Legislating Health IT: Beware of Land Mines

by Mark Leavitt, MD, PhD on June 8, 2009

A number of people contacted me this weekend about a bill on the floor of the New Jersey legislature which proposes to make the purchase of non-CCHIT Certified products illegal. I want to make a few facts clear, then share some news about our plans going forward in the new environment created by ARRA.

First, I do not believe this is an appropriate use of health IT certification. Our goal, stated in almost every presentation I’ve given, and to which I’ve adhered in my leadership of the Commission, has always been to unlock positive incentives for health IT adoption. Bridges to Excellence provides a role model for integrating health IT into outcome-based, pay for performance incentives. Successfully executed, ARRA might too. But the New Jersey bill is nowhere near that. Making software purchases illegal, like dangerous substances? Let’s “just say no” to that idea.

Second, neither I personally, nor CCHIT as an organization, have lobbied, advocated, sponsored, or had anything to do with that bill. We were unaware of it until it started showing up on listserves Friday. The bill has never been mentioned in any of our Trustee, Commission, or staff meetings.

Third, our Trustees, Commissioners, and Work Group members all serve in a volunteer capacity. They have full-time careers, volunteer for other organizations, and are members of various professional associations like AAFP, AAP, ACP, AHIMA, AMDIS, AMIA, HIMSS, etc. Beyond those connections—which are inherent in any profession or industry—there is no affiliation of CCHIT with any other organization. All volunteers and staff must disclose their conflicts of interest. In the case of staff and volunteer jurors, no connection to any vendor is allowed.

This controversy nicely depicts how the health IT stakes have changed upon entering the political and legislative arena. We’ve been observing, reflecting, and recognizing we need to make some major changes ourselves. Now we’re ready to share our thoughts and plans for your feedback. Watch for a press release soon, and Town Calls to be set up for next week.

{ 3 trackbacks }

CCHIT Town Halls and CCHIT Comments on New Jersey Bill | EMR (EHR) and HIPAA
06.10.09 at 10:23 am
Public CCHIT response to NJ "CCHIT or else" Health IT Bill — HealthFeedr
06.11.09 at 2:06 pm
Health Care. (united health care, universal health care) » Blog Archive » Public CCHIT response to NJ "CCHIT or else" Health IT Bill
06.12.09 at 4:01 am

{ 9 comments… read them below or add one }

1 Sherry Reynolds 06.08.09 at 2:35 pm

Nice reply to an issue many of us followed over the last few days as it moved out of committee on an 11 to 0 vote. Perhaps as a community we have now entered the “storming stage” and will soon start to develop the shared values and norms that are so crucial to the success of complex systems changes like we are engaged in.

I am encouraged by the willingness of organizations like yours that rely on a broad range of volunteer stakeholders to engage the broader community via new social media in almost real time and excited about the possibility of the openness, transparency and inclusion that you are modeling as we bringing more voices to the experts already there.

One concern that was raised on the HIS Talk blog is his relationship to HIMSS “the bill was introduced by Herb Conaway, Jr., a private practice physician, attorney, and Democratic assemblyman from New Jersey, introduces a bill that would make it illegal to sell or use non-CCHIT certified systems in the state. He previously introduced the New Jersey Health Information Technology Promotion Act that appears to mandate EMR use. HIMSS loves him, of course, having given him a 2008 State Advocacy Award and put him on the podium at the annual conference in Chicago. ” I found it interesting that his own practice’s EMR vendor went belly-up, maybe leading him to favor the larger vendors that can afford CCHIT certification fees and who wouldn’t mind seeing a bunch of competitors knocked out of the arena for one reason or another. Thanks to HIStalk reader Chip for the tip.I thought I was getting used to well-intentioned government intrusion into private business, but this idea leaves me speechless.”

As a HIMSS chapter advocate myself, I have never heard this type of legislation discussed nor proposed but here in the other Washington we tend to be pretty independent. I am quite sure that it will not get through the other house but it is important to look under the legislation and identify what the rational is for those who would want to have a bill like this? Clearly part of the motivation for both the bill and CCHIT is that we have had a market failure up until now with EMR vendors failing to provide interoperability.

The key question is where do we go from here to ensure patient centered, affordable, high quality care and how can we use Health IT tools as a tipping point.

