The Stimulus bill catapulted health IT – previously the domain of clinicians with a passion for applying technology to improve healthcare – onto the national stage. When you inject billions of taxpayer dollars, politics inevitably comes with it. There have been valid observations that CCHIT’s approach needs to change in this new world, and I wholeheartedly agree. But I’m stunned by the level of dishonesty a few have stooped to in a desperate attempt to toss aside years of work by hundreds of public-spirited contributors. Perhaps they want to bypass the challenge of supplying robust electronic health records and re-educating clinicians to use them meaningfully in transforming care, and just get unfettered access to some stimulus dough.
For months, I’ve been “turning the other cheek” to Dr. David Kibbe because I believe in devoting my energy to solving problems rather than to criticizing other people or worrying about what others think of me. But his repeated use of falsehoods and innuendo to attack CCHIT have found an audience in the national media, reaching a level that can no longer be ignored. By implication, he demeans the integrity of everyone who has contributed to that work – and I must rise to their defense.
David, in your most recent quote for the Washington Post, you called CCHIT a “vendor-founded, -funded and -driven organization.” So let’s take a look at the Commissioners, in chronologic order of service, who have served since our founding in 2004 — people who have been at the core of an organization you claim to be tainted:
Martin Harris MD, Doug Henley MD (whoops, your boss!), John Hummel, Sam Karp, Charles Kennedy MD, Graham King (vendor), Jane Metzger, Susan Postal, Wes Rishel, John Tooker MD, Reed Tuckson MD, Andy Ury MD (vendor), Abha Agrawal MD, Richard Atkin (vendor), Stephen Badger, David Bates MD, Karen Bell MD, Ned Calonge MD, Jane Delgado PhD, Suzanne Delbanco, Jeff Hillebrand, Chris MacManus, Denni McColm, Susan Miller RN, Jim Morrow MD (signed up with a vendor recently, so stepping down), Jonathan Perlin MD (big trouble — the scandal spreads to the new Standards Committee), Andrea Gelzer MD, Michael Ubl, Andy Wiesenthal MD, Jonathan White (AHRQ apparently in cahoots too), Steve Arnold MD (vendor), Rick Benoit (vendor), Sarah Corley MD (vendor), John Derr RPh, Linda Hogan, PhD, Mike Kappel (vendor), Joy Keeler, Jennifer Laughlin, David Merritt, Rick Ratliff, David Ross ScD, Don Rucker MD (vendor) – I’ll stop here, since those who want more information about our founding, funding, history and leadership have always been able to find it at our HYPERLINK “” website. Again quoting you in the Post, “even the appearance of a conflict of interest could poison the whole process.” In support of this heartfelt concern for transparency, could you arrange for the Washington Post to append to your statements a disclosure of any possible conflicts of interest you might have? Such as financial relationships with companies that market health IT products or services? I have none. Our standard regarding conflict of interest is the Federal one: any financial compensation, or any stock holdings over $10,000 by you or a family member. David, the biggest challenges for health care lie ahead for all of us. I hope we’ll see more of your talent invested in creating great new ideas rather than wasting it in this way.
Categories: Uncategorized
Why is gold used in electronic products as a conductor instead of
silver? I believe silver is the better conductor of the two metals,
but sometimes they seem to use gold instead of silver. Could this be
because the electricity passes on the surface of the metal and
silver’s surface is more easily tarnished than that of gold which
doesn’t tarnish? (The tarnished silver surface doesn’t conduct as well
as gold.)
Why improve Healthcare when there are too many people already?
If you were a doctor…..what would you think of a patient who is “mentally ill”?
Here in Texas, there are some hospitals and medical centers that are talking about integrating mental health care and general health. In plain English, this means that if a general hospital pulls up your electronic health record, it will also know if you’ve had mental health treatment. So, if you are “mentally ill” and see your primary care doctor, he/she will know immediately.
What can be a catchy title for this project?
Does electronic devices effect your health?
