Are you for or against CCHIT?

Yes, yes, I know this question elicits strong opinion on both sides of the debate. I'm actually not inviting a CCHIT response.

CCHIT polarises any EMR community into those vehemently against government control versus those who favor standards and the clarity that those standards might provide, or not as the case maybe. No question, this is an important debate which will continue as long as there are posters prepared to state and defend their positions.

We have some notable, vociferous and energetic EMR/u posters on both sides of this debate. I know all of these posters have genuine (or at least a grudging) respect for each other and they appreciate the chance to promote their view and values. It doesn't take a genius to work out why we have two camps; the EMR vendor who can afford CCHIT certification versus the vendor and Doctor who cannot afford a CCHIT-based product, and those in-between.

• Should EMR/u take a side? That's up to you. The collective feel of your posts is how we're judged as pro or anti-anything. I don't think we have a role either way except to try and support the debate. This was the whole point of the VECHIT forum section and it's aborted VECHIT.ORG web-site, to channel that debate into its own mini-community. Were we guilty of promoting an anti-CCHIT stance? Probably, but we're not paid to do this, so get over it. [me] I'm English, genetically I favor David over Goliath, small versus large, Doctor versus Vendor. [/me]
  
  
• Why has EMR/u moved VECHIT posts? This is a [wikipedia:Quid Pro Quo]. I've moved all the CCHIT content from VECHIT to the EMR forum and removed that forum area. I've done this to ensure we can continue the CCHIT debate -- it would be a fruitless task trying to move all CCHIT threads somewhere else. The trade I request is that we try to KEEP thread discussions to the originating THREAD as far is reasonable. That means please have a CCHIT debate BUT don't stamp it across other threads that have done nothing to deserve such a fate.
  
  
• May I abuse the phrase incorrectly attributed to [wikipedia:Voltaire]: "You may entirely, religiously and fundamentally disagree with that poster, but should stoutly defend his right to be heard and respected."

It would be pretty boring if there was no one brave enough to enter our discussions. You do know there are lurkers on this forum who -- can't say I blame them -- who are nervous about entering into the discussions because they fear injury, flame or ridicule. It can get pretty robust in here sometimes. Now that's losing a chunk of comment that could be valuable. Maybe if folks were a little nicer, a little more respecting of a forum thread, a visiting poster, a perspective, that wouldn't be such a bad thing?

Just for a moment, consider how difficult it is trying to moderate any of these discussions where we have such polarization and strong opinion. A moderator is by nature always wrong in someone's eyes, and yes, we have feelings too and a limited supply of Prozac. You should count yourself lucky. No one has asked you to moderate here.

Thanks, Nick.

It is very frustrating when a thread is about one thing and then we all end up on the same old soap boxes.  If we stay on topic I believe we can be of great assistance to the EMR Lurker Community that turns to this one of just a few sources on EMR/EHR with a long history.

Brendon:

Thanks, Nick.

It is very frustrating when a thread is about one thing and then we all end up on the same old soap boxes.  If we stay on topic I believe we can be of great assistance to the EMR Lurker Community that turns to this one of just a few sources on EMR/EHR with a long history.

I think Brendon has it right.

BTW Nick, as usual I prefer Lewis Carroll

Always speak the truth, think before you speak, and write it down afterwards (the Red Queen)

Why is it that the only ones it seems that I've seen of late that are neutral or pro-CCHIT are just high end vendors?

Nick Harrington:

Just for a moment, consider how difficult it is trying to moderate any of these discussions where we have such polarization and strong opinion. A moderator is by nature always wrong in someone's eyes, and yes, we have feelings too and a limited supply of Prozac. You should count yourself lucky. No one has asked you to moderate here.

Nick, thanks for your usual fairness and clear thinking. Although I made a bloody mess of things yesterday, I did learn something: when lots of doctors band together against you, you know you did something wrong!

Now see these young doctors- I don't know which EMR they will get, but if they happen to get $40,000 EMRs their loan goes up by that much.

http://money.cnn.com/2007/11/16/pf/young_doctors.moneymag/index.htm?cnn=yes

Does anyone know about that Dr.Notes EMR that was CCHIT certified ? \

Try this google, [link in new window] who's #3 ! 

