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TR Posted: 12-01-2006 8:38 AM

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Does I.T. Certification Favor the Big Boys?

By Joseph Goedert

The Certification Commission for Healthcare Information Technology recently reached a milestone when the Department of Health and Human Services designated it as a "recognized certification body."

But not everyone is enamored with the work of the industry-created organization, now working under a federal contract. An anti-CCHIT effort has sprung up on the Internet, and several participants have filed complaints with the Federal Trade Commission, alleging that CCHIT is engaging in unfair business practices. There are now 35 certified ambulatory EMRs.

The movement convenes on a Weblog at www.emrupdate.com, which is an online community for physicians looking for information from peers about electronic medical records.

But much of the information on the anti-CCHIT Weblog is not accurate. The site, for instance, alleges that CCHIT is owned by the very vendors it certifies and any profits made by CCHIT "are disbursed among the same CCHIT vendor-owners at year's end."

The organization actually is owned by three trade associations-one of which hosts an electronic medical records vendor special interest group among its many member services. Any profits would be reinvested in CCHIT, says Mark Leavitt, M.D., chairman, and CCHIT expects by year-end to become an independent, not-for-profit organization

But the site does raise some legitimate issues, says David Winn, president and CEO at eMDs Inc. The Austin, Texas-based EMR vendor is CCHIT-certified, and Winn served on the organization's functionality workgroup.

Some smaller EMR vendors that sell relatively inexpensive products, and the physicians they serve are concerned that the certification process is unfair and unaffordable, Winn says. The fear is that one goal of CCHIT "is to knock off some of these vendors and thereby limit the choices to a select group of EMR products," he adds. "CCHIT has enormous promise and maybe it will all work out, but there certainly are things to be concerned about."

Decreased competition?

In an interview posted on the anti-CCHIT Weblog, Alberto Borges, M.D., an Arlington, Va.-based oncologist and a leader of the anti-CCHIT movement, contended the certification process favors large vendors of expensive EMRs and is designed to squeeze out others.

"CCHIT will likely end competition from free to low-cost EMRs and will decrease the revenue of many EMR vendors," Borges said. He did not respond to several requests from Health Data Management for an interview.

Posts by others on the Weblog contend that certification costs can exceed $200,000, so vendors of basic $1,000 software for small and solo practices would have to sell 200 copies just to pay for certification.

Certification is very expensive, says Winn at eMDs. CCHIT charges $28,000 for the initial certification process, which bestows certification good for three years. But vendors also pay $4,200 for each of the second and third years. And certification is granted only for a specific version of a specific product, not to a vendor's portfolio of EMR applications.

The second and third-year fees are a "certification maintenance fee" that contributes to CCHIT's operating budget, Leavitt says. A "very significant" part of the budget is for communication and outreach activities; Leavitt took 50 trips during the first 10 months of 2006 to promote the certifying of health I.T. systems. "We aren't hearing complaints about the maintenance fee or that our marketing and communications are ineffective," he contends.

Further, CCHIT's contract with HHS ends in October 2008, and the organization must become financially self-sustaining by that time, Leavitt adds.

But the fees are only the start of certification expenses, Winn notes. He estimates eMDs spent $230,000 this year to get certified, including the $28,000 fee. "The test is 100% pass/fail so you have to spend an enormous amount of time and effort," he says.

But Winn also projects the company will spend $128,000 on certification next year. That's because each year certification criteria will change-even if it doesn't, a new product or new version of an existing product needs to go through the process. "My marketers say, 'If you don't certify each year, your competitors will use that against you and say there's something wrong,'" Winn notes.

Opponents of CCHIT on the Weblog contend the certification criteria, even in its initial stages, requires functionality that many small physicians don't need and won't use.

They have a point, says Winn, whose company serves small practices. His company had to increase its data security by adding functions that are "critically important in a large practice but overkill in a small one."

Requiring strong passwords and automated timing out of a user doesn't complement the workflow of a solo physician seeing patients in three rooms at the same time, Winn says. And comprehensive audit trails in a low-cost, small-practice EMR add a data processing burden that can adversely affect performance.

