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The HIT Realist Column
The End of CCHIT?

August, 2009

In 2005 David Winn, MD, the CEO of e-MDs wrote about his experience as a “volunteer” to the Certification Commission for Healthcare Information Technology (CCHIT). He warned the public about how CCHIT would shake up the world of health information technology (HIT), specifically the electronic medical record (EMR). CCHIT would be a mechanism by which “enterprise” EMR companies would diminish competition. I agreed that CCHIT was wrong and that it would fail. At the time most people disagreed with these sentiments.1,2

In October 2005 CCHIT was awarded a three-year, $7.5 million contract from the Department of Health and Human Services (HHS). In 5/25/2006 Dr. Mark Leavitt announced that CCHIT would begin certifying EMR software systems that summer. On 10/27/2006 CCHIT received a “stamp of approval” by the HHS in a government/private company partnership to certify that HIT products meet base line requirements for functionality, interoperability and security. Numerous complaints about CCHIT were sent to the FTC, and a letter writing campaign to public officials was initiated. Non-CCHIT-certified EMR vendors and interested parties tried to form a lobbying block called SHOVEL. All of these efforts were unsuccessful. The year 2006 ended with CCHIT still in high spirits, flush with cash and with the eventual support of over 100 vendors who paid $28000.00 each to certify their EMRs.3,4,5,6

On May 11, 2007 the IRS announced the relaxation of the “Stark” rules, allowing hospitals to help physicians fund CCHIT certified EHR systems (c-EHRs). Not only was certification now necessary for vendors to compete, but having close ties to hospitals was also a requirement, favoring only a handful of the largest c-EHR companies.7

The first crack in CCHIT’s rapid expansion and success came on 9/26/2007 when a House committee unsuccessfully considered changing from CCHIT to the National Institute of Standards and Technology (NIST). On 10/31/2007 the CDC biennial report published a 2-year study confirming that certified EMR (c-EHR) growth had statistically remained stagnant while “basic” EMR use continued to grow to almost 30% of physician marketplace.8

The year 2008 was not good to CCHIT. Throughout the Internet powerful blog sites questioned the necessity of a certification process that was stifling competition and increasing EMR costs. CCHIT failed to deliver on the main goal of interoperability. The certification year 2008 ended with the number of new EHR vendors participating in the CCHIT certification process to a new low- 72. The initial HHS contract ran out on 9/30/2008, but an extension of $1.4 million was awarded to keep it running through 2009.9,10

In 2009 came the passage of the HITECH Act, but although some sort of certification was needed, CCHIT was not being considered as part of the process. In the February 2009 Wall Street Journal Health Blog posters referred to CCHIT as “bogus”, “circus”, “defunct 501(c) 3 status”, and “involuntarily dissolved”. On 7/16/2009 ONC's Health IT Policy Committee finally released their recommendations on what is now referred to as "HHS Certification.” Dr. David Kibbe provided an important quote from this committee in his recent column:

"HHS Certification means that a system is able to achieve government requirements for security, privacy, and interoperability, and that the system would enable the Meaningful Use results that the government expects...[but] is not intended to be viewed as a 'seal of approval' or an indication of the benefits of one system over another."11,12,13

            So the HHS has finally, openly divorced itself from its association CCHIT, relegating it to the long list of the many organizations that have tried unsuccessfully to become “the” HIT standard.14

What will become of CCHIT now?

            In the short-term several vendors will continue to seek CCHIT certification as a marketing ploy, but unless it finds a new mission, it will become irrelevant and will “die on the vine” over the next 1-2 years.

What will be the new problems facing physicians and vendors regarding HIT?

There remain numerous issues, including:

  1. The exact nature of “ONC certification” needs to be detailed, and made to be an instrument to help, not hinder the physicians-patient visit.

  2. The use of penalties for non-participation in HIT is being used as an excuse for paying doctors less.

  3. The issue of how the use of HIT will actually increase the quality of healthcare remains unproven in good prospective, randomized, 2 arm trials using paper/EMR vs. c-EHR, and the few good studies have shown mixed or negative results.

  4. The need to focus on how c-EHR allows for patient safety and confidentiality.

  5. The real use of “intelligent” HIT mainly is for the use of less trained non-physician providers in a universal healthcare environment.

  6. The use of HIT to turn physicians into highly trained secretaries.

            CCHIT has been a detrimental force to HIT for over 3 years. Its demise will allow the future of HIT in our country to once again grow rapidly in a competitive process that allows physicians, not big government or the insurance industry, to select the best system that suits their everyday healthcare needs.

Al Borges MD

Bibliography

  1. http://www.e-mds.com/about/management.html

  2. http://www.emrupdate.com/forums/t/4013.aspx

  3. http://www.healthcareitnews.com/news/hhs-deems-cchit-recognized-certification-body

  4. http://www.emrupdate.com/forums/p/7165/56115.aspx

  5. http://www.emrupdate.com/forums/p/7195/56268.aspx#56268

  6. http://www.emrupdate.com/forums/p/5326/45511.aspx

  7. http://www.informatics-review.com/wiki/index.php/Relaxation_of_Stark_Rules_Explained

  8. http://www.healthcareitnews.com/news/house-considers-new-agency-lead-healthcare-it-standards-development

  9. http://www.cchit.org/products/Ambulatory

  10. http://www.modernhealthcare.com/article/20081120/REG/311209995

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

  12. http://www.emrandhipaa.com/emr-and-hipaa/2009/02/24/cchit-being-thrown-under-the-bus/  

  13. http://blogs.wsj.com/health/2009/02/12/one-other-health-outfit-stung-by-madoff-mayo-clinic/?mod=rss_WSJBlog

  14. http://www.emrupdate.com/forums/p/8530/63273.aspx#63273



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Alberto Borges, MD
Alberto Borges, MD, is in private practice and is an assistant clinical professor of medicine at The George Washington University School of Medicine and Health Sciences in Washington, DC. Check out his website at http://msofficeemrproject.com. The opinions expressed in this blog do not necessarily reflect those of HCPLive. If you like what Dr. Borges has to say, make sure to read his print column of The HIT Realist published in MDNG.

 


 
   

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