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February 18, 2009 Readers Write 10 Comments

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The Real Problem with CCHIT Certification
By Dewey Howell MD, PhD, Founder, CEO
Design Clinicals, Inc.

deweyhowellI have been reading discussions on the HIT provisions in the new stimulus bill that was signed this week by President Obama. One discussion that caught my attention relates to what it means to be a “certified” product. Throughout the bill, it states that funds are to encourage adoption of “certified” products. While it is not yet completely clear what this means, most folks are assuming it will mean certified by CCHIT.

Thus the debate begins. One camp argues that CCHIT is the only way to go, like the quote from the recent interview with Glen Tullman here on HIStalk: “Every physician who buys ought to be buying a CCHIT system.” The other camp counters that CCHIT hinders innovation. Their argument says that new companies doing innovative work and producing focused products that move the industry forward can’t get certification because of the time and resources required.

While I agree with this to a point (heck, I am the CEO of one of these new companies), it doesn’t get to the real problem with CCHIT certification. Even if I am sitting on a pile of money and have time and people to invest in the certification, I can’t get my products certified. This is because of CCHIT’s definitions and how certification is structured.

Our company’s products are used in ambulatory, inpatient, and emergency settings. Which certification do I choose? The real value of our products and those made by other small innovative companies is our focus on solving specific clinician problems. To be certified, though, the product must manage everything — patient demographics, meds, allergies, labs, order sets, decision support, etc.

If you have the best decision support product on the market, even if it easily integrates with any vendor system and adheres to strict integration and security requirements, it can’t be CCHIT certified. Period. Yet customers of the “certified” systems are still calling and looking for solutions to real problems.

This could stir up the old “integrated system” vs. best-of-breed approach. That debate aside, why not certify based on real hospital problems?

Carve out the enormous set of criteria for inpatient or ambulatory certification and create focused, results-driven certification criteria. Medication reconciliation, decision support, anticoagulation therapy, core measures, patient bed tracking, medication barcode administration, security auditing, medication ordering, order sets, etc. could all have their own certifications while keeping an umbrella certification process for systems that aim to do it all.

This would allow organizations with specific challenges to say, “We need to implement physician order sets because this is an area of risk for us. What are my options for certified products for this?” This focused problem would have a focused validated solution, rather than a certified system that does a plethora of things the organization doesn’t need. How could a hospital pick a certified pharmacy system? A certified nursing documentation system? A certified radiology or lab system? A certification process for these products doesn’t even exist.

Another deficiency of the current certification process is the lack of requirement for certification of results or outcomes. How do we certify and validate that the system actually delivers the outcomes that we are trying to achieve? The current process encourages vendors to throw a button or screen into their application that produces a specific action or display. But, there is no accountability to the patient and quality of care delivered with the tool. It encourages technology for technology’s sake, presuming that outcomes will be “better” just because a product is certified, instead of really validating results. Maybe this is a much tougher nut to crack, but it is considerably more important than things like, “The system shall provide the ability to allow users to search for order sets by name.”

Don’t get me wrong. Requiring certification on elements that promote access to data, usability, and clinician efficiency is a great thing because it improves patient safety, but vendors like me also need to be held accountable for delivering measurable results. This is the only way HIT will deliver on the promise of improving the quality of health care in this country.

Developing the Perfect HIT Conference
By Kurt Loincloth

You mentioned that HIStalk should put together an alternative conference (Un-Conference) that would be fun, less commercialized, and more educational and rewarding to attendees. Here is my thought on "The Open Health Care Conference."

  • Make sessions 45 minutes long, featuring a four-person panel discussing the thorniest issues
  • If there’s an exhibit hall, allow only working systems that can actually do something in an interconnected world
  • Make the conference affordable
  • Make it more modern and more relative to the younger generation

The panel sessions would have a five-minute moderator overview of context and problem – no biographies! Two panelists would be well-known thought leaders, but the other two would be more knowledgeable, lesser known, and more controversial. Each speaks for five minutes, then the rest of the time is audience Q&A.

Vendor demonstrations are not allowed to be done by marketing or sales people. No presentations. Only vendors who can interoperate with the rest of the world are allowed — no standalone products, Flash demos, or anything else that’s not working live (like the IHE area of HIMSS, which are the coolest part of the conference). If you have booths, offer only three sizes, draw randomly for location, and the size booth you get is determined by the number of solutions being demonstrated.

Charge enough to just cover costs. Offer free or cheap Webcasts of all sessions. All speaker materials must be made available at least one day before the session – no exceptions! Keep it compact, 2 or 2.5 days, with an optional field trip on the last day. Hold it in a central town that’s easy and cheap to get to (a Southwest hub), which also keeps the hotel and restaurant costs down.

Pick the topics and find the best people to do them instead of trolling for sponsored gigs. Do not pick your topics 15 months in advance — submissions are due back in 90 days and decisions made within 60 days of the conference. Offer live Webcasts. Field trips to get out of the hall! No sterile, boring locations like the Orlando mega-plex.

