Open-source developers and officials from the Certification Commission for Healthcare Information Technology apparently buried the hatchet Monday, and not in each others heads.
The two sides met at the 2009 Healthcare Information and Management Systems Society convention during a roundtable discussion hosted by CCHIT. They departed with members of the open-source community warily satisfied that at least a dialogue had been opened with the IT systems testing and certification organization.
For the past several months, bloggers sympathetic to the open-source movement had joined with other critics of CCHIT alleging, among other things, that CCHIT was in cahoots with developers of proprietary healthcare IT software in an effort to strangle in its crib the infant open-source movement in healthcare.
CCHIT Chairman Mark Leavitt attempted to address the suspicions head-on by detailing the history of the organization. He explained that CCHIT is a not-for-profit founded in 2004 by HIMSS, the American Health Information Management Association and the National Alliance for Health Information Technology at the behest of David Brailer, the first head of the Office of the National Coordinator at HHS. Brailer encouraged the IT industry to develop a private-sector seal of approval similar to that awarded by Underwriters Laboratories to boost physician confidence in and adoption of electronic health-record systems, Leavitt said.
Leavitt and CCHIT staffers explained that the three founding organizations contributed about $150,000 to get CCHIT off the ground and soon after several other groups, including the American Academy of Family Physicians, the American College of Physicians, payer UnitedHealth Group, the California HealthCare Foundation and at least one IT vendor, McKesson Corp., chipped in an additional $125,000 or so. Then, HHS signed a three-year, $7.5 million contract with CCHIT to initially test and certify EHR systems for office-based physicians, a scope of work that has since expanded to include testing and certification of systems for inpatient providers, some medical specialties and regional health information organizations.
Leavitt explained that he had worked for HIMSS at the time CCHIT was created, and until last year his paychecks were still drawn against a HIMSS account, though the money for his salary was transferred from CCHIT to HIMSS. Leavitts payand thus his loyaltyhad been a hot topic for the bloggers, since HIMSS last year came out in public opposition to then-pending IT booster legislation that contained funding for the development of open-source software in healthcare.
Leavitt, however, stated that CCHIT was not philosophically opposed to open-source development, and even has developed open-source software for its interoperability testing tools. In addition, Leavitt said, the organization develops its testing criteria and operates under a philosophy of community collaboration with volunteers.
It may not be open source, but its an awfully close cousin, Leavitt said.
The financial disclosures and the statement of sympathy with the open-source culture produced a palpable softening of the tension in the meeting room.
Timothy Elwell, vice president for healthcare open-source solutions at health IT vendor Misys, White Plains, N.J., then presented a list of 25 discussion topics and recommendations for CCHIT gleaned from open-source community members in 317 postings on a Google forum set up in advance of the meeting.
Although there was a diversity of opinions, according to Elwell, three topics that received the most votes for presentation to CCHIT, and Leavitts responses, were:
- To avoid vendor lock-in, for either proprietary or open-source vendors, CCHIT should focus on interoperability. Several critics spoke up that CCHIT uses too many criteria devoted to functionality and two few to interoperability.
Leavitt said, I totally agree with you on the issue of lock-in. You want to be able to export the record in some standard way that someone else could import. Leavitt said that one reason CCHIT has far fewer criteria for interoperability is that the data standards for interoperable transactions, which under the Bush administration procedures were delivered to CCHIT from the federally supported Health Information Technology Standards Panel, have been somewhat limited thus far. The HITSP, he said, has not given us the standards to transfer an entire record yet. Thats the goal. We appreciate any help you can give us.
- CCHIT should drastically lower the cost for certification of free and open-source health IT systems in recognition of their status as a public good. Leavitt explained about half of CCHITs operating costs, even with the federal contract, come from fees charged to vendors to test their products. Having a two-tiered testing fee structure would lead to proprietary vendors subsidizing their open-source competitors. But Leavitt said that he understands the point (emphasized by Elwell, that many open-source developers are very small operations, sometimes with only one person working with one software product) that were going to have to fund the cost of the tests and not make it such a barrier. Leavitt said one possibility is asking the government to fund open-source testing scholarships.
- CCHIT charges should be based on the vendors ability to pay. Leavitt said the organization originally considered a revenue model in which vendors would pay for use of its certification based on a flat fee plus additional fees based on the number of units sold, similar to what Underwriters Laboratory does for appliances. That model was shot down by vendor resistance, he said.