Home Forums Discussions General Discussion CCHIT

Any word on CCHIT?

Oh, we can't let this thread just languish without any answers, folks. So, in the spirit of CCHIT, I will resort to one of my favorite websites: http://www.heptune.com/pooppoem.html#Poop Lots of stuff about CCHIT there...

-- Famous presidential CCHIT statement: "Never kick a fresh CCHIT EHR on a hot day." - Harry S Truman
-- What you say to someone who is promoting CCHIT: "You sound like a CCHIT salesman with a mouthful of samples."
-- Now my take on a famous CCHIT poem:

CCHIT Happens
First Version Posted August 20th, 2008 by David Gibbsfreeverse
URL: http://www.everypoet.net/poetry/blogs/david_gibbs/shit_happens

CCHIT happens,
Now and again,
We all get our share,
So let's not pretend.

CCHIT EHRs can vary in size,
CCHIT EHRs can also stink,
But if you buy an expensive c-EHR,
You may end up stuck in thick CCHIT.

If so, hold your head up high,
Pinch your nose,
Meet it head on,
Try to take all the blows.

When the CCHIT hits the fan,
There's a hell of a mess,
But I believe CCHIT will eventually all disappear,
In time, more or less.

Sometimes the CCHIT EHR smell,
Lingers on politically for a while,
But let it not certify HITECH,
For you'd do better eating bile.

CCHIT happens daily,
Not often, but all over this land,
Don't think it's for you,
For it's not so, just understand.

If AC's CCHIT happens to you,
And you're at your wits end,
I'll offer my hand,
And stand by you, friend.

Al

It will be hear soon, and I don't think it will be that bad. The one POSITIVE thing I can see it it should keep everyone heading toward interoperability. Without CCHIT we would be PC/MAC or VHS/BETAMAX when any large Corp had a good bell or whistle and wanted to capture market share.

My vision of the future is lots of small companies making software that does what the Doctors need it to do, and able to share with other specialized software that does what other Doctors need it to do.

Hi Martin:

The problem with HITECH and CCHIT is that there is a "dark side" which involves the powerful lobbying of the "enterprise" EHR vendors who are trying to capture market share at the expense of their smaller competitors. This will lead to higher prices, eventual forced (not simply HITECH cooerced) "significant use" laws, and the reigning in of physicians that see universal health care patients to force them to not only see patients but to work as secretaries with mountains of HIT electronic "paperwork" in order to survive. Forget Medicare (it'll cease to exist after 2017), forget cash patients (in Canada they made seeing cash patients illegal- it'll happen here too), forget HMO/PPO insured patients (these plans will not be able to exist against a massive government run plan).

It's nice that AC is trying to do CCHIT, but I fear it may be too little too late. Right now the EMRs that will reign are already being defined by who surrounds the president:

1) Allscripts (Glen Tullman)
2) Cerner (Nancy-Ann DeParle)
3) GE (David Blumenthal M.D. )
4) Partners HealthCare System (John Glaser)
5) eCW (Thomas Frieden, M.D.)

(read my PPT presentation here or here )

I'm getting excellent backing of my thoughts by the press, as seen in these 2 recent Washington Post articles this week that are also looking into the underlying forces that have propelled HITECH to where it is now:

-- " The Machinery Behind Health-Care Reform "
-- " Group Seeks Sway Over E-Records System "

What- nobody liked my artistic aspirations as a future poet?

Al

Al I absolutely agree about the Darkside of CCHIT, but I am trying to be optimistic in these dark times. I just got off the phone with a close friend who is a DPM, and 80% of his practice is Medi-cal or Medi-Medi. In order to balance the budget in Calif, they simply have announced that Podiatry will no longer be a covered benefit. He is preparing to close his practice.

I don't think we will sit still for the Canadian system, but the Aussie's have a two tier, Public and Private system that may work for us. I still think the individual Dr. will be able to continue to drive the system enough that the big five you listed above will not be able to prevail. (The phrase, "whistling by the graveyard comes to mind!)

