecting HIE Certification Options

HIE Certification requires the Security test component, plus at least one of these transaction test components:

HL7 2.5.1. (HITSP/C35/C36) Lab Result Transaction (available now)
CCD (HITSP/C32) Patient Summary Document Transaction (available Apr 09)
CDA R2 (HITSP/C35/C37) Lab Report Document Transaction (available Apr 09)

You can apply or pre-apply for more than one of these transaction components. Your certification listing will indicate all of the transaction components you receive.

Because the C32 and C37 transaction test components are not yet available, you can only apply for Security and the C36 transaction now. You can, however, pre-apply for the C32 and C37 transactions. For any pre-applied certification transaction options, please indicate the approximate timeframe you request your testing to occur.

Certification Options - Apply Now


	Option	Availability
	Security Testing (Required)	Available Now (Payment due now)
HL7 2.5.1 (HITSP/C35/C36) Lab Result Transaction	Available Now (Payment due now)

Certification Options - Pre-Apply Now for Later Testing


		Option	Estimated Date (when you plan to start testing)
		CCD (HITSP/C32) Patient Summary Document Transaction	(mm/dd/yyyy)
		CDA R2 (HITSP/C35/C37) Lab Report Document Transaction	(mm/dd/yyyy)

Thank you for pre-applying for these options.

When you are ready to finalize scheduling of your Transaction Testing, CCHIT requires a “Supplemental HIE Application Form”, along with the certification fee, to be submitted This “Supplemental HIE Application Form” will be posted on the CCHIT website when each module of transaction testing becomes available.

HIE Information

The information you provide in this section is used to maintain CCHIT Certification records, and to publish an online directory of certified HIEs.

Provide a concise overview of the services provided by your HIE to be published in the CCHIT directory: *

(300 words or less)

Start date of your live data exchanges: *

Number of participants by type of organization


	Hospital	(numerical values only)
	Provider	(numerical values only)
	Laboratory	(numerical values only)
		Enter other participants (type and numerical value)

Volume of Transactions per Year


	Lab Results
	Lab Orders
	Medical Summary Records
	Clinical Messaging
		Enter other transactions (type and number)

HIE Architecture

Centralized Architecture

Data sharing is accomplished through a central document registry managing clinical documents stored in one or more repositories.

Federated (Decentralized) Architecture

Multiple independent databases must be queried to search for all clinical documents associated with a patient. May or may not employ an Master Patient Index (MPI).

Peer-to-Peer

Node systems share processing and storage tasks as equivalent members of the network.

Select one architecture classification that most closely matches the HIE to be tested: * Centralized
Federated
Peer-to-Peer
Other

Describe your other architecture: *

(Describe your other architecture in 100 words or less)

Technical Partners and Products Used to Support HIE Functions

CCHIT’s inspection process requires the applicant to identity all of the key technical partners and products used to achieve compliance with Certification criteria and test scripts.

This information is listed in the CCHIT’s Certified HIE Directory. Refer to the Certification Handbook for more details about this disclosure process, and how you can maintain this information over time.


	Function	Technical Partner and/or Product
	Interface Engine and/or Gateways
	Master Patient Index (MPI), Registry, Record Locator Service (RLS)
	Patient Records, Document Repositories
	Record/Document Viewing, Portal Services
	Hosting and Co-location Services
	Network Communications Equipment and Services
	Systems Administration and Support
	Other (specify function and partner)

Tested Environment

Will you use a separate 'Test environment' implementation of the network for the purposes of the Certification inspection? * YesNo

Describe differences between Test and Production environments

Indicate "none" if no difference between Test and Production environments.

Application Software: *

(Describe differences between Test and Production environments)

Network Architecture: *

(Describe differences between Test and Production environments)

Security: *

(Describe differences between Test and Production environments)

Other:

(Describe differences between Test and Production environments)

Certification Fees and Fee Reduction Grant

CCHIT has limited funds to be used as certification fee reduction grants for both the core security and transaction portions of the inspection process.

Eligibility is limited to tax-exempt not for profit HIEs and is determined on a first come basis. When the grant fund is depleted, fees are full price for all applicants.

	Fees	Fees with Fee Reduction Grant
Security	$20,000	$10,000

Transaction Options
First	$10,000	$9,000
Second	$10,000	$7,000
Third	$10,000	$5,000

Do you want to apply for the Fee Reduction Grant program? * YesNo

Grant Application

Do you attest your organization is an operational HIE organized as a tax-exempt not for profit entity? * YesNo

Do you attest the gross annual revenues (including grants) for your organization are less than $6M? * YesNo

Your answers indicate you are not qualified for the grant program. Please answer "No" to the Fee Reduction Grant application question.

Certification Fees

Application Fees:

Maintenance Fees:

Total Fees: