CCHIT Admits to Being a Marketing Tool and Not Up for Task of ARRA

In a recent post on the CCHIT website, they have the written testimony on electronic health records and “meaningful use” that CCHIT submitted to the NCVHS. Here’s a quote from that written testimony:

During our initial years, certification served as a confidence-booster for providers concerned about buying EHRs that lacked the needed functionality, security, and interoperability. Financial incentives for EHRs then began to emerge, but they pale in comparison to the bold goals and nationwide scale of the Recovery Act.

I love that CCHIT’s noble goals in the beginning were to be a “confidence-booster” for those purchasing an EHR. Sounds like a nice big marketing tool to me. I’m just really happy that they’re finally open to admit that was the goal of the certification. There’s no doubt that CCHIT has done a great job selling itself as a way for doctors to trust their EHR vendor more than they would have otherwise.

It’s just unfortunate, that CCHIT hasn’t done any reporting on how effective their certification has done for those EHR that have certified. You’d hope that having this certification would mean that certified EHR users would have more “functionality, security, and interoperability.” At least for now, I have yet to see any data that confirms this notion. In fact, I hear some noise that it could be the opposite. Possibly why we haven’t seen any of this data?

Now, for the real kicker. Here’s a second part of the statement by CCHIT for the NCVHS:

Certification must step up to fulfill a more strategic role, serving not only to reduce risks, but as a dynamic coupling mechanism between advancing policies and the real-world development, marketing, adoption, and use of health IT.

A noble and important goal. I just personally don’t see any EHR certification being able to achieve that goal.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

10 Comments

  • As far as security and interoperability, CCHIT has had little to no impact, nor do I think they will have any unless changes are made. The market demands will continue to drive these. CCHIT essentially glosses over both subjects with little substance.

    Taken down to its basic element, CCHIT is a simple functional checklist…..one that assumes one size fits all, dismisses the best of breed component and niche vendors, isn’t customer-driven, and as you point out is essentially a marketing tool.

    I cringe when I think of the ingenuity, time, quality, and opportunity lost in developing against this checklist.

  • “Certification” in many different guises has been a hot topic in the software industry for many years, and some of that experience seems directly relevant to CCHIT and healthcare certifications in general.

    In the software industry we certify individuals based on knowledge and experience – e.g., Certified Software Quality Engineer, Project Management Professional. “Certification” of software development organizations is also done – e.g., the Software Engineering Institute’s “Capability Maturity Model” is used to classify software development groups in terms of “process maturity” on a 1 (worst) to 5 (best) scale. ISO also has a software variant. All of the organization focused models are “compliance based” – i.e., they require defined processes and evidence of adherence.

    HOWEVER – none of them actually measure PERFORMANCE – a group can be certified at a high level and deliver very poor quality software – sadly, a common occurrence.

    It appears CCHIT is also compliance based. Has any effort been made to define and apply PERFORMANCE based criteria? e.g., how long does it take to perform a set of common functions using a given system? Is it user-friendly? How does use of a given system impact practitioner or group total overhead costs? (Even if all agree health outcomes improve, cost is and will be a consideration) How reliable are these systems? what is the mean time to failure?

    Defining performance criteria is not easy, but certainly doable – we are beginning to see that emerge in the software industry.

  • John, were you involved in the EMR market in 2006? 500+ EMR packages all very different from the other. CCHIT brought structure to the market – it did provide a level of assurance that the EMR being adopted had “X” functionality; moreover, a 3rd party validated that fact. Physicians aren’t Business Systems evaluators and you had and still have companies selling junk systems. With interoperability now a key component I want to make sure that each system speaks the same language to achieve that goal – standards serve great value in achieving that end. It is obvious from your remarks you don’t see the big picture nor to you understand the scope of this large effort. The Health IT is in it’s baby years – we have a long way to go. CCHIT serves as a guide for adoptors. Contraty to popular believe small practices don’t have a lot of money to repeat this effort; providing assurance and guidance mitigates the risk and ensures the selected CCHIT certified system is more likely to be compatible with future requirements than an non-certified platform. What are you really buying if the platform isn’t certified? don’t small physicians take on greater risk by buying a non-certified platform? will they get any money from ARRA with a non-certified platform – NO!

  • tomf,
    I’ve actually been writing about the EMR industry on this blog since December 2005. I just think it’s funny that you think that CCHIT has done much of anything to help solve the problem of 500 EHR systems. There are still at least over 400 EHR systems to choose from today.

    If you read the other comments above and many of the other posts on this blog, you’ll see that certifying a list of functionality does little to help a doctor avoid having their EMR implementation fail.

    I agree completely that Physicians aren’t business systems evaluators, but I believe that CCHIT does little more than make them think that they are getting a better system even though the reality is that they could be getting a worse system than if they’d searched beyond CCHIT certification.