For all the criticism and wiseacres about CCHIT, I have yet to see ANYONE provide a REASONABLE ALTERNATAVE to CCHIT as a means of ensuring some degree of UNIFORMITY of standards across the spectrum of electronic health records and the entities they serve:
1) Patients
2) Clinicians
3) Hospitals
4) Labs
5) Pharmacies/Dispensaries

There are not only HUGE COMPETING interest on the User Side but there are also multiple competing interests on the VENDOR side of the table. Each and every vendor tries to make it nearly impossible for a practitioner to transfer his/her data into a different system.

CCHIT may not be perfect, and it will never be; however, it will approximate a standard which in many ways provides an open path for smaller EHR's like AMAZING CHARTS to enter a market where other vendors, who are much better capitalized are playing, and compete.

At least, BECAUSE OF CCHIT, Jon understands EXACTLY what he needs to do with AC to pass certification, as opposed to having to spend time an money setting his own standards and not having the resources to compete.

So people who decry CCHIT, my question always is, would you rather have nothing? Because that NOTHINGNESS will leave you at the mercy of large EHR vendors and no other options but to pay thru the nose.

I agree that CCHIT seems unreasonable to many of us, but it is the first real attempt at standardization and setting goals, standards for an EMR to work towards. The fact that Jon is spending as much money as he is to get this to work indicates that he realizes that you can only stay away for so long.

Alborg, I viewed your presentation and this is what I came away with:

What I did not get from your presentation was:

How do you ensure a minimum feature set and interoperability WITHOUT standards?

From the CCHIT website

Simply stated, To transform that simple statement into successful practice, however, requires:
• A plan to incorporate still-maturing standards for representing, sending
and receiving a wide range of information types, each with a multitude of possible results, values and other content.
• Agreement on uniform ways to put those standards into practice in certifed
EHRs simultaneously.
• A logical sequence of EHR requirements that over time supplies the building
blocks of a solid foundation for sending, receiving and productively using information on a single individual from many different electronic points of origin – the essence of a patient-oriented EHR.
A secure electronic highway for conducting health information exchange (HIE) on a large scale.

I'm sure most of us do not disagree with this premise.

>>> So people who decry CCHIT, my question always is, would you rather have nothing? Because that NOTHINGNESS will leave you at the mercy of large EHR vendors and no other options but to pay thru the nose.

What do you mean by "nothing"? Before CCHIT we had over 400 vendors all with EMR systems made help physicians, all with different preferences to see patients faster and with more efficiency. They were rapidly bringing forth more powerful and less expensive programs brought on by the intense competition. We also had paper systems that have endured the passage of time and which still work to this day for many doctors.

During this time the average survival of patients went from slightly over 50 years of age in the early 19th century to closing in on 80 nowadays. Communication between physicians, hospitals, and other health care entities was progressing with the advent of the fax, and then with the internet. Standard interfaces and standard features were slowly being developed, many through the work of physician programmers. Large off-the-shelf software vendors were putting forth interfaces s.a. the one that comes with MS Access (ODBC). There were also the CCR and the HL7 formats still being developed to this day.

During those bygone years CMS/Medicare worked on their own HIT standards, mostly for billing purposes. It first developed the NSF ("National Standard Format") which worked well until they later came up with the ANSI Standard 837 format. Vendors could hook up to these formats easily and for FREE. There was no "enterprise" vendor involvement that would cause a conflict of interest which would end up with one group of professionals (EMR vendors) wanting to control and abuse another group of professionals (doctors) so as to enrich themselves.

The government also toyed around with a free, still working EMR for the VA Medical Centers that has saved the government big bucks and they claim increased the quality over their paper record system.

Why can't we have that? These initiatives were truly government sponsored and owned, and were free/inexpensive, simple, and effective.

I agree with you, gkfahnbulleh, that most of us would love to have a secure electronic highway. Google and Microsoft are working on versions of communication that can bypass anything that is being done by CCHIT. I don't understand why we can't have a GOTOMYPC or LOGMEIN version open highways. I use LOGMEIN daily and can log in using any browser- s.a. IE or Firefox to my office.