I believe in record keepng. I should be to one who controls the flow of information. This matter only concerns my doctors and insurance companies, not the
federal government.
“A small software company that caters to primary physicians practices in their community will undoubtly find the cost of entry to market extremely high and almost impossible.”
“Unfortunately, I see CCHIT as a strong arm to deny independent developers the right to continue in this arena.”
Amen.
The software world itself is changing, and if Health IT ever wants to be on the cutting edge, it needs to change too.
Dr. Leavitt, being the chairman of a committee on health IT certification, I can only assume that you have some technical background. Have you noticed that this very blog is hosted on the Apache web server? It’s open source, and the very best web server there is. Given that it was written on zero budget, I wonder where this blog would be if the authors had to pay $30,000 to certify compliance with a standard?
I have nothing wrong with commercial standards certification companies as long as they bill themselves as such. But when Federal money is concerned, and it becomes a national standard, we as Americans have a responsibility to support all innovation, to support the development of the best software possible. And the fact of the matter is, in this day and age (just look at the web, Apache, Mozilla Firefox, Linux, etc. as examples) that innovation may very well come from someone with much less money than a certification costs.
-Jason Antman
Systems Programmer, Rutgers University, NJ
NJ EMT-B.
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I believe the certification process for the EHR should involve more than one certifying body. CCHIT should not be the ultimate certifying body. The price is outrageous! I agree it caters to the larger vendors and leave the door nearly closed for the smaller vendors. Large is not always better. After working with some larger vendors (Epic and Cerner)and then experiencing smaller vendors (StatCom)I was much more impressed as a clinician with the StatCom product and what it had to offer for what it had to offer. Larger vendors tend to have more management than support persons who are intimate with their product.
Electronic Health Records: Why They Won’t Help Patients
The patient is blaringly absent from the health portion of the 2009 Economic Stimulus Act. Billions of dollars have been earmarked by Congress to encourage doctors to create electronic patient health records. But, no where is the focus on sharing the computerized information with patients.
I have supported electronic health records for two decades. In fact, in 1997, I co-authored a book for the Financial Times (UK) entitled “Electronic Patient Records, Smart Cards and Confidentiality.” We wrote:
To provide quality health quality healthcare, medical providers need to know a patient’s complete medical history, have quick access to laboratory and diagnostic test results, and be aware of treatments and medications that have been given or are currently being taken.
Each patient needs personal medical data in hand when they require medical care. So I was happy that my many medical doctors have put information about my health conditions on their computers. I am unhappy that I cannot get access to my medical information electronically.
I asked each of my specialists (7doctors in total) to e-mail my records to me. “Oh no, the HIPPA law prohibits this,” each exclaimed. I offered to sign a release from liability if they would do so, still the answer was no. “Can I read my record?” I asked, and was told that I could not. Some offered to mail me a copy.
Furthermore, I asked them to send my records electronically to my other physicians and hospital based doctors. They answered no, because they did not know if my other doctors’ computers had interoperability with their computer systems.
I know that medical mistakes occur when patients are wrongly diagnosed, patients are prescribed wrong medications and patients are given wrong treatments. Mistakes can be reduced if health providers have the correct information. This can be provided electronically, if the patient can carry a copy her own computerized records.
Should I need emergency care, I want health personnel to immediatly know:
• I have had cardiac bypass surgery and an angioplasty procedure with a medicated stent. Yet, I have no heart damage;
• I am taking a medication that lowers my blood clotting time;
• I have diabetes and that I take specific drugs to keep it under control.
And I want them to know all my information quickly, before treatments are begun. Not after waiting until they hear from my internist’s, cardiologist’s endocrinologist’s and oncologist’s computers.
Therefore, I decided to create my own electronic health record, because I haven’t seen any legislation that focuses on patients’ needs. I will place my information onto a flash drive. I intend to wear this computerized drive around my neck or wrist in order to have my data readily available and accessible. In fact, if I decide to move, like so many of my young colleagues, I can take my record to new doctors.
