Electronic Health Record (EHR) information and news

In a guest column on iHealthBeat, CCHIT Chair Mark Leavitt, MD, PhD, offers his opinions on the impact of the American Reinvestment and Recovery Act (ARRA).

While the funds associated with ARRA are garnering the attention, he states, it is the message the investment sends to the health care industry that is even more important:

But more important than the money itself is the message implicitly conveyed along with it. Will incentives be perceived as an intrusive, carrot-and-stick manipulation of health care providers’ business decisions? Or will health care providers interpret ARRA as the correction of a reimbursement anomaly, welcoming the opportunity to modernize their information management and transform the care they deliver.

So how should the health IT community respond? Leavitt calls for trusted leadership and creative solutions to address the issues. He also outlines how CCHIT is changing its certifications to better support the ARRA-fueled transitions in the HIT environment. Finally, he calls upon the HIT community to join the effort:

How ARRA will play out is not up to ONC alone, nor will it be determined by the choice of interoperability standards. The choice lies within the larger health IT community because collectively we set the standards that matter.

For more of Leavitt’s insights on the dynamically changing HIT enviroment, read “Health IT Under ARRA: It’s Not the Money, It’s the Message.”

As we worked to revise our roadmap and plans for CCHIT certification, we attempted to incorporate the feedback we’ve heard from the market—especially in regards to FOSS (free and open source software) in health care.

We unveiled this thinking to the public in our recent Town Calls.

The initial reaction to our proposed “new paths” to CCHIT certification has been positive. For example, Modern Healthcare asked FOSS proponent Fred Trotter for his opinion on the changes to certification. His response?

Fred Trotter, a co-founder of the new Liberty Medical Software Foundation and open-source advocate, said CCHIT had done a good job in developing the new certification pathways. “The new structure is far more compatible with FOSS (free and open-source software) and effectively answered the vast majority of community complaints,” he said in an e-mailed statement.

Stay tuned for more feedback from the call, as well as answers to the questions that arose during the session.

The Certification Commission will be hosting Town Calls this Tuesday (6/16) and Wednesday (6/17) to gather stakeholder input on new paths to certification of electronic health record (EHR) technologies. It is our goal to more rapid, widespread adoption and meaningful use under the American Recovery and Reinvestment Act of 2009 (ARRA). Areas to be explored during the Town Calls include the crosswalk from certification to meaningful use, enhancements to current programs, and new and updated programs to make certification more accessible to a wider variety of EHR technologies, including modular, self-developed, and open source applications.

To attend the town calls:

Tuesday, Jun 16, 2009 1:00 PM (EDT)
“New Paths to Certification: Dialog with the Open Source Community” (LiveMeeting link)
Dial-In Number: (866) 900-5706
Conference ID: 15249954

Wednesday, Jun 17, 2009 11:00 AM (EDT)
“New Paths to Certification” (LiveMeeting link)
Dial-In Number: (866) 900-5706
Conference ID: 15316708

For more information on the calls and instructions on using LiveMeeting (clients available for Windows/Mac/Linux), please see the CCHIT Town Call page.

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.

Health Data Management points to the growing list of CCHIT Certified products that have completed CCHIT Certified 08 Ambulatory EHR testing:

The Certification Commission for Healthcare Information Technology, Chicago, has now certified more than 50 ambulatory electronic health record applications under its 2008 criteria. Since mid-May, CCHIT has certified 10 more applications.

For more, see “More CCHIT Certifications Announced.”

The federal government has issued its proposed plan for establishing regional centers that will help physicians and hospitals choose and install electronic health records (EHRs) and get the most out of them. The target time frame for rolling these centers out is intended to support healthcare providers in time for them to qualify for Medicare EHR adoption incentives in 2011 and 2012, when the dollar amounts are the highest. Both the incentives and the plan for regional support centers are part of the American Recovery and Reinvestment Act (ARRA).

The Office of National Coordinator for Health Information Technology (ONC), which is getting $2 billion to improve the nation’s capability to use EHRs effectively and exchange information between them, has proposed that the goals of the regional centers be to encourage adoption of EHRs by clinicians and hospitals, help them become “meaningful users” according to the definition being developed to qualify for the incentives, and increase the odds that providers will become meaningful users. A significant portion of the centers’ activities will be to furnish individualized, on-site assistance.

This effort underscores the importance of choosing the right EHR system and dedicating the proper time and attention to making the system serve goals of healthcare improvement in the way it’s used. CCHIT encourages physicians to review the ONC plan in the Federal Register, comment on it and stay attuned to its progress in the coming year.

CCHIT final materials from the 09 development cycle and a new Concise Guide to CCHIT Criteria (PDF) are now available. The new guide maps the criteria to the requirements of an ARRA-qualified EHR and highlights the 09 changes.

CCHIT is transitioning its timelines to adapt to the new requirements of ARRA as well as the still-emerging work of ONC and its committees. Instead of immediately launching 09 certification programs, CCHIT submitted the criteria to the HIT Standards Committee for review, and we anticipate some degree of feedback by August 26, 2009. CCHIT will begin accepting applications for 2009-2010 programs as soon as possible after receiving feedback and resolving any gaps.

For more information or to download the materials, visit CCHIT certification materials for 2009-2010.

Mark Leavitt, MD, PhD, sat down with Modern Healthcare for an interview on the Obama administration, ARRA, and the future of CCHIT.

The chairman of the not-for-profit Certification Commission for Healthcare Information Technology is dealing with a lot of uncertainty as his organization institutes changes to conform its testing programs with the requirements of the American Recovery and Reinvestment Act of 2009, known as the stimulus law. In a wide-ranging interview, Leavitt spoke about what CCHIT is doing now and what future role he envisions for the organization under the Obama administration and the IT development structure established by Congress under the stimulus law.

For more, read part one of the Modern Healthcare interview with Mark Leavitt.

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.