CCHIT is supposed to certify EMRs for meeting minimal requirements for functionality, security/reliability and interoperability, and certified members must meet 100% of the criteria. But the criteria are created by committees whose members are pulled by many special interests, Winn believes.

That could lead to overkill on criteria, which could push out smaller vendors, he contends. For instance, one proposed criteria for 2007 that has been tabled would have required data be date-and time-stamped by Greenwich Mean Time, he says. "That would have been impossible for many vendors to incorporate," he adds.

The bottom line, Winn says, is that CCHIT should have different sets of criteria for vendors, depending on the size and specialty of the practices they serve. "Functionality requirements sound great, but all products will look alike and the only ones that will survive are those of vendors that can afford to go through the certification process."

CCHIT leaders are listening, and changes will come over time-starting in 2007-to make some criteria more specific to certain markets, Leavitt says.

Discussions are underway to have different criteria for different specialties, such as behavioral health, pediatrics and cardiology, he notes. "That constitutes running, and we needed to walk in the first year."

The goal of CCHIT, Leavitt says, is to make it easier for providers to select EMRs. Whether that requires a smaller number of vendors or existing vendors to change their products to meet specifications, "doesn't matter to us," he adds. "It's their choice. The marketplace will sort that out."

But not everyone is enamored with the work of the industry-created organization, now working under a federal contract. An anti-CCHIT effort has sprung up on the Internet, and several participants have filed complaints with the Federal Trade Commission, alleging that CCHIT is engaging in unfair business practices. There are now 35 certified ambulatory EMRs.

The movement convenes on a Weblog at www.emrupdate.com, which is an online community for physicians looking for information from peers about electronic medical records.

But much of the information on the anti-CCHIT Weblog is not accurate. The site, for instance, alleges that CCHIT is owned by the very vendors it certifies and any profits made by CCHIT "are disbursed among the same CCHIT vendor-owners at year's end."

The organization actually is owned by three trade associations-one of which hosts an electronic medical records vendor special interest group among its many member services. Any profits would be reinvested in CCHIT, says Mark Leavitt, M.D., chairman, and CCHIT expects by year-end to become an independent, not-for-profit organization

But the site does raise some legitimate issues, says David Winn, president and CEO at eMDs Inc. The Austin, Texas-based EMR vendor is CCHIT-certified, and Winn served on the organization's functionality workgroup.

Some smaller EMR vendors that sell relatively inexpensive products, and the physicians they serve are concerned that the certification process is unfair and unaffordable, Winn says. The fear is that one goal of CCHIT "is to knock off some of these vendors and thereby limit the choices to a select group of EMR products," he adds. "CCHIT has enormous promise and maybe it will all work out, but there certainly are things to be concerned about."

Decreased competition?

In an interview posted on the anti-CCHIT Weblog, Alberto Borges, M.D., an Arlington, Va.-based oncologist and a leader of the anti-CCHIT movement, contended the certification process favors large vendors of expensive EMRs and is designed to squeeze out others.

"CCHIT will likely end competition from free to low-cost EMRs and will decrease the revenue of many EMR vendors," Borges said. He did not respond to several requests from Health Data Management for an interview.

Posts by others on the Weblog contend that certification costs can exceed $200,000, so vendors of basic $1,000 software for small and solo practices would have to sell 200 copies just to pay for certification.

Certification is very expensive, says Winn at eMDs. CCHIT charges $28,000 for the initial certification process, which bestows certification good for three years. But vendors also pay $4,200 for each of the second and third years. And certification is granted only for a specific version of a specific product, not to a vendor's portfolio of EMR applications.

The second and third-year fees are a "certification maintenance fee" that contributes to CCHIT's operating budget, Leavitt says. A "very significant" part of the budget is for communication and outreach activities; Leavitt took 50 trips during the first 10 months of 2006 to promote the certifying of health I.T. systems. "We aren't hearing complaints about the maintenance fee or that our marketing and communications are ineffective," he contends.

Further, CCHIT's contract with HHS ends in October 2008, and the organization must become financially self-sustaining by that time, Leavitt adds.

But the fees are only the start of certification expenses, Winn notes. He estimates eMDs spent $230,000 this year to get certified, including the $28,000 fee. "The test is 100% pass/fail so you have to spend an enormous amount of time and effort," he says.

But Winn also projects the company will spend $128,000 on certification next year. That's because each year certification criteria will change-even if it doesn't, a new product or new version of an existing product needs to go through the process. "My marketers say, 'If you don't certify each year, your competitors will use that against you and say there's something wrong,'" Winn notes.

Opponents of CCHIT on the Weblog contend the certification criteria, even in its initial stages, requires functionality that many small physicians don't need and won't use.

They have a point, says Winn, whose company serves small practices. His company had to increase its data security by adding functions that are "critically important in a large practice but overkill in a small one."

Requiring strong passwords and automated timing out of a user doesn't complement the workflow of a solo physician seeing patients in three rooms at the same time, Winn says. And comprehensive audit trails in a low-cost, small-practice EMR add a data processing burden that can adversely affect performance.

CCHIT is supposed to certify EMRs for meeting minimal requirements for functionality, security/reliability and interoperability, and certified members must meet 100% of the criteria. But the criteria are created by committees whose members are pulled by many special interests, Winn believes.

That could lead to overkill on criteria, which could push out smaller vendors, he contends. For instance, one proposed criteria for 2007 that has been tabled would have required data be date-and time-stamped by Greenwich Mean Time, he says. "That would have been impossible for many vendors to incorporate," he adds.

The bottom line, Winn says, is that CCHIT should have different sets of criteria for vendors, depending on the size and specialty of the practices they serve. "Functionality requirements sound great, but all products will look alike and the only ones that will survive are those of vendors that can afford to go through the certification process."

CCHIT leaders are listening, and changes will come over time-starting in 2007-to make some criteria more specific to certain markets, Leavitt says.

Discussions are underway to have different criteria for different specialties, such as behavioral health, pediatrics and cardiology, he notes. "That constitutes running, and we needed to walk in the first year."

The goal of CCHIT, Leavitt says, is to make it easier for providers to select EMRs. Whether that requires a smaller number of vendors or existing vendors to change their products to meet specifications, "doesn't matter to us," he adds. "It's their choice. The marketplace will sort that out."

But not everyone is enamored with the work of the industry-created organization, now working under a federal contract. An anti-CCHIT effort has sprung up on the Internet, and several participants have filed complaints with the Federal Trade Commission, alleging that CCHIT is engaging in unfair business practices. There are now 35 certified ambulatory EMRs.

The movement convenes on a Weblog at www.emrupdate.com, which is an online community for physicians looking for information from peers about electronic medical records.

But much of the information on the anti-CCHIT Weblog is not accurate. The site, for instance, alleges that CCHIT is owned by the very vendors it certifies and any profits made by CCHIT "are disbursed among the same CCHIT vendor-owners at year's end."

The organization actually is owned by three trade associations-one of which hosts an electronic medical records vendor special interest group among its many member services. Any profits would be reinvested in CCHIT, says Mark Leavitt, M.D., chairman, and CCHIT expects by year-end to become an independent, not-for-profit organization

But the site does raise some legitimate issues, says David Winn, president and CEO at eMDs Inc. The Austin, Texas-based EMR vendor is CCHIT-certified, and Winn served on the organization's functionality workgroup.

Some smaller EMR vendors that sell relatively inexpensive products, and the physicians they serve are concerned that the certification process is unfair and unaffordable, Winn says. The fear is that one goal of CCHIT "is to knock off some of these vendors and thereby limit the choices to a select group of EMR products," he adds. "CCHIT has enormous promise and maybe it will all work out, but there certainly are things to be concerned about."

Decreased competition?

In an interview posted on the anti-CCHIT Weblog, Alberto Borges, M.D., an Arlington, Va.-based oncologist and a leader of the anti-CCHIT movement, contended the certification process favors large vendors of expensive EMRs and is designed to squeeze out others.

"CCHIT will likely end competition from free to low-cost EMRs and will decrease the revenue of many EMR vendors," Borges said. He did not respond to several requests from Health Data Management for an interview.

Posts by others on the Weblog contend that certification costs can exceed $200,000, so vendors of basic $1,000 software for small and solo practices would have to sell 200 copies just to pay for certification.

Certification is very expensive, says Winn at eMDs. CCHIT charges $28,000 for the initial certification process, which bestows certification good for three years. But vendors also pay $4,200 for each of the second and third years. And certification is granted only for a specific version of a specific product, not to a vendor's portfolio of EMR applications.

The second and third-year fees are a "certification maintenance fee" that contributes to CCHIT's operating budget, Leavitt says. A "very significant" part of the budget is for communication and outreach activities; Leavitt took 50 trips during the first 10 months of 2006 to promote the certifying of health I.T. systems. "We aren't hearing complaints about the maintenance fee or that our marketing and communications are ineffective," he contends.

Further, CCHIT's contract with HHS ends in October 2008, and the organization must become financially self-sustaining by that time, Leavitt adds.

But the fees are only the start of certification expenses, Winn notes. He estimates eMDs spent $230,000 this year to get certified, including the $28,000 fee. "The test is 100% pass/fail so you have to spend an enormous amount of time and effort," he says.

But Winn also projects the company will spend $128,000 on certification next year. That's because each year certification criteria will change-even if it doesn't, a new product or new version of an existing product needs to go through the process. "My marketers say, 'If you don't certify each year, your competitors will use that against you and say there's something wrong,'" Winn notes.

Opponents of CCHIT on the Weblog contend the certification criteria, even in its initial stages, requires functionality that many small physicians don't need and won't use.

They have a point, says Winn, whose company serves small practices. His company had to increase its data security by adding functions that are "critically important in a large practice but overkill in a small one."

Requiring strong passwords and automated timing out of a user doesn't complement the workflow of a solo physician seeing patients in three rooms at the same time, Winn says. And comprehensive audit trails in a low-cost, small-practice EMR add a data processing burden that can adversely affect performance.

CCHIT is supposed to certify EMRs for meeting minimal requirements for functionality, security/reliability and interoperability, and certified members must meet 100% of the criteria. But the criteria are created by committees whose members are pulled by many special interests, Winn believes.

That could lead to overkill on criteria, which could push out smaller vendors, he contends. For instance, one proposed criteria for 2007 that has been tabled would have required data be date-and time-stamped by Greenwich Mean Time, he says. "That would have been impossible for many vendors to incorporate," he adds.

The bottom line, Winn says, is that CCHIT should have different sets of criteria for vendors, depending on the size and specialty of the practices they serve. "Functionality requirements sound great, but all products will look alike and the only ones that will survive are those of vendors that can afford to go through the certification process."

CCHIT leaders are listening, and changes will come over time-starting in 2007-to make some criteria more specific to certain markets, Leavitt says.

Discussions are underway to have different criteria for different specialties, such as behavioral health, pediatrics and cardiology, he notes. "That constitutes running, and we needed to walk in the first year."

The goal of CCHIT, Leavitt says, is to make it easier for providers to select EMRs. Whether that requires a smaller number of vendors or existing vendors to change their products to meet specifications, "doesn't matter to us," he adds. "It's their choice. The marketplace will sort that out."

But not everyone is enamored with the work of the industry-created organization, now working under a federal contract. An anti-CCHIT effort has sprung up on the Internet, and several participants have filed complaints with the Federal Trade Commission, alleging that CCHIT is engaging in unfair business practices. There are now 35 certified ambulatory EMRs.

The movement convenes on a Weblog at www.emrupdate.com, which is an online community for physicians looking for information from peers about electronic medical records.

