Link: A Letter To The National Coordinator for Health IT

(Bold emphasis is mine)

The following is a letter sent by us and more than 20 prominent health care colleagues to Dr. David Blumenthal, the National Coordinator for Health Information Technology, within the US Department of Health and Human Services.

August 10, 2009

Dear Dr. Blumenthal:

We would like to request that the same exemplary openness, transparency, and support for innovation set by the HIT Policy Committee is followed by the HIT Standards Committee. We ask that the HIT Standards Committee support an evidence-based approach and open discourse about health IT standards and ensure again, as has been done so well thus far, that the results support innovators easily adding value to our health care system.

We applaud the work of the HIT Policy Committee to date. Just as it has been in the nation's best interests to re-open the EHR technology certification discussion in light of NIST's expertise and an international Conformity Assessment framework, it is in its interests to re-open the health IT standards discussion in light of recent experiences and market activity with health data exchange here and abroad.

While CCHIT and HITSP have accomplished some good work, both have been overly influenced by the same small group of special interests, and have created at least the appearance of conflicts of interest. Representatives from the legacy vendors, traditional health IT interests, and large health system enterprises have dominated the Health Information Technology Standards Panel (HITSP). A good example is HITSP’s June 2008 reorganization of its technical committees. Seventeen co-directors were announced for these six committees. Of the fourteen non-governmental co-directors, eight were current or recent employees of just three large pre-Internet enterprise vendors; three were from large vertically integrated delivery systems; and two were from large insurers. There were no co-chairs from emergent or potentially disruptive/innovative technology companies, or those with open source experience. No one representing Google, Apple, or Microsoft, for example. There were no practicing physicians and no patient advocates.

We are concerned because we hear from some of the people who are experienced in building successful standards in IT that the legacy standards largely promulgated by HITSP thus far will be a massive impediment to smaller more nimble innovators. It is very important that health IT standards not “lock out” the experience of other industries - e.g., financial services, e-commerce, and online publishing - which have evolved broad and deep Web-based infrastructures and marketplaces in which proprietary software and hardware are no longer prominent. In this case, it is vitally important to include the voices of the innovators in health care IT and data exchange, such as Microsoft and Google, Apple's iPhone, MinuteClinic and SureScripts, and their many partners.

At the very least, an evidence-based approach to health IT standards selection would consist of hearings to systematically review the best practices and lessons from health data exchange, particularly with respect to the uses of XML as a format and language for secure and interoperable transfers of summary health data like those contemplated as requirements under Meaningful Use by EHR technologies. The information distilled from this exercise could be placed alongside HITSP's conceptual constructs and enterprise use-cases. (In some instances, HITSP has recommended untested and unproven "standards" that experts have already questioned in terms of their suitability for real world implementation. Certainly, if ONC is considering translating these into national policy, they should be subject to full review in a public forum, followed by adequate testing.)

An evidence-based approach to standards selection would bring the innovators with actual experience to the discussion. An open forum would allow this testimony to help ONC's staff and the Committee members get a much better idea of what works, and what doesn't. This letter's signers and, we believe, others with deep field experience, would welcome the opportunity to testify and share their knowledge.

We understand ONC's and the Standards Committees' time pressures. On the other hand, an approach that ignores the evidence from the marketplace and practitioners outside health IT's "old guard," is simply a means of hurrying to failure, not marching to success. This is why we believe it is urgent that the discussion regarding health IT standards be re-opened immediately.

Thank you for your consideration.

Respectfully,

David C. Kibbe, MD MBA and Brian Klepper, PhD

Co-signatories:

Steve Adams, CEO, RMDNetworks, Inc.

Richard Benoit, Dossia

Edmund Billings, MD, CMO and EVP, Product Development, Medsphere

Warren Brennan, CEO, SMA Informatics, Richmond

Bill Crounse, M.D. Senior Director, Worldwide Health, Microsoft Corporation

"e-Patient Dave" deBronkart, Patient, Co-Chair, Society for Participatory Medicine

Michael Fleming, MD, FAAFP Chief Medical Officer Amedisys, Inc.

Sarah Greene, Managing Editor, Journal of Participatory Medicine

Alan Greene, MD, co-founder, DrGreene.com and President, Society for Participatory Medicine

Adrian Gropper MD, Chief Science Officer, MedCommons

James Allen Heywood, Chairman and Co-Founder, PatientsLikeMe

Stasia Kahn, MD, Founder, Physicians for Connectivity and General Internist, Fox Prarie Medical Group

Vince Kuraitis, Prinicpal, Better Health Technologies, LLC

Glenn Laffel, MD, PhD, Sr. VP Clinical Affairs Practice Fusion

Randall Oates, MD, President, SOAPware, Inc.

Martin Pellinat, CEO, VisionTree Software, Inc.

Rick Peters MD, President + CEO, Rocket Technology Labs, Inc.
Jane Sarasohn-Kahn, Principal, Think Health, Philadelphia

Tom Schwieterman, MD, Director of Research and Development, Midmark Corporation

Ravi Sharma, CEO, 4Medica

Rahul D. Singal MD, President and CEO, WorldDoc Inc.

Carl Taylor, Director, Center for Strategic Health Innovation

Mary Eleanor Wickersham, Director of Health Policy, GA Governor's Office, Atlanta

cc: Jonathan Perlin, MD, John Halamka, MD, John Glaser, Paul Egerman




Much good progress has been made in many areas in the emerging HIT requirements for "meaningful use." HIT Standards that are required need to have some evidence of practicality in the real world consisting of mostly small medical practices. The standards team brought together by the ONC is a brilliant collection of experts in the domain of large systems and large enterprises that are served by very politically powerful vendors of information systems. Let's hope they will take the time to open the discussion as to what is likely to be successful for the masses.

