By George Fallar We’ll be attending a CCHIT town hall conference call later today, we’re pretty sure it will include another push in an aggressive attempt to be ‘the’ certification process for federal stimulus funds. Why is this a bad idea?
- There is a great deal of perception in the EMR/EHR marketplace that it’s already a done deal and CCHIT is the de-facto standard for any stimulus funds. From whence did this perception arise? There is actually a statement on their web site that would lead you to believe they were selected in 2006.
- CCHIT is a ‘nonprofit’ organization, which does NOT mean they make no profit. They are free to give bonuses and other profit sharing incentives to their 23 employees. I’m sure that information will be available in their annual report, but since they just incorporated as a not-for-profit in January it won’t be published for awhile.
- The pricing is ridiculous. We won’t go through the entire list, but the initial fee for their ambulatory certification is $35,000, broken down as $29,000 for the ‘Application’ and $6,000 for ‘Certification Maintenance’. Ouch. Additional certifications for specialties range from $8,000 (Child Health) to $16,000 (Cardio). They are now proposing a Dermatology add-on, but there’s no mention yet of price.
- The fee structure includes, in effect, a penalty for software enhancements. A new version with ‘Significant Changes’ (we haven’t had time to root through the documentation to find their definition of ‘Significant’) carries a recertification fee of 15% of the Application Fee. So, if a company decided to roll out a new version with significant enhancements (one would assume to IMPROVE their product) before the normal two year certification period expired, they’d have to pony up at least $4350. Not a ton of money, but lots of people would just save the enhancements for the next certification process.
- If federal funds are being used for this EMR/EHR spiff, having ANY private organization involved beyond an advisory capacity is a golden ticket for influencing market pressure on any target of choice.
- Even with the CCHIT newfound enthusiasm for providing a realistic set of rules for specialties, it’s still necessary to meet 100% of their initial ambulatory requirements and THEN meet the additional requirements for the specialty of choice.
There are any number of other reasons to develop a better standard and a more efficient way of implementing them. We’ve been around the EMR/EHR block long enough to have already heard the opposing arguments, but few of them ring true.
Probably more on target for standards to be adopted is the open source community. I am too mercenary to fully embrace the open source standard for electronic medical records, but their arguments have merit. OEMR is a decent place to start following that trail if you have interest. CCHIT is perceived as anti open source.
We agree there should be some standards regarding security and other safety and ineroperability requirements to receive federal funding. What is definitely NOT required are the additional rules that expect EMR/EHR software to replace the individual physicians medical education, forcing the doctors to go through a tedious procedure for each patient encounter. Nearly every (I would say EVERY but that’s a big blanket statement) software application that implements the CCHIT standard includes way too much templating and clicking with the responsibility for completion lying directly with the physician. The end result is a noticeable reduction in the efficiency of the most expensive person in the medical practice. Is that going to REDUCE healthcare costs?
We, as a small specialty-specific EMR company, are hoping for a more rational choice. We release ‘significant’ updates to our software nearly monthly, almost always as a result of listening to feedback from our clients about what would help them run their practice more efficiently. We focus on providing a complete, secure, easily accessed patient record that’s maintained in concert with the patient, the office staff and the physician. We have confidence in the scrupulousness of our health care providers to provide the best patient care possible, we just provide a tool to reduce their costs and (usually) either see more patients per day or go home earlier.