CCHIT Certification and "Meaningful Use" of EMRs

Meaningful use is a concept that has emerged as basis for determining whether federal funds can be used to subsidize the purchase of certified EMRs by hospitals. CCHIT has established a presence as the key certifying organization. I must confess that I have not been following CCHIT very closely but my instincts tell me to be very suspicious of any organization that is closely linked to HIMSS. In a previous note, I discussed the role of HIMSS as a trade association (see: HIMSS Describes Itself as a "Trade Association" in a Press Release). HIT blogger Dana Blankenhorn holds the same suspicions regarding CCHIT as he opines in a recent note (see: Will meaningful use go down CCHIT rabbit hole?). Below is an excerpt from his opinion piece with boldface emphasis mine:

CCHIT, a creature of the HIMSS vendor group, currently controls certification of Electronic Medical Record systems, and wants its certification to control meaningful use. It has lined up its allies (including consumer groups) to retain that power. Trouble is, as John Chilmark writes, if HIMSS wins its fight then control over defining health IT passes from the public sector to the private sector, which could use it to define out innovation, as it has in the past. As John Halamka notes, there is a reason why the phrase meaningful use is vague. He predicts, “Each year, the definition of meaningful use will be expanded, setting the bar higher and requiring more features and more data exchange.” That’s important. One thing we can be certain of is that, over time, health IT technology is going to change. If you lock in details now, or if you let some private group define meaningful use in terms favorable to current technology, you lose the chance to adapt to change. Conservatives are constantly harping on the idea that, if regulation is to exist, it must be simple, straightforward, and light. Focus on results, and let the market direct the rest.

Certification and governmental regulation tends to favor the large and powerful incumbent companies in any particular industry. That's why big companies tend to favor such initiatives although one might assume that most of them would oppose market restrictions. These companies have scores of personnel who devote all of their time to meeting certification requirements. The more complicated the criteria the better for them because this makes it more difficult for new entrants in the market. HIMSS functions as a trade association and works closely with its larger industry partners to ensure that any certification scheme inhibits new market entrants. And here's the most insidious part of this strategy. The companies can assert with a straight face that they are working to ensure patient safety and information exchange while protecting their market share. [Applause]

Each year, the large HIT companies in search of new hospital clients, will invest more capital into certification and proportionally less in R&D. Meaningful use will soon be equated with the continuing ossification of EMRs. Less capital will be invested in new functionality for their EMR products because it will become more onerous to "certify" as safe any new features. Recall also that all of the major EMRs are highly proprietary by design in order to lock-in hospital clients so that "information exchange" will require a major and costly rework of them. Information exchange has not been a high priority for most hospital CEOs anyway as I stated in a previous note (see: Differentiating Between RHIOs and HIEs):

The primary goal of hospital executives is to increase their admission rates and they have very little interest in making clinical information more portable for patients. Although clinical belongs to the patients for whom it is generated, hospitals generally view it as proprietary to them. The consequences of the broad sharing of patient clinical information is to enable healthcare consumers to shop around among competing hospitals.

Update on 5/25/2009 at 10:15 p.m.

Mr. HIStalk comments on CCHIT thusly:

The Washington Post follows up its somewhat critical HIMSS piece with another that goes after CCHIT. The title is more exciting than the article: “Group Seeks Sway Over E-Records System — Health Association With Ties to Stimulus Lobbying Effort Pursues an Oversight Role.” All it says is that HIMSS created CCHIT, lobbied for big stimulus dollars, and now recommends CCHIT as the EMR certifying body. “Critics in the health-care industry have expressed concern that the certification commission is too close to information technology and health-care companies to be the best judge of what equipment doctors and hospitals ought to buy. Although the group is funded through a contract with Health and Human Services, it is run by a former HIMSS executive and one trustee also is the president of the trade group. Several board members work for technology vendors.”

Comments

[bev M.D.]

See also The Health Care Blog's recent extensive discussion and commentary on this subject. They echo many of your remarks and I agree with you both.