2 Marven Leftick MD 06.08.09 at 7:53 pm

This type of legislation is very troubling and worrisome. Some of the characters appearing in print seem to be have ties to each other or to the organizations noted above ie Conaway and HIMSS. I am afraid that the certification and EMR process could be hi-jacked. There is a lot of money involved and there is a rush to spend it to “improve efficiencies and save money”. If this is done in haste and imposed on the general medical community and patient population this could end up a disaster.
We should all be aware and follow the money trail as it is too large to ignore.

3 John Lynn 06.10.09 at 10:29 am

Mark,
I have to give you credit for taking a stand on this issue that might not have been seen as favorable for CCHIT. It’s refreshing to see this type of reaction since I didn’t expect it. I’ve written quite a bit about this bill: http://www.emrandhipaa.com/tag/new-jersey/ I’m glad that you support many of our views about this bill being a horrible idea.

4 Robert J. Porcelli, Ph.D. 06.15.09 at 12:17 pm

I tend to agree with all the above points. But I also believe that whatever is the reasoning behind such a bill (NJ) is based on either faulty thinking or some sub rosa relationship. Such a bill might be the opening swing in the expected fist fight over the trillions of federal dollars that will ultimately be in health care reform and in every corner expect there to be proprietary venodors looking to have their fat fingers in the pie. A place to start is to ensure that these agents have no part in the decision making process and that final outcomes, from “meaningful use” to “certification,” are based on the best interest of the American public, their health care, and their health care providers and not in the interest of profit and/or political or financial agendas.

5 Chris Bickford 06.16.09 at 1:53 pm

Dear Mark,

Things are definitely heating up. This legislation should garner substantial
press coverage. If it got out of committee or passed then we would probably
see MD activism like we haven’t seen since HMO or Medicare in 60s.
I agree with above comments that you seem to be walking these minefields
very effectively so far. I wonder if SGR and other reimbursment issues
will get lost in the EHR and eRxing turmoil..

Thank you for all the time that you have spent on this. I know that you
have been there since the beginning..

cbmd

6 Vishal Gandhi 06.16.09 at 5:39 pm

They are enforcing all the NJ providers to use CCHIT certified products for Financial Management, whereas there are plenty of CCHIT certified products which do not have BILLING SOFTWARE.

The assembly man doesn’t know anything about CCHIT. I would like your office to CONTACT the following ASSEMBLY MAN and explain then that CCHIT is for clinical work-flow management. You do not have anything to do with CLAIMS, BILLING, INSURANCE ELIGIBILITY, ACCOUNTS RECEIVABLES etc.

This will kill our Small Business with 50 employees and we can’t use our own Practice Management program and we would be forced to use some other product and pay thousands of dollars in Licensing.

On one side President OBAMA is trying to create more jobs and here is few politicians who want 50 jobs and many more jobs like that to be lost because they don’t understand the Healthcare Technology.

Moreover how can you force a brand new / young from school doctor to BUY COSTLY EHR product (CERTIFIED) when he doesn’t have money to invest $20000 in just software alone. He would obviously start out with Practice Management or Billing first, streamline his revenue before he invests into any costly EHR product.

7 M J 06.18.09 at 10:59 pm

I am truely proud of you all for standing up against this horible bill.

8 Cathleen 07.05.09 at 5:20 pm

This whole EHR idea seems very costly for the medical provider to implement. I am an MTSO and many of my clients have EHR already in place. However, many of them have several EHR systems within the facility that do not interact with each other. If there is to be a forced standard which sounds like there will be, they are going to have to scrap their current systems and invest in new ones that can be certified and then have to pay a new certification fee periodically. At least that is what I am learning here. If you haven’t seen provider activisim yet, just wait. I can see it coming.

9 Al Borges MD 08.10.09 at 5:21 am

Interesting what will happen to this bill now that CCHIT has been refuted by HHS on 7/16/2009 and replaced by the new “HHS certification” as described by Dr. Kibbe in his most recent column? This should certainly render CCHIT into a deep stupor, a coma, or outright DOA.

URL: http://www.thehealthcareblog.com/the_health_care_blog/2009/08/finally-a-reasonable-plan-for-certification-of-ehr-technologies.html

Al

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