Small and medium-size vendors who are doing really good things will use the platform and run with it.

Challenge the HIStalk audience to develop the perfect conference with this planted seed and see what happens.

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Currently there are "10 comments" on this Article:

  1. Even being a vendor….but much more importantly, passionate about improving healthcare….I think your HIT event sounds heavenly!

    Might take a little exception to implied old-fogeys : )

  2. I love the idea of the conference. Great thinking. I always find panels to be interesting as long as they keep the topics relevant. I’d also suggest no paper conference information. If you want something go online and print it yourself. Just make sure the conference has a nice fat internet pipe so we can write about the experience.

    Might I recommend Las Vegas as a good choice of locations. Plenty of fun things to do and easy to get to. There should be plenty of conference room availability and deals considering the brutal economy.

  3. Great conference idea….just be sure to allow vendors to give away gadgets as attendees still need to bring stuff home to their kids…..I am not sure a drink coaster from the Cheetah Club or a deck of cards with a hole punched through it from Ceasers will make you popular at home.

  4. EHR Certification: One could consider the ultimate certification for “substantial equivalence” to reside with FDA 510(k) compliance for medicald device software. Exactly where is the disconnect with an EHR collateral activity for ordering / documenting blood or components, transfer of hematologic scoring reactions for compatibility testing, FDA compliance issues for Transfusion Medicine, transactional data for tissue and organ transplantation, etc. and the list can go and on depending on your specialty where FDA 510(k) compliance class is an issue.

    Because of all the national attention and congressional billions being diverted to the entitlement “EHR” does certification from CCHIT address the rationale why EHR application is essential for dependable patient outcomes guaranteed a safe device?

    Once again, the Joint Commission should belly up to this conundrum, to certify or not to certify, that should be a JC issue. As mentioned in previous posting, there should be a major accreditation program through the Joint Commission uniquely for Shared Electronic Health Record (EHR) as purported by ISO/TR 20514: 2005. Health Informatics – electronic health record. CCHIT certification may fall by the way side once the market settles the issue of the Electronic Health Record.

  5. Overall, I really like the conference ideas presented by Kurt – nice job! My only changes would be that I have seen very few panel discussions that have been worth the time. I prefer presentations by folks in the trenches that either have success stories to tell or have disasters they try to help you avoid. Many of the panel discussions are too 30,000 ft and don’t have enough detail to be of use. I realize that other may like the panel discussion but for me – give me more nuts and bolts discussion on how to do things.

    Also, I find it very difficult to be bored in Orlando! Outside of these two things, I really like your ideas Kurt.

  6. How about some 2.0’ish stuff on top of that-

    Conference Tweeter type feed, chat rooms, forums… perhaps a presence in a virtual world (HIMSS, but better.) Best to have it open to all.

    ..and keep this stuff going post-conference!

    -John

  7. Re: Certification

    Certifications with overly stringent conditions of time, features, or money seem to defeat the purpose of certification and thus do not serve to enhance whatever they are trying to certify.

    This is an issue that repeats through the history of technology and is not unique to EHR, Think of certified products that make it to micorosofts hardware compatability list. Also one that lacks accountability as you suggest. There are many preferred partner programs that fall into this realm of questionable certification requirements.

    I am curious as to whether you have contacted the CCHIT with the above concerns. How have they responded?

    Nice to see cogent arguments on the subject! Thanks for the post.

  8. Re: Certification

    Certifications with overly stringent conditions of time, features, or money seem to defeat the purpose of certification and thus do not serve to enhance whatever they are trying to certify.

    This is an issue that repeats through the history of technology and is not unique to EHR, Think of certified products that make it to micorosofts hardware compatability list. Also one that lacks accountability as you suggest. There are many preferred partner programs that fall into this realm of questionable certification requirements.

    I am curious as to whether you have contacted the CCHIT with the above concerns. How have they responded?

    Nice to see cogent arguments on the subject! Thanks for the post.

  9. Cheers for the “unconference”. On biographies, our product’s history, and the all the statistics about our health system: no one cares! certainly not the terribly busy ones focused on on solving HC problems. And all the provider presenters HIMSS picks – most of these are too scared to say anything bad about their health system or vendor – so we get a happy presentation where everything went well except a few vague lessons learned like “be sure to get executive buy-in…don’t skimp on training”. We all know we learn from people who have gone to battle, come back, and tell us everything. And ones that have found a truly novel new approach to a problem and can speak concisely about it. I can’t afford to go to Las Vegas (would love to), so I like idea of a virtual conference. I’ll miss the networking, but no reason the knowledge transfrer from the presentations, panels, and exhibit halls can’t be done online. Product demos included (with real working products of course)… & I’ve never understood why vendors don’t demos online readily available?… do they believe that their competitors haven’t seen their product yet, or that someone is going to say, “wow, seeing the Premise bed tracking demo now gives me what iI need to go make money developing bed tracking software”?. So the unconference has my vote… & I’m happy to pay to cover the costs. And if HISTalk coordinated it to keep it real, I’d pay double.







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