The Certification Commission for Healthcare Information Technology said today that Dr. Mark Leavitt will retire as commission chairman in March. He’s been with CCHIT since its founding nearly five years ago.
SEATTLE—Here’s a juicy rumor from the first day of the sixth annual Healthcare Unbound conference: the Office of the National Coordinator for Health Information Technology is planning a July meeting with several people considering starting up certification bodies to compete with the Certification Commission for Healthcare Information Technology.
I say it’s a rumor because I haven’t been able to confirm this information yet. It does make plenty of sense, though. ONC head Dr. David Blumenthal wrote in the New England Journal of Medicine back in March that “many certified EHRs are neither user-friendly nor designed to meet HITECH’s ambitious goal of improving quality and efficiency in the health care system.”
This does not mean that CCHIT will get frozen out of the certification process, just that it shouldn’t come as a surprise if the federal government recognizes more than one certifying entity.
This is something I reported for the new FierceEMR last week: There’s a bill in the New Jersey legislature that would effectively ban the sale and use of health IT products that don’t carry CCHIT certification.
My story got picked up Friday by iHealthBeat, where it quickly became one of the top five most-viewed stories and No. 1 on the list of most e-mailed.
The story even drew a comment from CCHIT Chairman Mark Leavitt, who linked to a post on the commission’s blog. There, I learned from a commenter that the bill made it out of committee on a unanimous vote. That’s an ominous sign. If states start setting their own EMR rules, we’ll be left with 50 different systems of interoperability, few of which would actually interoperate with other. We will have wasted billions of taxpayer money on more silos.
If some of the paranoia about EMRs that I heard Sunday at the American Medical Association annual meeting really is representative of practicing physicians—and not just the protectionist Medical Establishment—this country is in trouble.
Thanks to Jill Rose, editor of Inside Healthcare, for the shout-out in the May issue. This blog was highlighted in the “Blog Watch” section of the print edition, on page 6. Jill excerpted from my April 7 post on the festering controversy about CCHIT and its relationship to HIMSS. I guess the word “pseudononymous” got some attention, even though I now see the more correct word is “pseudonymous.”
This seems to be the week for launching new programs.
A group called the Electronic Healthcare Network Accreditation Commission is going to start accrediting ASPs and other hosted EHR systems. Government Health IT has a story, which asks the obvious question of whether this will compete or complement the efforts of the Certification Commission for Healthcare Information Technology, but doesn’t exactly answer it.
But the big news so far this week is the Markle Foundation has come up with a framework document for discussing and defining “meaningful use,” which is the standards by which providers will qualify for health IT funding under the American Recovery and Reinvestment Act.
I’ve just read open-source advocate Fred Trotter’s blog post regarding the meeting the open-source community had with the Certification Commission for Healthcare Information Technology at HIMSS09. (CCHIT recorded the session and posted the audio and presentation slides here.)
Trotter says he was authorized by some of his colleagues to “go nuclear” and perhaps launch an alternative EHR certification program if CCHIT didn’t listen to their concerns. That was not necessary, he says, because the commission Chairman Mark Leavitt and Director Dennis Wilson gave them a fair hearing and agreed to consider the impact of CCHIT rules on developers of free and open-source software.
The most serious problem for open source seems to be that the true cost of certification is not the actual testing and maintenance fees, but the expense of continually updating products to meet standards that get more stringent each year. Since the whole idea behind open-source is to share code rather than protect it with licensing fees, the first FOSS developer to build to CCHIT standards will effectively be paying the bulk of the certification cost, while competitors will benefit from that investment when the first company releases its source code.
Trotter explains: “Under the current certification model I could wait for ClearHealth Inc. to figure out how to pass the current CCHIT tests, and then republish the changes to the current ClearHealth codebase required to pass CCHIT. ThenI could apply for CCHIT certification with my friendly fork of ClearHealth…. So I would be getting a certification for about 1/10th the price that ClearHealth pays.”
Thus, there is a definite disincentive for ClearHealth to spend big bucks—Trotter estimates $300,000 a year—on creating a product that will pass CCHIT testing.
Some of the comments that follow Trotter’s report then veer into uncharted territory, namely the prospect of self-certification. Since CCHIT makes its testing requirements public, there are those that suggest small vendors should get together and run their own testing program, following CCHIT protocols.
I’m sure there are some small EHR vendors out there telling their customers that their products are just as good as anything that has passed CCHIT testing, but I wonder about both liability and copyright issues. One commenter, Tim Cook, suggests that CCHIT should put together a self-certification affidavit that companies can sign to make sure CCHIT is not held liable for any software faults or resulting medical errors.
This makes me wonder several things:
- Would CCHIT even consider this if it became clear that someone was starting a competing certification program?
- Would more than a fringe group of the EHR customers—hospitals, physician practices and other care providers—want the risk that comes with using a “self-certified” product?
