Obama is smart. His signing of the Health Information Technology for Economic and Clinical Health
(HITECH) Act (as part of the Stimulus package) recognizes the
importance of health IT as the foundation for health care reform and
cost savings. Good data and good consumer experience is a way to drive
a policy consensus when payment reform and health reform come to a vote
on Capitol Hill.
Technology certification and meaningful health
records exchange are the cornerstones of the HITECH Act. Health IT
should be engineered to promote transparency in health care
effectiveness and to reduce regional differences. To achieve this, the
secretary of HHS must ensure that scope of the Certification Commission for Health Information Technology (CCHIT) does not extend beyond hospital health records.
must stimulate reform through systems and services innovation. As with
previous federal actions, such as the the break-up of the AT&T
monopoly, HHS can enable future generations of innovation by excluding
health information exchange and patient-controlled health records from
the domain of CCHIT, big hospital and big vendor interests.
Continuity of Care Record (CCR) formats and Web protocols of Google
Health, Microsoft HealthVault and MedCommons are innovations in
patient-centered, vendor-neutral collaboration. They must be certified
by HHS because they enable low cost software and encourage effective
competition by new and focused healthcare venues that help
Internet-connected consumers to get the best advice and the most
The CCHIT commission has tied its fate to a
tormented system that many business experts decry as a total failure of
competition. To the benefit of mega hospital networks and their mega
software vendors, CCHIT raises costs and bars market entry by
innovative services and the software they need. Where would the
Internet be today if AT&T and a few major companies had been
allowed to control both who can connect and what goes on the wire?
has codified the business strategy of the large established software
vendors – the ones who can afford the "volunteer" labor that came up
with our so-called harmonized standards. The vendor strategy is mainly
to lock-in the doctor by hosting both the clinical data store and the clinical application
needed to use the data. The analogy to old Ma Bell is uncanny– and a
harbinger of bad things that could come. As long as the established EHR
vendors are granted a monopoly on all standards, innovation by both
doctors and patient users of "certified" health records will be
CCHIT also has a direct impact on
innovation through the high costs for certification. Open source
business models depend on volunteers to write and support software
applications. An open source community cannot raise the $50 – 100,000 /
year to achieve and maintain certification.
Aside from seeking a
monopoly on all standards, CCHIT has also seen as its mission to grant
a monopoly to only one standard even when the public and commercial
adoption would argue for at least two alternatives. Even in the face of
requests from its own board members, CCHIT has refused to endorse the
the physician-led CCR clinical summary document standard as an
alternative to the vendor-promoted CCD document standard.
HHS Secretary Sebelius and Head of the White House Office of Health
Reform Nancy-Ann DeParle to support a strategy that will build
consensus and public approval through increased transparency and
citizen participation. CCHIT's scope must be confined to the hospitals
and their "integrated" delivery network vision. Alternate,
de-centralized solutions to health information exchange must be given a
The ASTM-CCR standard
must be allowed as a format for meaningful health information exchange.
To date, all commercial initiative on the Web has gone to CCR and its
continued growth should not be discouraged.
To help solve
daunting privacy problems, lightweight patient-controlled health
information exchange must be allowed as a certifiable alternative.
These Web-standard systems use widely accessible REST, OAuth and OpenID
protocols instead of the expensive and byzantine protocols favored by
Physician concern over the the quality and authenticity
of patient controlled clincal information can be addressed through
current technology. As an alternative to the CCHIT choice, the ASTM-CCR
allows each order, immunization, report and prescription in the summary
document to carry the digital signature of its original author. This
key CCR innovation enables competition with the integrated delivery
model by new, independent and focused venues for care.
health records policy has great leverage over health reform because it
is a non-partisan and low cost intervention that will greatly influence
more critical and expensive choices in the coming years. A policy that
keeps EHR certification separate from health info exchange
certification will avoid a monopoly and yield dividends for generations