But much of the information on the anti-CCHIT Weblog is not accurate. The site, for instance, alleges that CCHIT is owned by the very vendors it certifies and any profits made by CCHIT "are disbursed among the same CCHIT vendor-owners at year's end."

The organization actually is owned by three trade associations-one of which hosts an electronic medical records vendor special interest group among its many member services. Any profits would be reinvested in CCHIT, says Mark Leavitt, M.D., chairman, and CCHIT expects by year-end to become an independent, not-for-profit organization

But the site does raise some legitimate issues, says David Winn, president and CEO at eMDs Inc. The Austin, Texas-based EMR vendor is CCHIT-certified, and Winn served on the organization's functionality workgroup.

Some smaller EMR vendors that sell relatively inexpensive products, and the physicians they serve are concerned that the certification process is unfair and unaffordable, Winn says. The fear is that one goal of CCHIT "is to knock off some of these vendors and thereby limit the choices to a select group of EMR products," he adds. "CCHIT has enormous promise and maybe it will all work out, but there certainly are things to be concerned about."

Decreased competition?

In an interview posted on the anti-CCHIT Weblog, Alberto Borges, M.D., an Arlington, Va.-based oncologist and a leader of the anti-CCHIT movement, contended the certification process favors large vendors of expensive EMRs and is designed to squeeze out others.

"CCHIT will likely end competition from free to low-cost EMRs and will decrease the revenue of many EMR vendors," Borges said. He did not respond to several requests from Health Data Management for an interview.

Posts by others on the Weblog contend that certification costs can exceed $200,000, so vendors of basic $1,000 software for small and solo practices would have to sell 200 copies just to pay for certification.

Certification is very expensive, says Winn at eMDs. CCHIT charges $28,000 for the initial certification process, which bestows certification good for three years. But vendors also pay $4,200 for each of the second and third years. And certification is granted only for a specific version of a specific product, not to a vendor's portfolio of EMR applications.

The second and third-year fees are a "certification maintenance fee" that contributes to CCHIT's operating budget, Leavitt says. A "very significant" part of the budget is for communication and outreach activities; Leavitt took 50 trips during the first 10 months of 2006 to promote the certifying of health I.T. systems. "We aren't hearing complaints about the maintenance fee or that our marketing and communications are ineffective," he contends.

Further, CCHIT's contract with HHS ends in October 2008, and the organization must become financially self-sustaining by that time, Leavitt adds.

But the fees are only the start of certification expenses, Winn notes. He estimates eMDs spent $230,000 this year to get certified, including the $28,000 fee. "The test is 100% pass/fail so you have to spend an enormous amount of time and effort," he says.

But Winn also projects the company will spend $128,000 on certification next year. That's because each year certification criteria will change-even if it doesn't, a new product or new version of an existing product needs to go through the process. "My marketers say, 'If you don't certify each year, your competitors will use that against you and say there's something wrong,'" Winn notes.

Opponents of CCHIT on the Weblog contend the certification criteria, even in its initial stages, requires functionality that many small physicians don't need and won't use.

They have a point, says Winn, whose company serves small practices. His company had to increase its data security by adding functions that are "critically important in a large practice but overkill in a small one."

Requiring strong passwords and automated timing out of a user doesn't complement the workflow of a solo physician seeing patients in three rooms at the same time, Winn says. And comprehensive audit trails in a low-cost, small-practice EMR add a data processing burden that can adversely affect performance.

CCHIT is supposed to certify EMRs for meeting minimal requirements for functionality, security/reliability and interoperability, and certified members must meet 100% of the criteria. But the criteria are created by committees whose members are pulled by many special interests, Winn believes.

That could lead to overkill on criteria, which could push out smaller vendors, he contends. For instance, one proposed criteria for 2007 that has been tabled would have required data be date-and time-stamped by Greenwich Mean Time, he says. "That would have been impossible for many vendors to incorporate," he adds.