Now that I have told you of my concerns, I have some constructive suggestions:
1. Amend HIPPA to state clearly that a patient has the right to obtain her own medical record.
2. If the record is computerized, the patient has the right to get the record electronically.
3. Physicians should be required to give the patient a “read only” CD with her pertinent information on completion of a visit.
4. Use state and local health insurance assistance centers to help people create their own electronic medical records.
Eleanor G. Feldbaum, Ph.D.
Co-Founder of http://www.triphealthy.com
(I apologize for the duplicate Comment. It did not show up for quite a long time after I first attempted it. Thank you for your forbearance.)
Reed D. Gelzer, MD, MPH, CHCC
Advocates for Documentation Integrity and Compliance
This has been a fascinating discussion. My (lengthy) nickel’s-worth, donning one of my EHR domain hats, that of a three-year volunteer to CCHIT (and, incidentally, spouse to a past Commissioner) I would disagree with Dr. Leavitt’s assessment of Dr. Kibbe’s remarks in the Post. On the contrary, I found the Post article a helpful “status check” and Dr. Kibbe’s remarks, if somewhat strident, nonetheless reasonable concerns.
However, as I’ve discussed with Dr. Kibbe in other settings, I would also point out that Dr. Kibbe is at least partially in error on a point that seems to be implied, but not stated. In truth, though, he is in good company with this error it is very common in discussions about CCHIT. That implication is that CCHIT was intended, at its origin, to have an overarching charge to serve the public good which is not accurate.
It is much easier to understand, accept, and move forward from the current state of CCHIT if one returns to its actual original functional purpose. That purpose was, in advance of comprehensive EHR Functional Standards (which HHS had tasked to HL7 in 2004), to provide a platform where a subset of stakeholders-payers, vendors, and providers, could establish a process to “normalize” a basic set of EHR functions, a “floor” if you will, for initial, basic qualifications. At that time, HHS was pressing payers to, in some manner, favor EHRs but the payer community reasonably asked, “any EHR?”. The main, if not the only overt public purpose was to also increase interoperability, again as described on CCHIT’s website.
In other words, to fault CCHIT for representing its limited component stakeholders’ interests instead of the broader public good is to hold it to purpose it was never intended to meet. It also then deems a failure what has been its major success. It has, in fact, provided a platform by which those few represented stakeholders have greatly advanced the US towards what the Institute of Medicine’s seminal 1990 Computer Based Patient Record report said would be accomplished by 2000. (So much for EHRs for everyone by date X.)
Now we are simply realizing that the original limited stakeholder configuration has accomplished a given state, but that that state is not acceptable to the entire range of actual stakeholders and is not ready for mass deployment. It isn’t that the objectives reached are flawed, they are simply insufficient, with too many gaps, oversights, and limitations remaining as a direct result of its limited purposes. Once this is understood we can move to the next step and, given the increases in deployments envisioned by the Obama administration, its critical we move to that next step quickly because some existing limitations must be rapidly addressed as they represent such significant risks to the health care enterprise that mass deployment is unconscionable, yet today that is what is being mapped out under HITECH.
So, as Dr. Kibbe and many others, including myself, say, it is now time to assess the state of Certification and to reconfigure the stakeholders and governance to fill in the gaps and better attend to the weaknesses. In effect, the HITECH Policy and Standards Commitees are intended to accomplish this (though their stakeholder composition may raise concerns as well). Whether this necessitates CCHIT’s demise, augmentation, or facilitating competition remains to be seen and will be, fundamentally, a political question. CCHIT has adapted and is undoubtedly capable of further adaptation. Indefensible claims of virtue can suggest a certain lack of adaptability. On the other hand, a recent CCHIT acknowledgment that anti-fraud supports in EHRs are needed speaks for adaptability. Only time will tell. In the meantime, there is zero practical risk that the legacy of work done to date by so many committed volunteers will be discarded. It simply represents too valuable a resource, however insufficient, to wholly discard. Much of it is based on existing standards and stands as is, some will be superseded by updated and new standards, including the newly completed HL7 Records Management and Evidentiary Support Profile, an addition to the HL7 EHR-S Functional Model Standard (itself finally passed in 2007). (That said, I wager we confront the reality that, as of June 2009, there is no such thing as an HL7 EHR Functional Model-adherent EHR.)
