Thank you for your rebuttal!

>>> I probably know more about EHRA than you do.

Hmmm… I’m not to sure that. Before 2006 I knew nothing CCHIT, but then when the initial certification criteria was published I was both shocked and dismayed. I’ve been writing and complaining about this organization ever since. The way I see it may not only stifle competition to inflate prices, but those involved should be prosecuted by the full extent of law for breaking the RICO anti-racketeering statutes. What CCHIT does is no different than a mobster extorting money from businesses which in this case would be vendors to allow them to compete in society. What prevents any prosecution of CCHIT is the fact that President Bush and Health and Human Services Secretary Leavitt have wrongly backed CCHIT insulating this entity from the needed legal oversight.

CCHIT offers a concept that superficially looks like a good thing. Once you look at the whole forest rather than individual trees one sees the obvious fact that what is occurring here is that EHRA is trying to corner the market through its high certification fees by making it extremely difficult for its smaller competitors to survive. These smaller companies make up both the free and inexpensive EMR market. EHRA has ingeniously brought this on through its heavy lobbying efforts of Congress, other elected officials, and even a few physician organizations. It set up CCHIT as a not-for-profit entity and has obfuscated what is really happening by calling for “volunteers” and aligning its sister organization, HIMSS, with a couple of true not-for-profit groups.

The volunteers may consists of a few who religiously feel that this is an honorable way to affect our nation’s health system, but frequently, as you stated in your note, they represent the very member companies of EHRA which stand to make an enormous profit if other EMR vendors are eliminated from the marketplace. One such volunteer is the CEO of e-MD’s, David Winn MD, who worked as a volunteer to see how CCHIT was going to affect his company and by participating he hoped to get an early fix on what they needed to do to pass the tests be certified.

Since 2004 I have participated in numerous threads at a website called http://www.emrupdate.com, discussing some medical cases, but also a lot of programming and politics, the latter including CCHIT, pay-for-performance and e-prescribing and have posted over 4100 times concerning these topics. I have written to numerous members of Congress, to the FTC, as well as to the press about what is happening. I have a website (www.msofficeemrproject) that not only offers a free Microsoft Office EMR for download but also has numerous downloads that concern the politics of HIT. One particular download is a PowerPoint presentation called “What Has Gone Wrong with the Direction of the HIT in the USA?” (http://www.msofficeemrproject.com/Page3.htm) which has been downloaded over a thousand times and has been made into hard copy and distributed to members of Congress on 12/21/2007 just prior to the vote to attach HIT mandates to a physician pay reduction fix. You will note that although the HIT mandates were attached to the bill to prevent Bush from vetoing it, the $5 billion dollar funding was mysteriously removed at the last minute…

At my website you will also see the original CCHIT not-for-profit incorporation papers which state that at the end of the year (2006) all profits will be distributed to those vendors which were the original founders. The also downloadable 8/2006 monthly minute notes clearly stated that by Christmas, 2006 they would have over $1 million of profit. Doesn’t take much know-how to do the math! Soon after I made light of these issues the monthly minute note publications were suspended and then restarted on 11/2006 in a more concise, scrubbed, generalized matter. CCHIT’s not-for-profit status was later reorganized on 12/2006.

>>> Certainly, be cautious and hold your vendor to high standards. But, while “market forces” appear to be failing in other sectors, I believe that in the HIT market, vendors can deliver more value than skeptics might believe.

If you download and look at the slideshow (“What Has Gone Wrong with the Direction of the HIT in the USA?”) you will come to understand that CCHIT certified EMRs generally cost twice as much as those that are not certified, forcing purchasers to put more money at risk. You also see a recent CDC biannual report (pub on 11/2007), it found that although the uptake of EMRs in general has increased almost 30%, you will see that they found that the growth of expensive CCHIT certified EHR systems has statistically stagnated- physicians aren’t buying into this “added value” (i.e. BLOAT). This slideshow has references to the fact that although CCHIT promises to “assure” doctors, just in 2008 several CCHIT certified EHR systems have seen their stocks decline, have undergone restructuring, have been bought out, and/or have gone out of business altogether. A quick synopsis of this activity is highlighted in my download called the “CCHIT Hall of Fame” (some call it “Hall of Shame”…), downloadable at the same page noted above. If you look at the high deinstallation rate of expensive CCHIT certified EMRs of between 20% to 40% due to the complexity of the software, this makes the overall cost even higher.