What we don't need is a set of mandated "standards" which are really rules to control the way that a physician practices medicine, to control and ration health care through the use of HIT, and to increase the work load of physicians just to satisfy some pinheads in Washington DC and to enrich the likes of Glen Tullman of Allscripts.

>>> minimum feature set

Let the customers (physicians) determine which features they want and alternatively don't want. I see this being done here on the AC website every day. We don't need HIMSS, big government, insurance companies, some nurses sipping tea around a table, a bunch of academicians making broad stroke speaches, or some EMR salesmen telling doctors how to use some obtuse workflow environment see patients and use an EMR.

Al

Al, the primary purpose behind CCHIT is INTEROPERABILITY. You do not seem to want to ever address that. I will.

Secondly, Programs like LOGMEIN and GOTOMYPC operate on a very basic but expensive premise: that everyone who uses them has at least 2 PCs. Every IT professional WORTH HIS SALT, understands that having a use communicate with the data is the preferred manner of accessing data in a distributed computing environment. I use a program called TeamViewer for remote access FOR SUPPORT, not to do work when I am away from my network. For that I use VPN, and connect directly to my server using 256-bit encryption.

Interoperability is the capability of systems to SHARE AND CONSUME DATA. The operative word here is CONSUME. What do we mean when we talk about consuming data? Right now when you receive lab reports from LabCorp or SonoraQuest, you get a printed document. If AC has an INTERFACE for LabCorp, then AC can bring in the the DATA directly for the patient and integrate is automatically as a part of the patient record. Now why should a small company like AC have to write an INTERFACE FOR LABCORP and an INTERFACE for SonoraQuest? Why not have all labs conform to a single CCHIT standard so that AC, and other small companies only have to write a single LAB INTERFACE.

This same paradigm will work for transferring patient records from one doctor to the next. A PDF is not, repeat, IS NOT data. It is simply an electronic copy of a paper document.

Let me give you another example. Bert has a vaccine program called VIPER. Because CCHIT will DEFINE how ALL EMR's CONSUME this data, if Bert writes VIPER to the standard, all of a sudden his little 2 man company can sell its product to any Pediatrician irrespective of which EMR they use.

So the customers can determine which features they want, however, interoperability requires vendor-independent standards.


It has already been established that MS-Access is not scalable, as such it does not make a good multi-user datastore.


That would stiffle competition, restrict innovation, and be anti-capitalist. One can only imagine the hew and cry from every sector if the government MANDATED that the ONLY EMR physicians could use was a government built system.



Nothing I have read about CCHIT "controls" how a physician practices medicine. CCHIT's goal is to ensure the interoperability of multiple systems from multiple vendors by providing the standards.

Again the reason why you are able to buy ANY TELEPHONE and place a successful phone call to any other phone(land, cell, VOIP) is because there are interoperability standards set by the FCC, to ensure that all phones work in much the same way. Those FCC standards do not TELL YOU WHAT TO SAY during your phone call, neither do they tell you where to place your call from, they simply allow you to call.

In any event please answer the following question:

Look, gkfahnbulleh, let's agree to disagree on certain issues, but let's not turn this into yet another disagreeable argumentative "discussion". What pisses me off the most about your style is how you immediately go for the jugulars and begin to attack your opponent, rather than discuss the topic at hand. Phrases like: "Every IT professional WORTH HIS SALT..." really intend to demean and intimidate your opponents and ends up making yourself look like a jerk, a bully. 'nuff said...

>>> It has already been established that MS-Access is not scalable...

If it has an SQL backend, it could be an excellent front-end platform in a large hospital environment. In a small office, a Jet backend would be not only be workable but inexpensive and easy to program. It still works well in my office. If you end up using the SQL Server Express things would even be even better.

>>> [about the "Vista" VAMC EMR] That would stiffle competition, restrict innovation, and be anti-capitalist...

CCHIT and universal health care would end up forcing folks to use only a handful of EMRs. The British NHS, for example, lets one choose between Cerner and some generic Brit EMR. Same situation is seen in many of the Canadian provinces. If I had to choose between one anti-capitalist schenario or another, I'd choose the free big government route anytime than having the likes of GE act like a big mafia, with uncontrollable EMR inflation due to loss of true competition.

