The Stimulus bill catapulted health IT—previously the domain of clinicians with a passion for applying technology to improve healthcare—onto the national stage. When you inject billions of taxpayer dollars, politics inevitably comes with it. There have been valid observations that CCHIT’s approach needs to change in this new world, and I wholeheartedly agree. But I’m stunned by the level of dishonesty a few have stooped to in a desperate attempt to toss aside years of work by hundreds of public-spirited contributors. Perhaps they want to bypass the challenge of supplying robust electronic health records and re-educating clinicians to use them meaningfully in transforming care, and just get unfettered access to some stimulus dough.
For months, I’ve been “turning the other cheek” to Dr. David Kibbe because I believe in devoting my energy to solving problems rather than to criticizing other people or worrying about what others think of me. But his repeated use of falsehoods and innuendo to attack CCHIT has found an audience in the national media, reaching a level that can no longer be ignored. By implication, he demeans the integrity of everyone who has contributed to that work – and I must rise to their defense.
David, in your most recent quote for the Washington Post, you called CCHIT a “vendor-founded, -funded and -driven organization.” So let’s take a look at the Commissioners, in chronologic order of service, who have served since our founding in 2004—people who have been at the core of an organization you claim to be tainted:
Martin Harris MD, Doug Henley MD (whoops, your boss!), John Hummel, Sam Karp, Charles Kennedy MD, Graham King (vendor), Jane Metzger, Susan Postal, Wes Rishel, John Tooker MD, Reed Tuckson MD, Andy Ury MD (vendor), Abha Agrawal MD, Richard Atkin (vendor), Stephen Badger, David Bates MD, Karen Bell MD, Ned Calonge MD, Jane Delgado PhD, Suzanne Delbanco, Jeff Hillebrand, Chris MacManus, Denni McColm, Susan Miller RN, Jim Morrow MD (signed up with a vendor recently, so stepping down), Jonathan Perlin MD (big trouble — the scandal spreads to the new Standards Committee), Andrea Gelzer MD, Michael Ubl, Andy Wiesenthal MD, Jonathan White (AHRQ apparently in cahoots too), Steve Arnold MD (vendor), Rick Benoit (vendor), Sarah Corley MD (vendor), John Derr RPh, Linda Hogan, PhD, Mike Kappel (vendor), Joy Keeler, Jennifer Laughlin, David Merritt, Rick Ratliff, David Ross ScD, Don Rucker MD (vendor)—I’ll stop here, since those who want more information about our founding, funding, history and leadership have always been able to find it at our website.
Again quoting you in the Post, “even the appearance of a conflict of interest could poison the whole process.” In support of this heartfelt concern for transparency, could you arrange for the Washington Post to append to your statements a disclosure of any possible conflicts of interest you might have? Such as financial relationships with companies that market health IT products or services? I have none. Our standard regarding conflict of interest is the Federal one: any financial compensation, or any stock holdings over $10,000 by you or a family member.
David, the biggest challenges for health care lie ahead for all of us. I hope we’ll see more of your talent invested in creating great new ideas rather than wasting it in this way.
{ 5 comments… read them below or add one }
Mark, glad to see you respond to this article as it has been churning up a lot of discussion. I also wrote recently about the need for the private sector to be involved in health IT system certification and how this is standard in many of the countries leading in the deployment of health IT.
http://www.internetevolution.com/author.asp?section_id=767&doc_id=177110
The first sentence in this post is right on the spot. Enthusiasm of a small percentage of clinicians has been the driver to what has been accomplished in healthcare IT so far, 10% of healthcare providers and 17% of primary physician practices.
The other vast number, over 83%, have been reluctant to get on board with a certified or a non-certified solution.
Years ago the Healthcare IT industry heard their clamor which indicated that for them to invest heavily in an EHR they would only do it if it was certified. Hence the birth of CCHIT.
In order to help those non-enthusiastic and non-technologically inclined folks, certification had been an excellent leverage.
The whole idea of the HIMSS-CCHIT-Vendors conspiracy is ludicrous. And not understanding that each one of them represents critical stakeholder positions in the process falls close to ignorance.
Certification validates functionality, according to pre-defined criteria, that an EHR application if used appropriately it will deliver “Meaningful results”. Certification can not guarantee “Meaningful use” as some of us may concur. The technologically apathetic physicians have to give products that have been certified to deliver “Meaningful results” a “Meaningful use”.
A big problem we have is because we are simply using the “Meaningful use” qualifier and we have allowed the whole process to fall in unsubstantial politicking.
Dr. David Kibbe, what would you do to solve the problem? Do you want to lead a certification organization?
We are listening.
Thanks,
Michael Planchart
There has to be a line of certification, no 2 ways about it so we have software that will work. I think the issue all along has been the cost to be certified and maybe along with the pricing of everything else, drugs for example being pushed to become affordable, perhaps we could see something here?
Certification is almost a run away train, as technology advances are daily and there’s nothing we can do there, except work with it and evaluate to see how it benefits.
Medical devices now with Bluetooth reporting capabilities now complicate things even further too, so do we certify a device for one EMR or EHR? There’s 100s of them out there, and this could represent a lot of time and a lot of code too for the software manufacturers as each determine who their strategic allies are.
In my opinion, it’s better to certify devices through the PHR and then the software companies who create medical records have an easier job of it too. The can be certified to work with a certified PHR, one stop shopping, besides the doctor who only gets 16% of his time today to devote to patient care would appreciate this as there’s no way he can keep up with many device company software offerings to track his patients, so think about that one.
Also, the PHR keeps both the patient and doctor involved and the patient has the authority to say who and where their medical data from a reporting device can be viewed, seen and analyzed.
I have written about this quite extensively on my blog at the Medical Quack too, and perhaps it stands to maybe suggest a shift in paradigms with medical records, devices, certification and the processes that are ever changing to get there.
Mark:
Well put. As one who has lived in the “vendor” world, the FQHC world, the Academic Medical Center world, private practice, and the specialty society world (I was once on the Board of the Society of Teachers of Family Medicine – a sister organization of AAFP) .. I’ve seen this debate from all sides – and I can say with some objectivity that CCHIT is certainly not the vendors’ marionette. Yes – vendors have volunteers on CCHIT working groups – as we should! Yet our views are tempered and aligned with the views of others.
I also share your view that David is a brilliant man – and (like you) I have had my share of disagreements with him. Yet it is through these disagreements that we all learn from each other. I therefore enjoy my occasional interactions with provocative thinkers such as David. We are (let’s hope) all rowing this boat in the same direction.
CCHIT has certainly had its role in sorting out “valid” EMR/EHRs from “vaporware,” and hats off to all those who have worked to develop that certification mechanism. However, my belief is that the bulk of the criteria within CCHIT came from a time when massive, self-contained client/server EMRs were the leading edge, and these criteria may not be appropriate in a web-based, distributed, cloud-oriented world where newer EHR technologies have emerged. CCHIT, to its credit, is trying to modernize its criteria set to “catch up,” but my concern is that it may lag behind (and thus inhibit) technological innovation.
My hope is that CCHIT will become one of several pathways for HITECH “certification.” The new “certification” and “meaningful use” criteria being worked on should be about achieving results, not so much “certification” of a proscribed feature-set.
I have posted a more in-depth blog piece about this on the Practice Fusion blog here
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