So I don’t know where you got the idea that CCHIT’s “high standards” has prevented the failing of the EHR sector. This summer some of the CCHIT-vendor companies have shown some improved market strength, but that was mostly due to speculation on the misguided e-prescribing mandates passed on 7/2008. I’m sure that their stocks will plummet again in the next 3-6 months when reality sets in.

What CCHIT offers physicians are not high standards but the technological capability which can eventually be used by insurance industry and the government against physicians to eventually pay them less while having them work more through a process called “data mining”. These EHR systems which supposedly offer artificial intelligence and decision-making support will pave the way for the day in which insurance companies and the government will pay nurses and physician assistants to see patients as if they were doctors. Doctors aren’t stupid- they will continue to reject high priced CCHIT-certified EHRs for many years to come.

BTW, I trust my vendor since my vendor is ME!!! I first programed my EMR back in 1990 using Paradox for DOS and by 1995 due to the popularity of Windows I changed to the MS Access platform. It’s been a rewarding endeavor from day one and has been a both inexpensive and powerful solution that runs my office- EMR, oncology, and PMS.

I believe that what is happening in Congress is that our representatives are beginning to see that even with their touted 2% incentive to use e-prescribing, very few docs have signed on for e-prescribing and for the use of CCHIT-certified EHR systems. They are trying to do what they should have done from the beginning- rely on low cost alternatives, simplify the process, and make HIT truly a worthwhile investment for a physician’s time and efforts. The practitioner should NOT have to pay for this technology in which he has the least to gain.

Cheers,
Al

~Order Entry in the product was integrated
~Order Entry from documentation was solid
~Medical terminologies could be pretty well managed
~It was responsive and generally information was integrated
~Interface specifications were defined and documented

The bad points -

~Aggregate reporting was tricky
~Pharmacy and the ancillaries were pretty bad
~Inconsistencies in the user interface and user conventions between modules
~Developer documentation was not the best but the on-line community was great
~Some of the user interface conventions were not well suited to both ambulatory and hospital-based operations
~Some modules were neutered from what I saw at the VA – medication administration and some portions of PACS
~Workflows and some functions that were not aligned with ambulatory operations

Some of these points have been addressed (ex: ambulatory functionality, PACS) while others are still there.

If you are looking for industrial strength software, OpenWorkbench fits the bill. http://www.openworkbench.org/ It is like project (fat client) with a few scheduling differences that actually should drive more organizations to use the tool. It is really geared towards managing a single project or group of small inter-related projects.

Web based alternatives are a better choice if you are interested in more collaboration and centralized management. They also may be a better depending upon how you staff or schedule resources. THIS IS A KEY POINT. Also, take into account what-if’s and reporting. Workbench is better IMHO when you are making broader estimates and then deciding to allocate staff to it.

Computer Associates (CA) bought out the underlying company and posted the software for open source, then has focused their new development efforts of aggregating the information from individual projects in the fat client application. Pretty creative strategy for CA. I have used it. It is workable.

GANTTProject is another open source project. It is workable and less sophisticated. This is good for many people and for the way many people manage. I have used it on a few small projects. It worked fine. I do not know if it would work as well on a large initiative with many inter-related parts. It is not as collaborative as you may need to be. For being a fat client Java app, it is pretty fast. It stores data in XML which is interesting if you like to dabble and want to write some aggregation reports yourself.

For a web-based system, I used dotProject on one small initiative. It is PHP and MySQL-based. It was also workable. It is good for small development projects as it is really geared towards collaboration. The integration of ticket tracking is slick if you are assigning features for development or for test issue resolution. Again, it depends upon how you want to schedule and your approach.

Search-around – there are some Excel-based basic project management planning tools as well. They work fine if you are really managing at higher levels and on individual projects.

Good luck