Whatever the future configuration of Certification, I would, though, additionally and most strongly caution CCHIT about overstating the comprehensiveness and meaningfulness of its current requirements. For example, at the recent HIMSS convention, updating EHR testing showed that none of the four CCHIT-certified ambulatory EHRs I evaluated produced an accurate record of the test scenario used, with two authors providing different parts of the services in the course of a routine patient visit (a basic requirement in Ambulatory, where commonly there are at least two people contributing to the each encounter record).
The recently passed added accuracy and Compliance supports in 2009 Ambulatory will necessitate the capture multiple authors, but actually producing an output showing accurately which author did did what won’t be required until 2010 by the current schedule (now delayed to align CCHIT with ARRA-HITECH timelines).
Until the 2009 requirements (again not yet in effect), an EHR could obliterate the original version of an amended record and still pass Certification.
(Continued on next Comment)
My apologies, this is a lengthy comment. I hope, though, it will clarify some fundamental points and suggest an approach for concord over discord.
Donning one of my EHR domain hats, that of a three-year volunteer to CCHIT (and, incidentally, spouse to a past Commissioner) I would disagree with Dr. Leavitt’s assessment of Dr. Kibbe’s remarks in the Post. On the contrary, I found the Post article a helpful “status check” and Dr. Kibbe’s remarks, if somewhat strident, nonetheless conveying reasonable concerns.
However, as I’ve discussed with Dr. Kibbe in other settings, I would also point out that Dr. Kibbe is at least partially in error on a point that seems to be implied, but not stated. In truth, though, he is in good company with this error as it is very common in discussions about CCHIT. That implication is that CCHIT was intended, at its origin, to have an overarching charge to serve the public good. This is not accurate.
It is much easier to understand, accept, and move forward from the current state of CCHIT if one returns to its actual original purpose. That purpose was, in advance of comprehensive EHR Functional Standards (which HHS had tasked to HL7 in 2004), to provide a platform where a subset of stakeholders-payers, vendors, and providers, could establish a process to “normalize” a basic set of EHR functions, a “floor” if you will, for initial, basic qualifications. At that time, HHS was pressing payers to, in some manner, favor EHRs but the payer community reasonably asked, “any EHR?”. The main, if not the only overt public purpose was to also increase interoperability, again as described on CCHIT’s website. As a prior commenter notes, it is a fairly basic set of functions, though, as I’ll detail later, not basic enough in some key respects.
In other words, to fault CCHIT for representing its limited component stakeholders’ interests is hold it accountable to a goal it was never intended to meet. It also then deems a failure what has been its major success. It has, in fact, provided a platform by which those few represented stakeholders have greatly advanced the US towards what the Institute of Medicine’s seminal 1990 Computer Based Patient Record report said would be accomplished by 2000. (So much for EHRs for everyone by any date X.)
Now we are simply realizing that, while the original limited stakeholder configuration has accomplished a given state, that state is not acceptable to the entire range of actual stakeholders. It’s not that the objectives reached are fundamentally flawed, they are simply insufficient and too many gaps, oversights, and limitations remain serving the purposes of some, but not all. Some of the existing limitations, though, must be rapidly addressed as they represent such significant risks to the health care enterprise that mass deployment is unconscionable, yet today that is what is being mapped out under HITECH.