Great article, Joseph! The dude in the article was stupid, though, to pass up the $9000 a year state medical school for the $29000 a year osteopathic school. Dumb move. I don't understand why the couple didn't join the Reserves- you give the Army a year, and they will pay for a year of schooling. It's not a bad deal if you stand to owe a lot of money.

I went to a "state school" in Richmond, VA which cost me $9000 (including room and board). They even paid for some of my vacations, since as "secretary" of the AMSA (American Medical Student Asso chapter) I got to go to meetings in other states,

Next thing you'll know, this budding anesthesiologist will be buying up a "big boy" EHR. Heck, why not? What's $700000 vs $740000 in the hole? I know those types- they like to spend money like crazy all the way up to bankruptcy.

Jason- there is no way that Dr. Notes was ever CCHIT certified, but I'm sure that they could have passed had they ponied up that $28000 a year!

Dr. Notes went out of business.

Acermed is the staple for what CCHIT means to financial viability.  If you have the buy in and the features can be presented in a one day review, you get certified.  The solution can be entirely vaporware and screen shots, but if it is seen as finished and in the current release, it is certified.

Acermed proved that CCHIT has a long way to go in proving companies really do what they passed to do.  This is where this Acermed case really dissapointed me, as it proved the one company that is alledgedly certifying functionality of a particular version actually failed to do so.

In any case it is the only such organization and hopefully they improve on this disaster. 

That being said, I think you are off base to say all CCHIT products are changing new office startup costs from $70,000 to $740,000.  Lets see two of the people on the list is eMds and eClinicalworks for 2007 and going on.  There are 10 certified vendors and two of them I know for sure charge around $10,000 for one physician and $7,500 for each additional physician.  I hardly can see you extrapulating $100K plus from this, and definetely not a $500,000.

See not all EMR/EHR certified are 30K per physician, but some are.   Your analysis are false and the facts don't bare out.

I understand your hatred for CCHIT and Mark Leavitt.  I am not a big fan either, because of the structure and costs.  I believe that the process should be free or low cost and provided by the Government, not a quasi-private/government organization.

But you cannot make a argument of cost, you have to use something else.  Unless of course you think everyone should give away software for free.  I don't see where taking away profit and free enterprise would benefit innovation and the end user.  I don't think you would be speaking for all Physicians/Consumers if you stated that the profit motivation and innovation should be taken out of EMR/EHR software.

This would be terrible for the industry.  For example, our eMedRec would not exist.  I am not developing software for our end users out of the kindness of my heart.  I am doing it so that I can feed my employees and earn a living to pay my bills and grow my company.  I am working hard to keep our consumers happy, that is the American Way.  If you want it free, go to Cuba.  You can get it free, but hardly can you get it improved on, since there is no motivation to do anything profitable.

 

Unless you are going for the cigars, no need to go to cuba, just drop by Boston in March. 

I don't fully understand the issue with CCHIT (not being a doc explains a lot) - my question is - how does it differ from HL7 in that it may be led by major industry players but there is a common good to all speaking the same language.  Except it is not systems speaking it is docs expecting a minimum set of features from a system.

At *least* the features, test cases and certification process is open - I think that is rather progressive and lets me into the game.

For me it gives me something to shoot at, and sure it will not certify code quality nor business owner savy (how could it) but at least it helps show that Open Source can be in the same ballpark as a commercial system (way to go Vista).

Of course perhaps I am being optmistic that I can persuade them to certify me for free (or all the spare change in my wallet).  But even if they don't I will simply show online how my system meets every criteria (as could anyone needing to save the 24k) - so I get certified or virtually certified (maybe that is Al's premise).

Disclaimer - I doubt I will have *all* the functionality implemented until near the end of next year.

 Greg

http://www.patientos.org

 

good points,

but the politicians have spoken and Medicare will only reimburse on CCHIT certified systems, not compatable systems.

 

Really, now that's not nice.  When does that start?  Is that just for ambulatory - or inpatient too?

Not nice, not because of the criteria but the price - did someone say 24k - that wasn't per year was it?

Hmm, maybe I should lobby for some simple criteria that would throw at least one large vendor into disarray in an effort to meet it.

I guess I better start saving up... or looking for some social benefactor...

