Despite transgressing my blog recently there have been some really interesting comments made on my blog. A couple were so good I think they deserved their own post. Here’s a few of them from my thread about CCHIT Certification.
As many of the doctors and IT people are aware it costs about $37,000 for a IT vendor to get his/her EMR certified by CCHIT. It costs about $200,000 to pass the certification. The certification is version specific.(So if you get an update it does not mean it is still cerfied). It is just a list of 300 items to be passed. It does not have anything about interoperability that is the goal of payers and federal Government. It was paid $2.8 million by Federal Govt and more than $100000 by a California organization to develop this interoperability.
Per Chicago Sun times recently CCHIT aims to be self sustaining by 2008. That means to say the fee will remain the same or may go up. Initially the vendors pay this fee to stay on top of game. They may feel like getting certified due to peer pressure, company XYZ is getting certified, they will get more market share and lock the customers, I should do the same. Ultimately they will pass this on to customers which will be Doctors and Hospitals to pay for these expensive EMRs. The EMRs which are certified do the same functions as non certified EMRs- write the progress notes, view the imported items, write scripts, view old notes, demographics. The process is simple, but CCHIT is glorifying this simple process and charging a hefty money for this. For a doctors office in a day to day practice it means nothing to be certified as taking care of patients is still the same way, spend time with your patient, listen to your patient. Getting certified will no way improve the care of patient and the doctor has to use his/her due deligence as it always has been.
In these days of diminishing office reimbursements, where EMR is supposed to make it easier to document and serve patients, CCHIT is a unwelcome intrusion between IT vendors (read EMRupdate.com-CCHIT discussions) and doctors. It does nothing to serve the patients.
Ask any doctor if the HIPPA transaction standards implemented a few years ago did anything to improve the patient care. All it did was that many offices had to do buy new softwares that met the HIPPA guidelines, the remimbursements for doctors services and time remained the same. The same will happen with CCHIT certification too. Doctors and Hospitals need to open up the eyes as they are the ones paying for this ultimately without improving the care of patient. Duplication of tests is what everybody talks about. Certification by CCHIT will not eliminiate the duplication of tests. Doctor and offices being deligent in ordering tests, getting old records and reveiwing them is what will avoid duplicate tests. There are other ways of getting the results to doctors appropriately that need to worked upon at different levels, getting CCHIT certification will not make that problem go away.
I spoke with lab chief at our local hospital, interfaces built between lab computers and EMRs fail at times as somebody made a mistake in the middle initial or forgot a character in the name of patient. This will be rejected. The only way of tackling those is to manually go and fix those. Getting a CCHIT certified product will not make that go away.
Ultimately if this is widely adopted, the following will happen
1. The ones who are already using EMRS willbe forced to buy expensive EMRs, with organizations like ACP, AMA etc just stading as a innocent bystanders, not doing anything to avoid this unnecessary waste of precious resources.
2. With reports of just 15-20% usage of EMRS in US, the adoption will be slowed as doctors will want to wait till the uncertainity settles.
3. The ones who get certified will have support problems-if they gain market share and sign up more doctors. Doctors who get those certified ones already have to sign a contract with EMR vendor agreeing to pay for legal expenses of EMR vendor if the relationship sours and doctor has to file a suit against the EMR company. So doctors office will be at the mercy of EMR vendor if there is no support. So I caution doctors to read the contract carefully before signing any new contract with Certified EMRs.
We have been running a paperless office successfully for more than 2 yrs using a small vendor EMR and so are many others. CCHIT has created an unncecessary burden in successful implementation of paperless office- a goal of many doctors who toil day in and out to take care of patients and EMR vendors who aim to keep costs down. CCHIT will stiffle innovation and kill competition
Alberto Borges MD commented:
The following forces will drive physicians away from HIT:
1) Any process, s.a. CCHIT that will increase the overhead of vendors will ultimately increase EMR prices.
2) Insurance intervention with pay for performance schemes to decrease physician incomes will also dampen physician use of EMRs.
3) I firmly believe that CCHIT was invented by HIMSS to eliminate the competition from small to medium sized vendors. This decreased competition will result in increased prices.
Great blog, BTW.