So, as Dr. Kibbe and many others, including myself, say, it is now time to assess the state of Certification and to reconfigure the stakeholders and governance to fill in the gaps and better attend to the weaknesses. Whether this necessitates CCHIT’s demise, augmentation, or facilitating competition remains to be seen and will be, fundamentally, a political question. CCHIT has adapted and is undoubtedly capable of further adaptation. Indefensible claims of virtue can suggest a certain lack of adaptability. On the other hand, a recent CCHIT acknowledgment that anti-fraud supports in EHRs are needed speaks for adaptability. Only time will tell. In the meantime, there is zero practical risk that the legacy of work done to date by so many committed volunteers will be discarded. It simply represents too valuable a resource, however insufficient, to wholly discard. Much of it is based on existing standards and stands as is, some will be superseded by updated and new standards, including the newly completed HL7 Records Management and Evidentiary Support Profile, an addition to the HL7 EHR-S Functional Model Standard (itself finally passed in 2007). (That said, I wager we confront the reality that, as of June 2009, there is no such thing as an HL7 EHR Functional Model-adherent EHR.)
I would, though, additionally and most strongly caution CCHIT about overstating the comprehensiveness and meaningfulness of Certification requirements. For example, at the recent HIMSS convention, updating EHR testing showed that none of the four CCHIT-certified ambulatory EHRs I evaluated produced an accurate record of the test scenario used, with two authors providing different parts of the services in the course of a routine patient visit (a basic requirement in Ambulatory, where commonly there are at least two people contributing to the each encounter record).
The recently passed added accuracy and Compliance supports in 2009 Ambulatory will necessitate the capture multiple authors, but actually producing an output showing accurately which author did did what won’t be required until 2010 by the current schedule (now delayed to align CCHIT with ARRA-HITECH timelines).
Until the 2009 requirements (again not yet in effect), an EHR could obliterate the original version of an amended record and still pass Certification.
So, current (2008) CCHIT Certification does not yet require basic records accuracy and trustworthiness supports which, as both Dr. Leavitt and Dr. Kibbe know, has been a primary point advanced by my organization but remaining unfulfilled by CCHIT Certification. Why basic medical records business rules can continue to be violated under Certification is, to me, a key point that demonstrates that CCHIT, as currently configured, has outlasted its utility. It is not bad, it has simply reached the end of its current configuration’s abilities to provide the necessary full range of stakeholders with EHRs supporting accuracy, trustworthiness, and so, comprehensive value. If it persists in its current form, it will simply be a continuing drag against accurate, trustworthy EHRs by also abetting the persistence of improperly designed systems that, even when used as intended, cannot auditably support standard medical record functional requirements.
Back on track, where must Certification go, now given the HIT stimulus money to flood into the marketplace? Unfortunately, we have a sudden new reality and no time to incrementally evolve CCHIT. We’re going to spend billions to stimulate uptake of EHRs that, if current CCHIT requirements are used, cannot even be 2007 HL7 Functional Model Standard compliant. Furthermore, even by 2014, the likelihood that they could additionally be compliant with the Records Management Evidentiary Support (RM-ES) Profile, is zero. There simply isn’t sufficient time to incrementally modify CCHIT requirements by its current guidelines, even if the only changes the market demanded were Functional Model and RM-ES Profile compliance, which clearly cannot be so.
So, generally speaking, today and for near future I see three broad choices for where to go from here for EHR Certification:
1. Explicitly accept that we’ll spend many billions (the stimulus money only being the incentives, not the actual costs of course) on getting many, most, or everyone onto non-standardized, non-compliant, less-than-trustworthy but nonetheless incrementally and minimally “Certified” systems by 2014. To get a trustworthy medical record, place the burden for basic records management due diligence on the purchaser/user, the defects burdens on the patients and providers.
2. Augment current requirements immediately with basic Records Management requirements that raise the “floor” to match other business domains’ minimum necessary, such as Federal Rules of Civil Procedure requirements for legal admissibility as business records, as the “minimum necessary trustworthiness”. (This would put the emphasis for assurance more onto the marketplace, favoring those existing systems that already been built to support trustworthiness and integrity and that have advanced onto modern program designs and force obsolete designs to change or fail. Think Toyota, Ford vs. GM.)