>>> Nothing I have read about CCHIT "controls" how a physician practices medicine.

What Obama and his group of health care pinheads want to do is to mandate the use c-EHR systems to control the way health care is delivered, from patient denial of care to denial of physician payments based on data mining. They want to force all physicians to use eRx, CPOE, etc. through the use of CCHIT c-EHR systems. The catch word of the day now is "significant use", which means that if a physician is to make a profit with Medicare, he/she will have to do all the above using a c-EHR.

>>> CCHIT's goal is to ensure the interoperability of multiple systems from multiple vendors by providing the standards.

I'll discuss CCHIT and interoperability when finally CCHIT c-EHR systems do become inoperable. CCHIT started in 2006, and here we are 3 years later with a bunch of standards most of which have absolutely nothing to do with interoperability. The only really interoperable systems usually are based on one platform, s.a. the VAMC and to some degree, Kaiser.

It is interesting that Kaiser, after installing EPIC at a cost of more than $4 billion is still unable to make their whole program from "sea to shining sea" interoperable. My next article in the MD Net Guide magazine will be on HIT and universal healthcare systems in the USA, BTW. Don't miss it.

CCHIT was formed to "cull the heard" by forcing EMR vendors to pay a large amount of money up front and on-going then making the standards onerous enough to force EMR vendors to exert a vast amount of money in becoming compliant.

By itself, the idea would be a good one, and would have joined the list of many prior health standards that have been lost to obscurity. Then HIMSS got the HHS to go back them up as an "official accreditation agency" and at the same time CMS/MEdicare has been trying to force EMR use by contracting physicians through the use of certified EHR systems (c-EHR) as a way to get paid appropriately. The feeling is that this one-two punch will finally get more than 4% of doctors to buy c-EHR systems.

HHS, a government body is essentially insulating HIMSS, and the CCHIT certification process, to bypass Federal RICO anti-racketeering laws which has resulted in killing off much of the competition. What HIMSS/CCHIT does is no different than a mobster extorting money from businesses which in this case would be vendors to allow them to compete in society.

I discussed this further here:

-- http://www.emrupdate.com/forums/p/7953/60493.aspx
-- http://www.emrupdate.com/forums/p/11551/75582.aspx#75582

>>> How do you suggest ensuring INTEROPERABILITY without a standards body to set the standards?

CMS/Medicare could have simply asked for providers to follow certain medical parameters (eg- smoking cessation, HgbA1c levels, PAP smears, etc) and let it up to the physician to use whatever "tool" (paper, EMR, hybrid system) he wanted to use to deliver the results. They could have set up a simple RIO-like system by which any EMR could hook up to for "interoperability" without having to resort to an "enterprise" level CCHIT c-EHR.

Al

Alborg wrote:


I will bow out of this discussion since we obviously have two DIAMETRICALLY OPPOSITE views of the word INTEROPERABILITY.

>>> we obviously have two DIAMETRICALLY OPPOSITE views of the word INTEROPERABILITY

I don't think so, but so be it. I just hope you don't bow out thinking that CCHIT now offers interoperability. It doesn't. In the past they have looked at the HL7 and CCR, but it's still being worked out. Not that I care... doesn't make HIMSS/CCHIT any less wretched.

On CCHIT we most likely do differ a lot, since you're looking at things from an IT programmer's viewpoint. I, on the other hand, am looking at it as a physician who realizes that this HITECH movement will affect my bottom line. It'll also affect how I'll end up practicing medicine in the last part of my earning career as it comes to a close.

What do I care about interoperability? Not much. It won't improve the speed at which I see patients, it won't put more money in my pocket. Now that CMS/Medicare is in the process of having HIMSS direct the "carrots/sticks" that can be used to force me to buy their own "enterprise" c-EHR products, all I see is that after 2017 if I'm still a Medicare participating physician my payment can decrease by as much as 5%, as dictated by the HIMSS programmer lobbying group.

