Raising Legitimate Questions and Concerns About Health IT Certification, Without Getting Personal

By DAVID C. KIBBEKibbe

In a recent blog post on THCB, Mark Leavitt wrote this about me:  “[Dr. Kibbe’s] 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.”

The truth is that I respect both Dr. Leavitt and, equally important, the many fine people who have contributed to CCHIT work.  I regret that he has made me the target of his anger about investigative reporting in the Washington Post, which I certainly did not initiate.

To clarify what I actually said, after a brief interview, quoted in the second of two articles in the Washington Post by Robert O’Harrow, Jr, a Pulitzer Prize finalist :

“One has to question whether or not a vendor-founded, -funded and -driven organization should have the exclusive right to determine what software will be bought by federal taxpayer dollars,” Kibbe said. “It’s important that the people who determine how this money is spent are disinterested and unbiased . . . Even the appearance of a conflict of interest could poison the whole process.”

Raising questions and concerns like these does not reach the level of “falsehoods and innuendo.”  In my opinion, it is entirely appropriate to ask tough questions about whose interests are being served when $36 Billion of tax payers’ money is involved, and the future of health IT in the U.S. will be the result of certification.”

I am not the only one with these concerns. Many other health care and health IT professionals have raised legitimate questions about CCHIT and its practices, its relationship with HIMSS, and yet to date these have not been resolved. A response that attacks me personally and labels me a liar is far from adequate, and so the questions will remain.

The stakes are too high to simply look the other way.

David C. Kibbe MD MBA is a Family Physician and Senior Advisor to the American Academy of Family Physicians who consults on healthcare professional and consumer technologies.

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Joe Bucklecandida abev M.D.S SilversteinMichael McBride Recent comment authors
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David C. Kibbe, MD MBA
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David C. Kibbe, MD MBA

Gilles: Many thanks for these references, and I’ll study them. It looks as though there may some applicability to the current EHR technology conundrum. Back to you when I’m finished reading…
Joe: Thanks for your comments. I have had many, many conversations with the smaller vendors who feel they’ve been shouted down and kept out of the CCHIT group, and it’s good to hear some voices from that corner.
Regards, DCK

Gilles Frydman
Guest

Anybody interested in the meaningful use debate should read Dr. Ted Eytan, MD’s last post, http://www.tedeytan.com/2009/05/28/3086 and Jane Sarasohn-Kahn latest HealthPopuli entry, ” Meaningful USe – or, whose health is it, anyway? ” http://www.healthpopuli.com/
Both say the same thing: Jane says it all in “Meaningful use is about US” while Ted writes “Is it meaningful if patients can’t use it?”

Joe Buckle
Guest

As a vendor to small practice doctors I applaud Dr. Kibbe and the others who continue to ask tough questions regarding “certification” and “meaningful use” in this important HIT debate. The CCHIT certification process and requirements are seriously flawed when applied to small medical practices. I’m dumbfounded at Dr. Leavitt’s comments in his video posted on this site where he states the certifcation process and fee structure are not a ‘barrier to entry’ for small specialty software companies and startups. Dr. Leavitt’s post above does not address any of the serious issues raised by Dr. Kibbe or anyone else in… Read more »

Gilles Frydman
Guest

David, you can start with the history of the SRS: http://bit.ly/CJlQU You should also look at Amendment 11: http://bit.ly/WOWMo The following is of particular interest in our current situation: “In order to create an environment conducive to the development of robust competition among domain name registrars, NSI will, either directly or by contract, develop a protocol and associated software supporting a system that permits multiple registrars to provide registration services within the gTLDs for which NSI now acts as a registry (Shared Registration System).” I think you’ll enjoy this simple presentation: http://bit.ly/FaAeM And this one from Vinton Cerf: http://bit.ly/mB1O5 For… Read more »

David C. Kibbe, MD MBA
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David C. Kibbe, MD MBA

Dear Scot: I DO think that your writings have been noticed, I certainly pay attention to your blog, and that there is still the need for a much larger public debate about health IT. Again, I think leadership, transparency, and money are all important to what creates “newsworthy-ness” in the mainstream press. Notice that Mark Leavitt said or wrote very little in defense of CCHIT until the Washington Post covered the story. I wish that Mark and CCHIT leaders would have spent the time and energy responding directly the many questions that have been raised rather than “raise their ire”… Read more »

S Silverstein
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S Silverstein

David,
I find it interesting that sites such as mine (http://www.tinyurl.com/hit-misadventure) that challenge the HIT status quo, as well as my writings on Healthcare Renewal, have never drawn the ire your writings have.
Perhaps it’s because those who would proffer such ire know they would be eaten alive in a public debate, and that such a debate would raise visibility of the issues I and like-minded medical informatics colleagues raise.