3. Set aside HITECH’s timelines, pending a HITSP, Policy Committee, Standards Committee, etc. consensus that robust, compliant, trustworthy records systems exist in sufficient numbers, at low enough cost, and are sufficiently interoperable to testably assure an accurate reliable bedside longitudinal record, basic trustworthiness is a “minimum necessary” for all.
Unfortunately, the current majority plan is item 1.
Like Dr. Kibbe, I have the audacity to hope that we can do better, based on science, engineering, and good clinical care, with the minimum of wishful thinking and well-meaning though uninformed rhetoric. As a realist, though, to provide for the option that item 1 will remain the national policy, due diligence testing tools are available. One thing Dr. Leavitt, Dr. Kibbe, and thousands of others share is certitude that HIT is a critical component for improving all aspects of health care, we just disagree on the path to achieve that promise. (BTW, the HL7 Functional Model, Interoperability Model, and Records Management-Evidentiary Support Profile, as well as, undoubtedly, other EHR-related Standards, already merit updating. We’ll be improving Standards and systems for generations, so let’s also work on adjusting expectations and settling in for a more comfortable ride because it is going to be a long one.)
That’s my rant for today, sorry it ran on for so long. Remember we all are working toward the same end, just debating who should navigate and whose benefits first. Cheers!
Reed D. Gelzer, MD, MPH, CHCC
Advocates for Documentation Integrity and Compliance.
Mark Leavitt, WHERE ARE YOU? Will “Uncle Steve” give you permission to come out and play?
Mark Leavitt, WHERE ARE YOU? He is waiting for “Uncle Steve” to give him permission to speak.
In a recent New Yorker article (http://bit.ly/64H1P), Dr. Atul Gawande accurately depicts the root cause of our health care crisis – misaligned incentives.
Two additional articles, one in BusinessWeek (http://bit.ly/Ei4QQ), the other in the Washington Post (http://bit.ly/Jn5xq), suggest that some aspects of health information technology actually may not be part of the solution, but potentially may be part of the problem.
To paraphrase Shakespeare, Dr. Leavitt “doth protest too much, methinks.” His remarks, by their nature, tend to prove the very points he is disputing.
Dr. Silverstein: In general I found the documents you provide links to to be enlightening. For example these points you cite above, drawn from those documents, make sense to me:
· user-centric design practices in industry through studying health IT problems that legitimately cause physician resistance,
· empowerment of Chief Medical Information Officers (CMIO’s) with executive presence and managerial authority,
· reformation of the hospital MIS department “designer-centric” culture,
· improved financial incentives for IT adoption,
· studies of systemic organizational and societal barriers with an aim to improve them.
Regarding Ludditism, the behavior of physicians, likely most physicians, can be accurately characterized as Luddite, as defined as resistance to change that they fear will disrupt the patterns of activity that they feel comfortable with. None of your points seems to me to contradict that assertion.
In this posting the change “agent” resisted is the adoption and use of computer technology to record clinical activity, so that the data recorded can later be manipulated or transmitted electronically, rather than manually.
The source of the resistance goes further than resistance to incorporating computer interaction in regular clinical activities, it extends to “work processes” that physicians and clinical/administrative support staff are used to. The economic structure of providing medical services, as I repeatedly note, insulated service providers to the pressures exerted in a competitively-determined market. Therefore these providers are largely oblivious to those pressures that providers of other services or products experience continually, with the consequence that they change work processes to deliver services at every lower prices.
In regard to the delivery of medical services, I have been reading a recently published book by a noted management scholar, Clayton Christensen, whose academic work is centered on what he calls “disruptive” innovation, the source, in his study, of much positive change in economic activity.
He and his two co-authors, both practicing (one died before publication of the book) physicians, analyze the healthcare system in the USA using this perspective. In my opinion the analysis presented in the book (1) is accurate, (2) shows how the healthcare industry as now constructed can be changed to permit “disruptive agents” to take hold.
One key element of enabling the disruptive agents is the universal implementation of EMR systems which is the topic in this posting.