How the Feds will spend the first $1.16 Billion on HIT

The best summary I have found is at Chilimarkresearch.com - Spigots are Opening: $1.16B for HIT in 2010

(Bold emphasis added is mine.)

$1.16B will be distributed in 2010 to address two priorities, setting up extension centers and helping states create RHIOs. Putting each of these initiatives right up front in the funding cycle makes a hell of a lot of sense to us.

"First, dedicating $598M to the Health Information Technology Extension Program (HITEP) for the establishment of some 70+ extension centers, as well as a national Health Information Technology Research Center (HITRC), which is separately funded at $50M, will put in place the needed infrastructure of technical advisers to assist physicians in adopting EHRs and insuring that their deployment will support meaningful use, well at least that is the plan, which is much easier said then done. We still wonder where the feds and these extension centers will find the necessary skilled staff to man these extension centers once this market begins to heat up.

Second, dedicating $598M to assist states in establishing RHIOs is logical, if not critical, if indeed we want to have true care coordination. Besides, if the feds are going to demand that one of the core precepts of meaningful use be information sharing, then it is the responsibility of the feds to facilitate building the infrastructure to make it happen. Nearly $600M being distributed to States or State Designated Entities (SDE) is quite a boat load of money to make this happen, hopefully it will be spent wisely and not result in more cobbled together RHIOs that live from one grant to the next and have no sustaining business model. Maybe they could make a condition of receiving a grant – a clear business plan that shows a self-supporting entity within say three years of go-live.

All in all quite a tall order considering most RHIOs have not gotten much further than distributing labs and test results. But really what choice does ONC and HHS have? Congress, in its infinite wisdom, has put into legislation that some $36B+ must be spent in a very short time period to get the healthcare sector into the digital age. The aggressive schedule put forth by this legislation leaves HHS with little choice but to charge ahead. Considering te circumstances, HHS/ONC are being about as thoughtful as one could expect. Let’s hope that when it comes to actually executing on these initiatives the measured approach taken to date continues."


Overall, I agree the announcements are better than I expected, and are even a nearly reasonable use of the initial funds. Hopefully, we will continue to see reason prevail.

Thanks SOAPware community!

In the past year, we are grateful that SOAPware has been fortunate to have experienced a growth in income. This has allowed us to continue our development efforts. What is particularly gratifying is that this comes during the worst recession since the great depression and during a time of great uncertainty and tribulation within the physician community. This situation has led to an overall slowing in the EMR business for most.

The following from - Why is EMR Adoption Still Slow? – probably explains our good fortune.


"The solution is to purchase a simple, flexible, and inexpensive EMR system. Physicians should select the most basic system that will fulfill their needs and conform to meaningful use requirements. Flexible systems can adapt to new requirements, and may prevent physicians from being stuck with a system they don’t like. Avoiding unnecessary features will reduce prices and reduce implementation time to qualify for the 2011 payments."


Now, SOAPware 2009 is on the verge of public beta, and carries this tradition to the next level. The transition from the old, trusty bicycle (SOAPware v4) to "air travel" the past 3 years has been painful at times for all of us. It has been particularly challenging to build the plane while in flight. Presently, several of the early (i.e. private) SOAPware 2009 beta sites have started using it in production. Especially with e-prescribing, the enhancements and improved ease of use are significant. We are going slow with this release, and are continuing an extended testing and quality control process. However, the increased speed and usability of SOAPware 2009 has proven to be too enticing for many to resist. The initial release will be followed, soon, by an update to include built-in formulary, patient eligibility, and prescription fill histories.

Following the initial release of the billing system, the SOAPware community can anticipate announcements regarding our preferred solutions for patient registry (performance reporting) and patient portal options. We are being careful to architect this transition to a full EHR in a fashion that is as simple, flexible and inexpensive as is possible with the tools that are available. We anticipate the increase in income from sales of our fully integrated billing system will allow for the acceleration of development with product releases coming more quickly.

Along with these software evolutions, we have made great progress putting together an Implementation Toolkit. Drafts of this are now available on request.


Most practices should be focused, at this time, on preparing themselves for the change process this upcoming transition to “meaningful use” requires. While we will be increasing the change management information in SOAPedia, most practices will need some more direct hand-holding along the way. We will be announcing some major changes in our Partner Program to facilitate the creating of local/regional entities to facilitate practices' ability to migrate to true information systems containing real data in addition to the traditional, customary, free-text narratives. This facilitation of practices is not something that is specific or related to the SOAPware EMR, but is a more fundamental cultural change and workflow re-engineering that must take place to meet success with any comprehensive EMR. We are very eager to collaborate with emerging entities that have demonstrated an understanding of this fundamental social change that must take place prior to introduction of health information technologies. Please contact us if you have insights or interest in promoting these initiatives, or know of resources already available in your community.

For most, for the next few months, it is time to be installing peopleware rather than hardware and software.

Ok Docs, is it Time to Defend the Horse?

DEFENDS THE HORSE AGAINST THE MOTOR;
New York Times, February 23
Section: Business & Opportunity,

Official of the Horse Association Says He Is Still the Best for His Day's Work. SEES HIM REPLACING AUTO. Cost Said to Be Only Half of Motor Transport to Reach Places in Easy Distance."

The horse is more than holding his own against the automobile, is replacing automobile trucks for many kinds of hauling and needs to be more used instead of being leas used in big cities, according to a statement of Wayne Dinsmore, Secretary of the Horse Association of America. The statement was a reply to Dr. John A. Harriss, Special Deputy Police Commissioner in charge...


History will have a similar perspective when clinicians, today, state...
"Bah, Humbug!! My paper records cost less than half than an EMR to get to all the information I need!"

:-?