David C. Kibbe, MD MBA
Guest
David C. Kibbe, MD MBA

Gilles: Very, very interesting analogy. I do remember the story, but am not familiar with the details, so thank you for bringing to our attention. Do you have other resources, perhaps something available on the ‘net, that we could look at to get a better idea of the ICANN history?
Thanks, DCK

Gilles Frydman
Guest

I was re-reading the history of ICANN, the Internet Corporation for Assigned Names & Numbers, after thinking that the disagreements expressed during its creation and subsequent transformation parallel the conversation (if you can call it that!) between David Kibbe and Mark Leavitt. ICANN failed while people thought it had an unduly strong connection with commercial entities who clearly intended to keep the status quo. The original monopoly for domain name registration was clearly a problem and opacity of the process didn’t make things easier. How did this mess get resolved? ICANN “introduced new principles in global policy-making like bottom-up coordination,… Read more »

David C. Kibbe, MD MBA
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David C. Kibbe, MD MBA

Dear Bev M.D.: I think the situation is worse than you think – the two sides can’t agree on the size of the table, who should sit around it, or what should be put on it! My viewpoint, one that seems to be generally shared by many commenters, is that we need to have a very open debate, that includes a lot more people than are now included (patients/consumers, for instance), around a very big table onto which we put everything we can think of as an issue before anything is excluded. If only the “experts” can understand what’s going… Read more »

S Silverstein
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S Silverstein

The term “certification” is indeed a problem. It implies far more than the substance behind what actually occurs. “Features qualification” would be more precise. As I wrote at http://hcrenewal.blogspot.com/2009/03/few-not-so-random-thoughts-on.html : Having worked in pharma (Merck), I would like to know how CCHIT functions differently from a fictional “Drug Certification Commission.” Imagine such a Commission founded by PhRMA and other pharmaceutical industry advocates, partly staffed at high levels by pharmaceutical executives, and “certifying” drugs for consumer purchase simply on the basis of their being manufactured under cGMP guidelines (current good manufacturing processes). Imagine this Commission declaring drugs “certified” without clinical trials,… Read more »

candida a
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candida a

The magnitude of the dangers of HIT gear being deployed to control the care of patients has been kept from view by contractual gag clauses well described by Koppel and Kreda in JAMA. Despite Koppel (JAMA) reporting 22 new mistakes generated by CPOE devices and Han (Pediatrics) showing a 2.4 fold increase of deaths of babies, we all know that never ever ever, according to the HIT zealots and industry CEOs and CMIOs, has any defect, flaw or abject failure (“unplanned downtime”) of such equipment ever resulted in the death of a patient. It is always user error. Yet, there… Read more »

Michael Planchart
Guest

Unfortunately, CCHIT will not answer why they charge a fee of $30,000.00 for a certification of an EHR. CCHIT relies on volunteers for most of their functioning. Dr. Leavitt expressed his support for Open Source software at HIMSS 2009. For the FOSS community a 30K wack is not support. We need multiple certification commissions that compete one against the other. Maybe the fee will drop down to a realistic 3K or less. I’d say less. Prehistoric vendors must accept that this is a new era. An ice age is upon us. Dinasours will succumb to the striking meteor of healthcare… Read more »

bev M.D.
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bev M.D.

Well, the 56 comments on Dr. Leavitt’s post were too much to do more than skim, but here’s my outsider’s, IT know-nothing’s take on these 2 posts: 1. Nothing Dr. Kibbe has ever written on this blog has given me any idea that he is anything less than professional, whether I agree with him or not. 2. Dr. Leavitt’s post, as noted by others, revealed a level of smoking anger which makes me wonder where the fire is. 3. This whole health IT discussion is beginning to take on the dimensions of the 2 countries (which ones? help me remember)… Read more »

S Silverstein
Guest
S Silverstein

DEbate back and forth on the merits and risks of HIT is a healthy activity. Yet I fear the domain of health IT has left the realm of science and entered a world of cybernetic mysticism, or religion, where critique is viewed as apostasy. Robert Merton (1973) described four norms that are prerequisites to scientific activity: 1. Organized skepticism: (Nothing is ever taken on trust) – yet the health IT skeptics (or, as I am, a gadfly of HIT mismanagement) are often chastised. 2. Universalism: (acceptance of the integrity of research relies on its merits, and not status of the… Read more »

Michael Planchart
Guest

Evan Steele, Your company develops EMRs that are different from “classical” EMRs. You also compete against the certified EMRs and have indicated, from what I’ve read, in some blogs that these EMRs don’t guarantee a succesful implementation and I agree with this as well. I have also read that SRSoft has installed succesfully many hybrid Electronic Health Records where the “classical” ones have failed. I have a few questions for you: 1. What are the essential differences between hybrid EMRs and classical ones? 2. How has the industry-wide voluntarily certificacion adoption process impacted the hybrid EMRs? 3. We can see… Read more »