- How much money would vendors save anyway if they’re still updating their products to meet the same standards? Granted, they wouldn’t be paying the testing fees, but the consensus seems to be that the real cost of certification is in the development, not the actual testing.
- And, of course, the biggest question remains, will non-certified EHRs still be eligible for stimulus money?
CHICAGO—For all the ranting and pseudononymous posting going on of late regarding the Certification Commission for Healthcare Information Technology, there hasn’t been a real, cohesive, thoughtful argument that CCHIT critics can hang their hat on. Until now.
This morning, Will Weider, the Candid CIO, wrote a cohesive, thoughtful argument about why the American Recovery and Reinvestment Act makes the current CCHIT mechanism unworkable. “However, assuming CCHIT can determine acceptable EHR functionality is based on the flawed assumption that an EHR is a single purchase from a single commercial vendor. Organizations that have achieved EHR functionality through the use of multiple specialized applications don’t have a certified EHR in the eyes of CCHIT (and therefore in the eyes of the ARRA it appears),” Weider writes.
He makes it clear he’s a fan of CCHIT and places the real blame on the lawmakers who wrote ARRA. (Leave it to Congress to screw up the best intentions.) But this gives us a good, true starting point for a debate on certification. Semi-sane rants do not.
Dear Calvin Jablonski, Rocky Ostrand, Maggiemae Ph.D., or whatever your real name(s) is/are,
As I mentioned a couple of days ago, Mark Leavitt, M.D., Ph.D., chairman of the Certification Commission for Healthcare Information Technology, that organization you love to hate, has agreed to meet with the free and open-source software development community during next month’s HIMSS conference.
Healthcare FOSS guru Fred Trotter and Linux Medical News editor Ignacio Valdes, M.D., are leading the event, Monday, April 6, at 2 p.m. in Room 10d at the Hyatt Regency McCormick Place at 22nd Street and South King Drive in Chicago. Trotter called the encounter “like offering to meet with the Rebel Alliance at the annual Death Star conference,”, but I imagine they intend for things to be civil.
That doesn’t have to be the case. Calvin, Rocky, Maggiemae and your ilk, you are hereby (unofficially) invited to join the festivities and create some fireworks. Unmask yourself or selves and make it more like Luke and Leia finding out the true identity of Darth Vader. Or are you not the evil one? Here’s your chance to prove it.
We await your reply.
The Health IT Media and Blogging Communities
UPDATE 1 a.m. CDT: I just received an e-mail from Trotter informing me that two CCHIT sessions will be Webcast:
Date: Monday, April 6, 2009
Room 10d, Hyatt McCormick Conference Center, Chicago
Session #1 1:00 – 2:00 PM CDT
Interoperability 09 and Beyond: a look at CCHIT’s roadmap for the future
Session #2 2:00 – 3:00 PM CDT
Open Source Forum: a dialogue on certification for open source EHRs
Here is the link to register for the webinar:
After registering you will receive a confirmation email containing
information about joining the webinar. We will also be recording
these sessions, and plan to make the media files available on the web
for later downloads.
You have no excuse to miss it now.
I may be inviting some more venomous comments with this post, but here goes anyway. The Certification Commission for Healthcare Information Technology (CCHIT) announced Monday that the federal economic stimulus legislation has caused the commission to move up its “advanced technology” certification programs for clinical decision support, interoperability, quality and security to 2010 instead of 2011. Because of this new development, CCHIT has pushed back its annual volunteer recruitment period to March 26 through April 20.
Meanwhile, CCHIT Chairman Mark Leavitt, M.D., Ph.D., has agreed to meet with some of its harshest critics, namely open-source software developers, in a session at next month’s HIMSS conference. The meeting, led by Fred Trotter and Linux Medical News editor Ignacio Valdes, M.D., is scheduled for Monday, April 6, at 2 p.m. in Room 10d of the Hyatt Regency McCormick Place in Chicago. Trotter, who calls the encounter “like offering to meet with the Rebel Alliance at the annual Death Star conference,” has more details here.
We may have a definitive account on the recent controversy about the Certification Commission for Healthcare Information Technology and its relationship with the Healthcare Information and Management Systems Society. I sure hope it’s definitive, because it’s a story I wrote for Healthcare IT News—my first byline in that publication after several years of working for a competing publication that’s no longer around.
Having to hew to actual journalistic standards rather than the lawless nature of the blogosphere, I did not name “Calvin Jablonski,” “Rocky Ostrand” or “Maggiemae Ph.D.” in the article because I was unable to confirm those identities. In fact, the Jablonski and Maggiemae comments were so similar in language and tone that I suspect they might be from the same person. I also wonder if “Rocky Ostrand” wasn’t somehow a play on the name of Racquel Orenick, corporate counsel of HIMSS, whom I quoted in the story.
I also left out of the story some of the more incendiary comments from the pseudononymous critic or critic, but included the critiques of those willing to go on the record with their real names.