Have a happy Memorial Day!

Cheers,
Al

Alborg, development of ANY SYSTEMS, Medical Treatment Systems, Software Systems, Technology it is THE EARLY ADOPTERS who pay the highest price. In the development of medical treatment systems, it is very well the test subjects that pay the highest price. They show us WHAT DOES NOT WORK and allow the researcher to figure out the why. Technology is no different.

If you look at this AC board, it is EASY to spot the EARLY ADOPTERS. Those are the people who cut their teeth because of their early adoption of AC, long before it "was proven."

Your statement on EPIC and Kaiser seemed to suggest that the system is a failure, however, a recent article in the Milwaukee Journal Sentinel contained the following:

Addition link:
A Physician’s Experience with Kaiser’s Epic/HealthConnect Rollout By Bernie Tupperman, MD

I would prefer to keep the discussion to CCHIT, instead you continue to throw in red herrings such as "universal health care." When you know full well the two are not tied together, and it is possible to have one without the other.

So you can spend all the time decrying CCHIT as a "criminal enterprise." It is going to happen, and no amount of complaining is going to change that. That process started LONG BEFORE Obama.

I intended to focus on HOW to make it better, as opposing it and leaving nothing in it's wake.

HIMSS is lobbying to make sure that CCHIT is tied to Obama's universal health care dreams. If not CCHIT, the "certifying" body will have pretty much the same outline as CCHIT, or so it's rumored.

>>> So you can spend all the time decrying CCHIT as a "criminal enterprise." It is going to happen, and no amount of complaining is going to change that.

All I'm trying to do is to convince physicians not to buy into HITECH, and if I'm successful, then HITECH will be history. So far, if you read many of the numerous blogs on the 'net, the overall feeling is in agreement with my views, not yours. Having the Washington Post to back me up this past week has been a boon. Same goes for the multiple recent articles in the Wall Street Journal, as well as recent mention of universal health care and EMR on John Beck and O'Reilly. As a columnist in the MD Net Guide (where Jon writes on occasion, BTW), I can reach 250000 physician offices just through their print version which is fantastic.

So this is all like a chess match- Obama has the presidential power, the money, and the ability to promise several billion dollars to physicians (that he doesn't have, BTW). He is hoping that physicians are stupid enough to buy into HITECH. Those like me have the airwaves and the sentiment of the very providers that Obama needs in order to make his mandates successful. I think that we've done a pretty good job at convincing them of the fallacy of the $44000 HITECH award.

Time will tell who will win. I would bet on the bloggers and the columnists... they hold the true power.

Al

BTW, CCHIT is so pase... Not even HITECH mentions it anymore, so arguing about its merits is getting stale. If we are going to discuss HIT, we need to discuss a generic certified EHR (the "c-EHR").

Al

I'm really not able to keep up with all of you about the technicalities of the CCHIT debate, but gkfahnbulleh's comment (above) left me thinking. How could anyone else provide an alternative to CCHIT? Our government has made it the sole arbiter of what is acceptable "interoperability". Why would anyone go out on a limb to try to provide another set of standards? It's as if a group of hospitals decided to decline JCAHO audits and go with a 3rd party. Instant decertification by all government insurances, probably economic failure would follow, or at least a Congressional hearing!

My concern about CCHIT is that it is a single standards organization, not made up by all interested EMR developers. As such, I think it is or will eventually stifle innovation. Other technical standards organizations (I'm thinking of IEEE) has open membership for the individuals & industry organizations it serves, and pushes multiple emerging technologies. Remember how some of us used "draft-N" wireless routers, and most stuck with "g"? What if IEEE told us we could only access the internet with one standard? Who would have ever made or bought a new standard? I think that the technology world is full of such examples, that a cutting edge development, good or bad (think viruses and Trojans), changes the established structure of all the rest. CCHIT is just plain composed in the wrong way to make this happen.

ryanjo,

With respect to IEEE and wireless standards. Within the IEEE draft group, there is an INTEROPERABILITY group, which ensures that Wireless B/G/N routers work together. Amongst router vendors ALL of them SUBSCRIBE to the IEEE Specs or Draft Specs. While IEEE may be an OPEN organization, I do not believe that Johnny-off-the-Street, has the capacity to produce specs, over Cisco, Netgear, Apple, Microsoft and some of the larger vendors, and the only way for a NEW ROUTER COMPANY to break into the market is to FOLLOW the SPECS.