The bottom line, Winn says, is that CCHIT should have different sets of criteria for vendors, depending on the size and specialty of the practices they serve. "Functionality requirements sound great, but all products will look alike and the only ones that will survive are those of vendors that can afford to go through the certification process."

CCHIT leaders are listening, and changes will come over time-starting in 2007-to make some criteria more specific to certain markets, Leavitt says.

Discussions are underway to have different criteria for different specialties, such as behavioral health, pediatrics and cardiology, he notes. "That constitutes running, and we needed to walk in the first year."

The goal of CCHIT, Leavitt says, is to make it easier for providers to select EMRs. Whether that requires a smaller number of vendors or existing vendors to change their products to meet specifications, "doesn't matter to us," he adds. "It's their choice. The marketplace will sort that out."

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gchiu replied on 12-01-2006 2:56 PM

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TR:

The goal of CCHIT, Leavitt says, is to make it easier for providers to select EMRs. Whether that requires a smaller number of vendors or existing vendors to change their products to meet specifications, "doesn't matter to us," he adds. "It's their choice. The marketplace will sort that out."

The goal of CCHIT was to increase uptake by physicians.  This new goal is not the same. 

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digital-doc replied on 12-01-2006 3:29 PM

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gchiu:

TR:

The goal of CCHIT, Leavitt says, is to make it easier for providers to select EMRs. Whether that requires a smaller number of vendors or existing vendors to change their products to meet specifications, "doesn't matter to us," he adds. "It's their choice. The marketplace will sort that out."

The goal of CCHIT was to increase uptake by physicians.  This new goal is not the same. 

I'm not opposed to CCHIT on principle, but if their goal is to genuinely accelerate adoption, then they should keep it simple and work on mandating an EMR interface that is intuitive and operable without spending thousands of dollars on training.  ALL EMRs should be intuitive enough to have a para-professional enter the demographics, and  the doctor be able to create a simple chart note based on their exam findings. Friendly productive software is what will accelerate adoption. IT requirements should be recommended but not necessarily mandated.

 CCHIT favors deep pockets/Big Boys, just ask any compliant vendor that defines deep as more than $28k, the mere tip of the financial iceberg.

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alborg replied on 12-01-2006 8:22 PM

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>>> The organization actually is owned by three trade associations-one of which hosts an electronic medical records vendor special interest group among its many member services. Any profits would be reinvested in CCHIT, says Mark Leavitt, M.D., chairman, and CCHIT expects by year-end to become an independent, not-for-profit organization

That is an absolute LIE! We don't make false accusations, and what we've stated so far is well documented. The statement, "Any profits that are made by CCHIT are disbursed among the same CCHIT vendor-owners at year's end." comes right out of their operating agreement, located at:

 http://www.cchit.org/NR/rdonlyres/527C461A-2471-4D8A-88BC-8BE45A14D7A0/0/CCHITOperatingAgreement_asof_20060119_Finalsigned.pdf

Unfortunately it's now password protected (and with my CCHIT password doesn't work there anymore). It's I guess on a "need to know" basis, and I don't need to know anymore.

BTW, a very precise, concise, and informative expose can be found here: http://www.emrupdate.com/forums/post/59035.aspx.

Overall, though, the report is well done!  I'll have to write to the editor to get the above corrected. We have to be completely accurate. I stopped posting the above PDF URL because shortly after I first published a reference to it, it was administrative password protected on the CCHIT website.

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gchiu replied on 12-01-2006 8:56 PM

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Al, what's this about ?

 ""CCHIT will likely end competition from free to low-cost EMRs and will decrease the revenue of many EMR vendors," Borges said. He did not respond to several requests from Health Data Management for an interview."

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alborg replied on 12-01-2006 9:17 PM

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That's a lie. When have I ever backed away from an interview... I love the limelight! Anyhow, why would I write to them several times than not want to speak with them?

Unfortunately, HDM is in the pocket of HIMSS/CCHIT. I'm surprised that they posted this article at all! It means that they are feeling the heat and wish to diffuse it...