Greg

http://www.patientos.org

>>> Really, now that's not nice.  When does that start?  Is that just for ambulatory - or inpatient too? Not nice, not because of the criteria but the price - did someone say 24k - that wasn't per year was it?

It was $28000 for 1st year, then $4000 a year for years 2 and 3, BUT now Dr. Leavitt is pushing only those certified for the current year, and the Stark anti-kickback relaxation law only covers current year certifications, which means that they want vendors to pay $28000 a year.

The Medicare P4P trial will be only for the ambulatory setting.

>>> but the politicians have spoken and Medicare will only reimburse on CCHIT certified systems, not compatable systems.

Brendon, I could sense your (and everyone else's) anxiety over this, but in my study on CCHIT I've realized that those MOST angry at CCHIT/P4P/forced EHR ownership are the medical practices themselves who are looking at adding further useless expenses in an environment of payment cutbacks.

Just as there are fools that still answer their spam mailings, there are some physicians that want to give P4P a try since they've been promised by Medicare to make a killing even if it means that in a cost-neutral envirnment they will be stealing their "wealth" from their fellow physicians. Eventually they will switch back to the stark (pun intended) reality that Medicare will use P4P to DECREASE everyone's incomes, and that they could do better just seeing patients from PPOs, HMOs or for cash only. By that time, unfortunately, they would be $30000 to $60000 in debt in a useless, bloated CCHIT certified "EHR".

The Department of Health and Human Services has decided to run this P4P trial only using a "opt in only" basis because they know that if they force it on everyone they run the chance of losing the majority of participating physicians that currently work with Medicare.

That is the reason why only the portion of my anti-CCHIT effort that addresses physicians is what is important and fortunately has been most effective. If vendors want to throw money away at this lame excuse for certification, then its their prerogative. They need to understand, though, that they are funding the "enemy", i.e. those various enterprise-level vendors that wish to do them harm by cutting off their exposure to the EMR market by whatever it takes.

In my future activities I'll be working for Al Borges "the doctor" and not Al Borges "the vendor who gives out a free EMR" as I've found it frustrating to work with certain vendors on this. It may be that they don't understand the issues involved, or maybe they have the misguided feeling that only through certification can they make a living, or simply CCHIT doesn't affect them nearly as much as doctors who are going to get royally scr*wed if this stuff ever becomes law. Anyhow, vendors are on their own from now on... I'm tired of preaching to that crowd.

Al,

Good answer, but again the argument is against high price.  As I presented there are solutions in the 10k range.

>>> But you cannot make a argument of cost, you have to use something else.

You see that is where physicians and vendors differ- most physicians are price conscious because we're getting our livelihood dessimated by Medicare/BCBS/Aetna/United and other insurance companies.

You guys think that we have deep pockets and unlimited resources... we don't. Even $10000 is a lot, but please don't ignore what I've complained about the other problems with CCHIT that bug most doctors:

• the effect of the CCHIT certified bloat on workflow can be seriously problematic.
• The effect on CCHIT to be the kernel of the P4P schemes is now the center of attention.
• The effect of CCHIT on EMR competition and thus our choice of EMR is also criminal.
• Its abuse of the not-for-profit statutes is also on the fringe of the law.
• Forcing physicians to purchase these bloated EMR is simply misguided.

So it is not just cost- I've mentioned numerous arguments in most of my notes; there are a dozen other CCHIT problems outside of cost. But cost is important, and if you force a physician to purchase "x" EHR if they don't want to, then ANY cost is way too much- even if it's FREE.

>>> There are 10 certified vendors and two of them I know for sure charge around $10,000 for one physician and $7,500 for each additional physician.

Plus costs for hardware, teaching (this can be more than the up-front costs), maintenance and other miscellaneous costs, as well as the $500/month or 15% per year fees. The $10000 is only to trap the enduser into the other open-ended agreement that is not unlike any other rental agreement.

I've posted the 2 articles from the aafp website that shows that the same $10000 per license can equate to between $125000 (one article) to $250000 (the other article) over 5 years... not chump change.

Physicians want something that will cost them $1000 for software, training, etc for a ONE TIME CHARGE, with slightly more for the hardware. Why do you think the AC group is so vocal and protective of their software? This is the usual and customary costs for most other industries- just because a purchaser is a physician, chiropracter, dentist, doesn't mean that he has to pay outrageous sums of money for an EMR.