Tag: ONC

Making Sense of the NHIN


The National Health Information Network (NHIN), which was the previous ONC head’s (Kolodner) top priority, or at least seemed that way is a concept that has its advocates and detractors.  To date, we have been more of a detractor as the original NHIN was a very heavy, top down approach by the federal government to establish a national Health Information Exchange (HIE).  Certain federal agencies loved the idea (e.g., Social Security Administration which has an embarrassing 18 month backlog of disability claims), but those in the field (local hospitals, RHIOs, HIEs, etc.) were not such a big fan of the concept.  Heck, we can’t even get RHIOs established, let alone an NHIN.  Adding to NHIN woes was its platform, built by beltway bandits with technology ill-suited to create a flexible, lightweight transport mechanism for the exchange of health information.

Thankfully, a new administration has come on board, new people have joined ONC and the bloated NHIN of recent history is getting a major rework – actually being split with NHIN referring more to the policy constructs that will define information exchange (the DURSA – Data Use and Reciprocal Support Agreement) and NHIN Direct, a much lighter weight technology stack to enable point to point communication.Continue reading…

In ONC I Trust …

It’s my nature to question authority.

Whether it’s religion, politics, or even my local administrative leadership, authority figures must earn my trust.

Earning that trust is not easy. As folks who work closest with me know, I believe that much of Dilbert is based on true case studies.

Over the past year, I’ve worked very closely with many people at ONC – David Blumenthal, John Glaser, Judy Sparrow, Farzad Mostashari, Chuck Friedman, Carol Bean, Doug Fridsma, Chris Brancato, Jonathan Ishee, Arien Malec (on loan to ONC for 8 months), and Jodi Daniel. I’ve worked with HHS CTO Todd Park. I’ve worked with US CTO Aneesh Chopra.Continue reading…

Why Rush Vendor Certification of EHR Technologies?

A surprise move by ONC/HHS indicates the wheels may be falling off health IT reform at about the same rate they’ve fallen off Democrats’ broader health reforms.

David Blumenthal and his staff have unveiled two separate plans to test and certify EHR technology products and services. We don’t think this is a good idea. We’ve supported the purpose and spirit of the ARRA/HITECH incentive programs, and believe ONC’s/HHS’ re-definition of EHR technology puts it on a trajectory to improve the quality and efficiency of health care in the U.S. But this recently-announced two-stage EHR technology certification plan bears all the marks of a hastily drawn up blueprint that, if rushed into production, could easily collapse of its own bureaucratic weight.

The new Proposed Rule puts vendors through the wringer, twice. As defined by ONC, vendors with “complete EHRs” and those with “EHR modules” will have to find an “ONC-approved testing and certification body” (ONC-ATCB) that will take them through a “temporary certification program” from now until end of 2011. Then in 2012, under a “permanent certification program,” they’ll have to switch over to a National Voluntary Laboratory Accreditation Program (NVLAP)-accredited testing body for testing, after which they must seek an “ONC-approved certification body” (ONC-ACB, not to be confused with ONC-ATCB) that can provide certification. The ONC-ATCB will be accredited by ONC, but the ONC-ACBs will be accredited by an “ONC-approved accreditor” (ONC-AA).Continue reading…

Where were you?



I distinctly remember the first time I heard the title, “National Coordinator for Health Information  Technology”.  It was 2004.  That’s, of course, the year that RAND released its important national report card highlighting the overall mediocre state of health care quality.  You know the one that told us “it’s a flip of a coin.”  I was an RWJF Health Policy Fellow working on the Hill with then Majority Leader Bill Frist’s health policy staff.

There was a flurry of staff activity regarding the president’s pending executive order pushing adoption of the electronic health record and creating a new federal health information technology, dare I say, czar. . . . But what to call this new position?  To be honest, when I initially heard folks say the words, “national coordinator for health information technology,” my first thought was, “Well, that’s a mouthful.”  My second was “It sort of sounds like a character from that TV show, ‘The Love Boat’”.  But I kept those smart remarks to myself and quite quickly got on board—and, to be honest, never looked back.Continue reading…

CCHIT’s Latest Gambit


Many of us have enjoyed a few good minutes of fun having our fortunes told by soothsayers who claim they can predict our future based on patterns of tea leaves in a cup or the playing cards we’ve pulled from a deck.

We pay a few dollars for the entertainment and if the fortune teller is skilled, we are temporarily impressed by his “insight.” But once we leave the carnival, we come back to our senses. Fortune-tellers can’t predict the future.