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alborg replied on 12-01-2006 9:36 PM

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Dear Mr. Geodert:

Your article, "Does I.T. Certification Favor the Big Boys?" was well written. Thanks for bringing up the important issues surrounding both CCHIT and the anti-CCHIT movement. There is are a couple of things that I would like to clarify:

You state>>> "But much of the information on the anti-CCHIT Weblog is not accurate. The site, for instance, alleges that CCHIT is owned by the very vendors it certifies and any profits made by CCHIT "are disbursed among the same CCHIT vendor-owners at year's end.""
Dr. Leavitt states>>> "Any profits would be reinvested in CCHIT, says Mark Leavitt, M.D., chairman, and CCHIT expects by year-end to become an independent, not-for-profit organization

Just like CCHIT is supposedly not-for-profit, Dr. Leavitt is not-so-truthful. You can check their "operating agreement" papers. I did just that a while back and it clearly stated:

"Any profits that are made by CCHIT are disbursed among the same CCHIT vendor-owners at year's end."

 http://www.cchit.org/NR/rdonlyres/527C461A-2471-4D8A-88BC-8BE45A14D7A0/0/CCHITOperatingAgreement_asof_20060119_Finalsigned.pdf

Unfortunately, this PDF is now on a need-to-know basis, with an administrative password that only those insiders have. I'm sure that I have a copy of it on my home laptop if you wish to review it.

Everything that I've quoted is cited and verified. Now, you state this in the article:

>>> "CCHIT will likely end competition from free to low-cost EMRs and will decrease the revenue of many EMR vendors," Borges said. He did not respond to several requests from Health Data Management for an interview."

When did you contact me? Nover! I enjoy interviews and would very much wish to speak with you about these issues further. Why on earth would I send off several letters to the editor to you then simply rebuff your efforts for an interview? That doesn't make any sense... Here is my contact information:

• Office (12nn to 11pm)- xxxxxxxxxx
• Beeper- xxxxxxxxxx
• Home- xxxxxxxxxx
• Skype- "alborgmd"
• email- alborgmd0-1 at yahoo.com
• http://emrupdate.com- contact me privately or start a thread of discussion.

(all I ask is that you don't contact me while I sleep, between 6am and 12nn ET)

Again, thank you and warm regards.

Sincerely,
Al Borges MD

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gchiu replied on 12-01-2006 10:03 PM

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alborg:

Nover!

Never! 

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alborg replied on 12-02-2006 1:00 AM

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>>> Nover!

OOPS!

Actually, I got the document with the "profits" quote to download. The problem is that the CCHIT site is even slower than this one; it'll time out if you put in your name and password while trying to download the PDF. You have to log into the site, wait 5 minutes, then try to download the document. It's best to do a search for "operating agreement". You need to look at chapters 3.4 and 5.4.

If anyone has any problems, I could email the document to them... Since it is the property of CCHIT, it would be best not to post for download.

Cheers,

Al

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alborg replied on 12-02-2006 1:26 AM

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Follow-up letter-to-the-editor:

----------------------------- start ---------------------------------

Dear Mr. Geodert:

This is a follow-up to my reply to Your article, "Does I.T. Certification Favor the Big Boys?" Actually the publication, the "CCHIT Operating Agreement" can be downloaded from the site. Unfortunately, the CCHIT site is very slow. It'll time out if you try to download it and sign in at the same time, so you have to first sign in, wait 5 minutes, then do a search for "operating agreement". If you want, you can temporarily download the document from my personal download site at http://briefcase.yahoo.com/alborgmd (I'll keep it up there through Tuesday).

The 2 paragraphs that discuss profits are 3.4 and 5.4:

3.4 Shares. Each Member shall hold one share that cumulatively shall represent the
Members’ 100% interest in the capital of the Company, the profits, losses and allocations of the Company from and after the date of the issuance of such Share, including any increase in the value of the Company’s assets and business from and after the date of issuance of such Share, and any distributions made by the Company, all as more specifically set forth in this Operating
Agreement.

