Pediatricians Roll at CCHIT!

Some live-blogging from CCHIT.

My comments below are my off-the-cuff notes about what I saw and heard today and yesterday at the CCHIT meeting.  I certainly expect that some of what I report here is wrong or misinterpreted and I welcome any feedback either way.  I don’t intend offense to anyone and have no interest in somehow undermining my effort.  That said…

– CCHIT membership has changed quite a bit this year.  I may have the numbers wrong, but only 2/3 of last years’ members are back, the impression is that most of them re-applied, but weren’t invited.  There are ~80 members from last year and 150 new members.  Nearly 630 people submitted ~1120 applications.

On a related manner, the audience (thanks, Sue) figured out that CCHIT just signed us up to a 2 year committment, not the one year we expected.  I think that’s actually a good thing, given how much institutional knowledge they may have just lost this year – were 1/3 of
the members really not functional?

Mark Leavitt In Action– The table I was at, Child Health, was by far the most talkative again this year.  Not only did we do the most whispering, nearly everyone at the table addressed the room a few times. There were nearly 50 tables in the room, perhaps 40 of them said nothing.  Peds DOMINATED. According to Dr. Marcus, there are 29 pediatricians – more than 10% of the entire group – in CCHIT and Dr. Zurhellen said nearly 70 treat children directly. Crazy!
– Mark Leavitt (my sneak photo of him during the opening is over there on the left) mentioned that the massive increase in applications this year means “they must be doing something right” which is, unfortunately, demonstrably bogus. I don’t think the increase in applications is an endorsement of CCHIT by the volunteer public, but a direct reflection of the stimulus package.  Does anyone think that the applications would have gone up 2.5x without it? Not at my table, they didn’t.

– I find it interesting that 60% of the CCHIT certified vendors are < $10m and 25% are under $1m.  Which leads me to this rant:

The bashing of vendors both within and outside of CCHIT is bogus.  Vendors aren’t only the software companies.  Every one of those hospitals, IPAs, health systems, etc. at the table – Taconic IPA, Parkview Health Systems, and so forth – DWARF most of the vendors getting certified.  Does anyone think an IPA or health system is there simply for the greater good?  No way – they are there to protect their turf, their members, their money.  And you’ll have a hard time convincing me that most hospitals/IPAs/health systems are any less immoral/corrupt/etc. than the majority of HIT vendors (bad as they are).  Let’s be real about it – yes, there is some big vendor control at CCHIT, and that’s not entirely a bad thing.  They’re key stakeholders.  But the other interests in the room are even bigger – non-profit doesn’t mean “good guy.”

Lest anyone get the wrong impression, I’m not even sure I count as a vendor, so I’m not being defensive.

– I don’t have the time to do this, but if you want to check for influence, someone do a body count of who the chairs of each committee are.  They have a LOT of control over what happens, priorities, etc.  Are the chairs only 30% vendor-driven?  Can’t tell, but if you want to look for sneaky influence, look there.

– I was glad to have ML be direct on the matter of EHR-S.  It’s fraud protection.  I’m sure it’s spelled out in their materials somewhere, but I’ve had to simply follow that implication all along.  Nice to have someone say it.

In fact, his description of the EHR-C, EHR-M, and EHR-S models is exactly what I think I’d suggest if I were forced to follow this certification model.  In fact, it’s a clever and sophisticated methodology and I applaud CCHIT for the effort.

That said, I am acutely aware of both the criticisms of the models (Dr.  Borges’ piece on-line is a good one) and the potential impossibility of, in particular, the EHR-S model.  How are they going to review the 10K sites that might want it?

– I also approve CCHIT’s recent maturity and recognition of their weaknesses.  For the first time, I heard ML say (though I’m sure he’s said it elsewhere, often) that the “one size fits all” model they put together in 2005 simply wouldn’t work.  We brought this issue up at the meeting last year and it didn’t get much traction.  He also implied that some of the newer paths to certification, namely the -M and -S, would have more than the binary gradiation of Certified/Not-certified…long overdue, in my book.  He ALSO added that they are going to make the scripts more generic so that the different specialties can provide input and focus.  His example was pediatric, which was nice.

– They are also getting rid of “version lockdown.”  In other words, if someone gets certified, they can continue to improve the product and re-number it and NOT have to go through re-certification.  As he said, “If a product stops providing meaningful use, the users will let the vendor know and the problem will be fixed.”  Another new one for me – the first time I’ve heard the use of market forces trusted by CCHIT.  Good news.

– Bobbie Byrne is a great addition to the CCHIT team.  Sure, I’m biased (I think she helped keep me on the committee), but she’s a naturally funny and engaging speaker…who doesn’t waste time.  More than that, she’s about the only speaker from CCHIT who doesn’t seem defensive.

– In the middle of the meeting, there was an uncomfortable back-and-forth with the behavioral health folks.  It culminated with ML saying into the microphone something like, “…there’s a reason why you were the only group who worked for an entire year on the project and couldn’t hand something in.”  I thought it was incredibly thoughtless, myself – even if it’s true, is that how you want to talk to them publically?  Especially when CCHIT might be part of the problem?  He apologized a minute or two later for any “misunderstanding,” but he’d already showed more than a flash of his infamous style.  I’m sure this will get me in trouble, but I find that behavior scary and a bad sign of leadership.

– During the presentation, I learned, the Child Health segment will cover inpatient visits in 2011 or 2013, which was news to me and, I think, everyone else on the committee.

– Bill Zurhellen got up and said something which drew a round of applause.  “If our goal is to certify to get ARRA payments, we’re doing the wrong thing.  We should be focusing on improving health care.”  ML replied, “We should consider changing the mission statement to reflect healthcare outcomes and improvement…” because, right now, the mission statement is focused solely on improving HIT use.  It doesn’t actually reflect the greater intent to improve healthcare.  Balanced against his reaction to the behavioral health folks, this was a sign of GOOD leadership – not just because I agree with him, but because he handled this critique very differently.

Day Two:

– CCHIT changed its name a few months ago?  The acronym is the same, but the name is different.  I missed what the old one…

– We watched this hysterical and clever video:

http://www.rossmartinmd.com/2009/05/hitech-interoperetta-in-three-acts.htm

Worth it to get to the end.

– We got the C-C-H-I-T pronounciation talk again.  Ha ha ha.

– I didn’t realize, but should have, that CCHIT also owns ehrdecisions.com and phrdecisions.com.  And a twitter account.

– Their communication policy is a LOT MORE CLEAR this year and I can’t argue with it.  If you’re speaking for yourself or your company, do what you need to do.  If you’re speaking for CCHIT, then you need to clear it with them.  No early disclosure of information, even to your employer (yeah, right…like that’s happening).  No “cheating.”  I’m OK with that.

They also encourage us to respond to or alert them of “misinformation” that we read on other blogs, tweets, etc.

Hence, my blog today.

– The “set up” data for testing is going to get more fluid with the ability for the specialist groups to provide more input.

– The first test pass rate is over 90%.  No surprise, it’s an open book test with the teacher helping.

 

Spent a lot of time arguing about the Meaningful Use information that got cleared today.  I think our Child Health crew suffers the most in this regard, because it’s completely adult-health skewed and trying to figure out what to do with it.

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