With its latest announcement, the Certification Commission for Healthcare Information Technology (CCHIT) appears to have entered the fortune telling business.

And if information provided on blogs published by its founders is to be believed, some EHR vendors plan to have their fortunes told by the former EHR certification monopolist.

In June, ONC’s HIT Policy Committee released a Meaningful Use Matrix and proposed that it should serve as the basis for EHR certification as mandated by ARRA, the economic stimulus program signed into law last winter.

The Matrix consisted of five “Health Outcomes Policy Priorities” and associated Care Goals, Objectives and Measures. The Committee anticipated that the latter would be transformed into EHR certification criteria.

After a 2-month public comment period, the Committee tweaked the Matrix, essentially pushing back time-frames for implementing computerized order entry, and accelerating time-frames for implementing personal health records.

By mid-August, the Committee had approved a final version of the Matrix.

This document includes the very latest information on ARRA-mandated EHR certification criteria. It is in the public domain, there for all to see. ONC is expected to finalize these criteria next spring.

The criteria are not consistent with those used by CCHIT to certify EHRs. They are outcomes-oriented (CCHIT’s are feature, structure and process-oriented), and they do not require that any particular technology (such as the client-server applications used by the legacy vendors who sit on the board of CCHIT) be used to achieve the results.

Subsequently, HHS announced that it planned to assume responsibility for deciding which EHR systems qualified for bonus payouts under Medicare, and shortly thereafter, ONC’s HIT Policy Committee said that it planned to recommend that several entities should certify EHR systems.

In its announcement, the Committee envisioned the establishment of 10 to 12 such agencies.

The upshot of these moves by the Federal government are that (1)CCHIT no longer decides what criteria will be used to certify EHRs, and (2)its days as the exclusive provider of EHR certification services are numbered.

What has CCHIT decided to do in response to these setbacks?

It’s decided to become a fortune-teller!

New Role for CCHIT

Last week, CCHIT announced it will begin offering “streamlined,” or “modular” certification options, in which EHR vendors can apply to the agency for approval of distinct EHR modules like e-prescribing or electronic patient registries.

But as mentioned above, ONC won’t sign-off on its “meaningful use” criteria until the spring of 2010. In effect, CCHIT is asking EHR vendors to gamble that CCHIT can, like a fortune teller at a carnival, predict what those final recommendations will be.

“Choose the risk you want to take,” CCHIT Chairman Mark Leavitt recently challenged vendors. “Go ahead now (with a CCHIT review) and have an extra year to implement, with a small risk that there will be some gap in which EHR systems would have to be updated to receive final certification…” or risk the consequences of sitting on your hands, he presumably would add.

Never mind that the latest information is in the public domain, and that any vendor can compare it against their current capabilities and development plans! Disregard the fact that CCHIT has no track-record in promulgating outcomes-oriented certification criteria or in certifying against them!
What is CCHIT charging for its fortune-telling expertise? According to Government HealthIT, a HIMSS sponsored publication, prices for modular certification begin at $6,000 for up to 2 modules. They rise to $24,000 for up to 20 modules and to $33,000 for more than 20.

As always, fees for CCHIT’s comprehensive certification are $37,000 for ambulatory systems and $49,000 for hospital systems. Annual renewal costs are $9,000 for each.

That’s chump-change for the legacy vendors whose top executives sit on the board of CCHIT, but it guarantees nothing.

Conclusions and Recommendations

EHR vendors should perform their own analyses against the published HIT Policy Committee criteria and follow the HHS Web site for announcements regarding meaningful use criteria and the process by which EHRs will be certified.

If a vendor insists on having its fortunes told, it should consult with a reader of tea leaves next time the carnival is in town.

Glenn Laffel is a physician with a PhD in Health Policy from MIT and serves as Practice Fusion’s Senior VP, Clinical Affairs.  He is a frequent writer for EHR Bloggers, where this post first appeared.

Why Standards Matter (1): The True Meaning of Interoperability


Americans are generally skeptical of words that otherwise intelligent and articulate people can’t pronounce.  “Interoperability,” like nu-cu-lar, is one of these. After a while, these words can take on a mystique all their own.But interoperability is a hugely important word in the context of today’s ongoing debate about the use of EHR technology by physicians, hospitals, and patients too. The federal government is going to provide billions of dollars to encourage today’s fragmented health care providers to convert from mostly paper to mostly computerized information systems. It is critically important for these systems to talk with one another. We want health data to flow between and among these systems and to be, well, interoperable.  And it isn’t now.

So how can this word be so difficult to put into action?  Here’s a clue: a lot of people are confused about its meaning.Continue reading…


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