Now how is that different from what CCHIT does

In Every Standards SOME PLAYERS will carry more weight than others.

I don't see the Department of HHS backing the IEEE specs and forcing its use onto the general buying public, threatening penalties if end users decide to buy a non-certified cheaper router.

Big difference there. If 96% of end-users don't want to use c-EHR systems, then it's a sign that they should die on the vine... THAT's how capitalism is supposted to work, not with CCHIT endorsing the losers.

Al

Or develop new specs, that are so compelling that the organization adopts new standards. USB...Firewire...

It's not what it does, it's what it is.

That's it. The whole organization. The IEEE has 300 local IEEE sections, 1,300 technical chapters, and 300 annual IEEE conferences worldwide.

Let's look at the commissioners. " Director, Medical Informatics", "President and Chief Medical Officer", "Senior Program Manager, Intel", " Professor and Assistant Dean, Department of Medicine", "Co-CEO, SureScripts", "Vice President and Chief Medical Officer, Siemens", and so on. Not a single practicing physician, and not even an organization in which the commissioner has regular contact with a practicing physician-user.
Anyone ever asked you to joint CCHIT, submit input, revise standards? Didn't think so. Are we experts -- hell, yes!

By the way, I thought capitalizing words in a discussion was shouting. Are you shouting at us?

ryanjo, No A new company cannot develop new specs. Neither USB nor FireWire were developed by A COMPANY. Both of those standards are managed by Standards bodies:
USB - www.usb.org
Firewire - IEEE (btw, the Official name for Firewire is IEEE 1394)
A new router company wanting to sell it's product would be wise to produce a product that is compatible with the ALREADY EXISTING laptop cards.

No matter "how compelling" the new technology is, if there is no [b]INTEROPERABILITY with existing devices it won't fly.[/b]

No you are the subject matter experts, you are not, repeat you are not the technology experts. Jon is a technology expert, because he has an understanding of developing technology. 95% of the Doctors out there can tell me what they do, that does not make them experts at the development and implementation of the technology.

P.S. I'm not yelling at anyone.

I thought USB was developed by Intel and IEEE 1394 by Apple. In any case, both were incompatible with existing standards for computer peripherals when introduced. If IEEE was like CCHIT, USB & Firewire wouldn't have been "certified", since they weren't "interoperable".

Which is what is wrong with the way CCHIT is working on EMRs. I didn't mean to divert into tech, which is beyond me. But I have concern whether CCHIT's version of compatibility may stifle innovation. The issue is that there isn't enough developer input into CCHIT at different levels to enable this.

I am all in favor of interoperability -- I certainly don't want to buy something that's not going to work with other parts of the system. I just don't think CCHIT, or any government "chartered" organization is the answer. The EMR industry needs to get their act together and develop an inclusive standards body that echos other such industry wide organizations.

ryanjo,

I think if you are able to trust Jon with building AC and you use it to run your practice, you should be able to also trust that he is making the best decision for his customers and his company.

You are not a developer, and neither are you involved in the day to day running of a software enterprise, thus I'm not quite sure where the overarching concern about CCHIT "not working" comes from, other than it is a "government chartered organization," or as Alborg claimed "a criminal enterprise."

The last time I checked, the FCC is a government organization, and it has done an excellent job ensuring that telephones (cellular, land, etc) work very well together.

From Intel's website

From Wiki

Well, this has been an amazing discussion, in that both of us have been able to talk right past each other. That's all from me.

Seems like nobody liked my CCHIT poem...

I liked it. I just refuse to get into this discussion.

Leslie

My original question of when AC will be CCHIT certified did not get answered LOL

Version 5 with CCHIT certification is expected sometime this year (Jon said sometime this summer but...)