5.4 Allocation of Profits and Losses. All Profits and Losses of the Company shall be
allocated to the Members equally.

It doesn't say anything about reinvesting the profit back into CCHIT.

Now, if you wish to look at profits, check out the document at http://www.cchit.org/files/Commission_Minutes/20060821CCHITComMtgMinutesFINAL.pdf (or check out my briefcase above):

"Operations Oversight Committee Sam Karp reported that the Operations Oversight Committee met last week by teleconference. The discussion focused on the status of the 2007 budget and the role of the Committee. The committee looked at revenue derived from first round of certification and will be looking at costs of certification. Sam noted that cash flow has improved due to reimbursement for costs and that we could end up with net income of one million dollars at the end of the fiscal year, which is December. Staff is working on the budget for fiscal year 2007. The committee will establish the budgetary process for the new organization."

As you can imagine, collecting the above data is difficult, but by law they have to be transparent. I hope that this helps clear up the confusion you might have had.

Sincerely,
Al Borges, MD

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gchiu replied on 12-03-2006 3:40 PM

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The second and third-year fees are a "certification maintenance fee" that contributes to CCHIT's operating budget, Leavitt says. A "very significant" part of the budget is for communication and outreach activities; Leavitt took 50 trips during the first 10 months of 2006 to promote the certifying of health I.T. systems. "We aren't hearing complaints about the maintenance fee or that our marketing and communications are ineffective," he contends.

I think this is telling.  Leavitt wants the vendors' monies so he can preach his gospel.  Remember, no evidence = religion, and this religion has to keep him in the life style that the government monies made him become accustomed to. 

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Robert Gleeman replied on 12-05-2006 5:45 PM

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EMR Update is obviously having an impact on the EMR industry. Both Dr. Winn and Dr. Borges are quoted in this excellent news story.

If you don't think anyone reads your posts or cares about your opinions, I hope this thread will change your mind.

We are providing a very valuable platform, a philosophical laboratory in the great tradition of the "surgical gallery", where knowledge trumps status and progress is a matter of fact.

I congratulate us all.

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Chris Brancato 2 replied on 12-08-2006 10:03 AM

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As I lurk on this (and having moved out of the vendor world and into the consumer world, again!), I continually ask myself "what is the value certification offers the stakeholders"?

I have to say, I remain stumped on the value prop of CCHIT or any other certification. I DO understand the apparent need to widen adoption but certification doesn't appear to even begin to address the various and sundry barriers to entry for physicians. Indeed, it doesn't even appear to create the "apples to apples" comparison shopping guide to make the decision of EMR selection easier.

When I was a vendor, I certainly felt that CCHIT favors those companies who were better capitalized than we were. To my earlier point, I don't see it making that much of a difference in terms of the number of installs. Again...wasn't that the point?
 

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Robert Gleeman replied on 12-08-2006 4:55 PM

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Chris Brancato 2:

As I lurk on this (and having moved out of the vendor world and into the consumer world, again!), I continually ask myself "what is the value certification offers the stakeholders"?

I have to say, I remain stumped on the value prop of CCHIT or any other certification.

I heard somewhere that the CCHIT organization earned a one million dollar profit in its first year of operation.

So far, it's the most profitable EMR company in the history of the world.

Maybe that's the value prop.

P.S. Check out my latest interview with Dr. David Winn. He talks about CCHIT from the perspective of a vendor who has passed this certification with flying colors. The impact has been huge, but we're still not too sure about the benefits. For one thing, it looks like e-MDs might actually come out with an additional second EMR product that is purposely not designed to be CCHIT certified. Such an EMR product would still have the core funtionality a solo physican or small group needs, but not a host of hundreds of little-used features which certification does, in fact, demand of the software developer/vendor. Hopefully, this will all be good for the physician consumer, because regardless of so-called 'certification requirements', doctors will always be able to obtain a good basic EMR at a fair price--or free of charge. That's what we call 'freedom of speech'.