In response to reader commentary:
I read with interest Dr. Hayward Zwerlings concerns about the Certification Commission for Healthcare Information Technology and Dr. Mark Leavitts response. As a multiyear volunteer serving CCHIT, first I take no offense at Dr. Zwerlings remarks and do not find them disparaging of volunteers. Rather, he raises questions about CCHITs governance and unintended consequences thatI agree with Dr. Leavittpartially miss and partially misconstrue key aspects of CCHITs purposes and functions. A key point is that CCHIT was established as a stakeholder platform, which means that stakeholders make and guide its operations, so it should be no surprise that participating stakeholders interests are addressed.
That said, it will soon be time, if that time has not already arrived, to reassess CCHITs mission and purposes and stakeholders standings. This especially in light of the Obama administrations commitment to electronic health records within five years, counterpoised with the current release of the National Academies report warning, Not ready yet. Additionally we have the 2005 Office of the National Coordinators report warning that, near term, EHRs would increase healthcare fraud. With a contracting economy, interest in attacking the estimated 200-plus billion healthcare dollars diverted into overt criminal enterprises would seem an elevated stakeholder priority. Increasing reports of health information and identity theft further expand the range of concerns and the appreciation of unintended consequences. Also, in my conversations with smaller EHR companies, certification costs, direct and indirect, do represent a major obstacle that could justify a sliding scale for fees, especially since, from a compliance point of view, some of the better systems are newer and usually smaller.
As a volunteer also to the Health Level 7 Electronic Health Record System Functional Model Standards Profile for Records Management and Evidentiary Support, or RM-ES/Legal EHR, I can also say that the range of gaps between basic health record and business record management practices and the current EHR marketplace also gives pause. CCHIT surveys standards and translates them into certification requirements, and those of us working in the standards trenches also say, not quite ready yet. The RM-ES profile is only now approaching standard status. Dr. Don Simborg, co-founder of HL7, prior EHR developer, and vocal health IT advocate calls the current state of national policy an EAR-acheEHR Adoption Regardlesswhere were pushing massive subsidies for an EHR industry that remains nonstandardized, noninteroperable, and though rapidly improving, still not ready yet for mass deployment.
So, perhaps its time to reconfigure CCHIT to ensure that its stakeholder representation includes an updated balance of additional stakeholders interests, including more emphasis on clinicians utility, privacy and standardized patient care quality measures support, as well as basic data integrity in alignment with healthcare device requirements and, my personal favorite, auditable documentation integrity. The latter is about ensuring that the primary source itself is a trustworthy record, meriting our faith in it as the fundamental building block for all the gains we hope to see arise from health IT. In the meantime, I demonstrate my own investment in CCHITs continuing and expanding success, as one of a short list of CCHIT volunteers on nobodys payroll for the work I do there and, for the near term, caution that care should be taken that CCHIT not assert value it cannot quite yet demonstrably ensure, but will most definitely achieve in time.
Reed Gelzer, M.D.Data quality and EHR integrity consultingAdvocates for Documentation Integrity and Compliance Wallingford, Conn.