    I think it’s funny that you suggest that I don’t see the bigger picture. The difference is that the big picture I see is different than the one you see.

    Just imagine the scenario that a small doctors office implements a “certified EHR” which costs them more money than a non-certified EHR. Soon, they find out that the CCHIT certified EHR has lot of features, but which are unusable for that doctors office. CCHIT has admitted that their certification does little to make sure this scenario doesn’t happen. They even have a disclaimer that says as much. In this case, the doctors office have sunk a ton of money into a certified EHR and that supposed EHR stimulus money won’t be showing up at their door either.

    The scenario listed above is very reasonable and could hamper the adoption of EHR more than the EHR stimulus money will help. You’re welcome to see another big picture, but that doesn’t change that there are a number of possible scenarios.

    As far as the ARRA money, I’ve said a number of times that those implementing an EHR in the hopes of ARRA money could be very disappointed. An EHR should be implemented on its own merits and the ARRA money a nice bonus if things work out.

    I do agree with you that the government could help establish some rewards and support some standards of interoperability. I just don’t think CCHIT is the right tool for establishing those standards of interoperability. However, I think if the government doesn’t support the interoperability, no one else will have the motivation to really make healthcare interoperability happen.

  • Hayward,
    Interesting article. Lots of good points, but I have to disagree with you that they’re going to make some large database of health information which can then be sold off to third parties. Certainly some of these SaaS emr companies will do as much. Hopefully it’s disclosed.

    What I do think is a strong possibility (post to follow on this subject) is that the government wants the “meaningful use” data in order to be able to have data to try and fix Medicare and Medicaid. You can take that one to the bank.

  • Glen Tullman is a waste of skin.

    A few months ago in a Bloomberg.com article, reporter Alex Nussbaum quotes Glen Tullman, CEO of Allscripts and CCHIT trustee as saying providers should make the financial commitment to purchase EHRs “to ensure that doctors have some skin in the game.”

    It is no longer enough for doctors just to heal disease, and financial commitments to medical school don’t count because they don’t help Allscripts.

    Another leader of a big business from the 1950s put it this way: “What’s good for GM is good for the country.” Still another earlier leader once said, “Let them eat cake.”

    So let’s take the next step: What is good for Allscripts is good for GM is good for the country. Let’s force all Americans to take out loans to buy lousy cars that they don’t want so that they too will have some skin in the game.

    D. Kellus Pruitt DDS

  • Nice analysis. I think it’s funny that Glen Tullman would say that by implementing an EHR that means the doctors will have some skin in the game. I think by not implementing they are actually saying even more.

  • John, I also like your blog. I’d like to share with you some information that popped up in a Kaiser article today. It reflects some of the issues of your recent posts.
    http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=58548

    The Healthcare Information and Management Systems Society (HIMSS), an organization founded by healthcare IT technology vendors and other stakeholders, is the parent organization of the Certification Commission for Healthcare Information Technology (CCHIT). In fact, CCHIT is presently managed by HIMSS’s former chief medical officer, Mark Leavitt. That’s not all. The Kaiser article points out that until recently, Leavitt was being paid by HIMSS while working for CCHIT. As some of us already openly suspect, the public-private powerhouse called CCHIT certainly sports the architecture of world-class conflict of interest in the Victorian style of the late 19th century.

    Just yesterday, Robert O’Harrow Jr., writing for the Washington Post, said documents show HIMSS asked the Obama administration to require that any electronic health-record equipment receiving stimulus funding be certified by CCHIT – the stakeholders’ bastard progeny.
    http://www.washingtonpost.com/wp-dyn/content/article/2009/05/20/AR2009052003600.html

    Well, O’Harrow actually didn’t use the words, “bastard progeny.”

    HIMSS naturally thinks keeping CCHIT as the steering organization of healthcare IT is a really swell idea, and maintains that ‘meaningful use” of their goods is very, very important in rewarding stimulus money. Yet as significant as the buzz-word sounds, it looks to me like “meaningful use” will be better described as “clicking for cash.”

    The Kaiser article says that Leavitt brushes off the critics of CCHIT as would-be vendors who are angry because they failed certification. Incredible mind, that man.

    Even before I read this article, and the accompanying “In related news” blurb about National Coordinator for Health IT David Blumenthal, I have seen a few things that make me suspect that Blumenthal and CCHIT leaders, specifically Glen Tullman from Allscripts, are probably already viciously, but secretly butting heads. I interpret this real-time history to show that soon, Blumenthal will either hang Leavitt and CCHIT over “meaningful use’ or he will resign in frustration.

    But what do I know. I’m a dentist, not a plumber.

    D. Kellus Pruitt

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