This is really getting funny. EMR Update, Kibbe, Lynn, Planchart, Margaret A. and many others have taken pot shots at CCHIT for years. Where were they 4 years ago when there no way for a physician to compare one EMR to another? What have they done to help the process? Kibbe has tried, can’t say about the rest. How about lighting a candle before you curse the darkness. When Leavitt finally stands up to answer the incredible charges that slander CCHIT’s staff, mission and volunteers everyone runs back to their holes and acts like they are the victims. Get real, maybe CCHIT’s time has passed, but your actions and charges do not bring credit to your reputations.
“2. Provide allowance for data entry personnel for private practices. HIT represents, in fact, the largest transfer of clerical work to skilled professionals, ever.”
“2. Technology as is is intrusive. Physicians can’t give quality care with a computer shoved between their face and the face of the patient. This would also create jobs. I agree.”
Gentleman:
Are you really saying that for HIT to be “efficient” each provider would need to be accompnied from exam room to exam room by a full-time data entry clerk?
That would increase my payroll by 50%. And this saves the system money by . . . ?
Thanks.
aten.olol,
Could you use a name other than a medicine?
What do you mean by: “your own conflicts and self interest”? Please expound.
Thanks,
Michael Planchart
As someone who has worked with small practices and independent physicians, I can say that CCHIT does serve a purpose. At the very least it qualifies companies to be financially stable enough to pay for certification. It wasn’t long ago when all 500 EMR vendors were out competing for business, and physicians bought the system was functional enough for them at a price they could afford. Unfortunately many of those initial 500 vendors are gone, leaving these practices to support themselves.
More importantly, transitioning data from one EMR to another has not exactly been proven effective or affordable at this time. Without CCHIT, I suspect many more practices would be investing in systems that may not be around in 2 years.
Like Reality Check said, it is irresponsible/insane to let patients suffer because physicians don’t have the guidance to choose the right EMR the first time around.
That said, I respect the argument that CCHIT increases barriers to entry and limits innovation.
“2. Provide allowance for data entry personnel for private practices. HIT represents, in fact, the largest transfer of clerical work to skilled professionals, ever.”
“2. Technology as is is intrusive. Physicians can’t give quality care with a computer shoved between their face and the face of the patient. This would also create jobs. I agree.”
Gentlemen:
Are you really saying that effective use of HIT requires a full-time data entry clerk assigned to follow each provider from exam room to exam room?
With four providers in our office, we utilize a part-time transcriptionist/medical records clerk. Hiring 4 data entry clerks would be tremendously expensive.
Thanks.
aten.olol,
You need to study the lesson here:
http://www1.ca.nizkor.org/features/fallacies/ad-hominem.html
I forgot to respond to this statement of Wendell Murray
“Comments such as R. Watkins’ about the the poor performance of EMR software do not reflect reality. All well-designed commercial products that have been introduced or refactored since, 2000 to arbitrary set a date are good and function well. Failure is inevitably caused by poor implementation of one type or another”
Mr. Murray, the National Research Council of the National Academies has much more to say on this issue, and they make their statements that refute the view of HIT as “working well” based on rigorous observational study and decades of expertise. The press release is at the link below; read the full report.
http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12572
aten.olol,
Could you please expound on what you mean by my “own conflicts and self interest”?
Thanks,
Michael Planchart
CCHIT criteria are the bare minimum expectations of functionality that is needed in a system to perform workflows and improve care. What is the point of installing EHRs if you can’t improve patient health through basis preventative things like smoking cessation counseling, mammograms and flu shots.
Read the criteria yourself (http://www.cchit.org/certify/index.asp). They are mostly minimum functions needed for real workflows and certification is very open to innovative ways of meeting the criteria. Some are non-obvious and are typically things that have put patient’s at risk when vendors didn’t do them in the past.
With the new stimulus gold-rush even more half-baked systems are sure to pop-up. Putting patient’s at risk and wasting a hospital or clinics time and money figuring out which vendors are all talk and no functionality is insane.