Readers Write 2/19/09

Submit your article of up to 500 words in length, subject to editing for clarity and brevity. I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

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

I 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.