My company and I are watching the latest developments in Congress with interest/concern/optimism, and despite the lobbying muscle the legacy EMR vendors (no need to name) have, I am impressed by my boss (please see Dr John Haughton’s review of the pending stimulus bill on the Healthcare Blog – http://www.thehealthcareblog.com/the_health_care_blog/2009/02/stimulus-bill-offers-docs-big-incentives-for-technology-but-demand-effective-use-.html) and other internet-oriented HIT company CEO/Founders’ ability to reach Congressional staffers/leadership and help them understand the difference between “certification” and “efficacy/cost-effectiveness.” Perhaps we should raise our prices through the roof as they have and convince our customers they HAVE TO pay that much to join the “21st century” but then again, I probably couldn’t live with myself.

To David’s question #2; CCHIT, among MANY other positive and NEGATIVE components, does NOTHING to mandate SEMANTIC interoperability among applications which is critical to exchanging clinical data in a meaningful and relevant way. We work with CCHIT certified EMRs EVERY DAY trying to get them to talk to each other and they simply were not designed to share population-based clinical data in any kind of way. CCHIT, like “certified-EMRs,” is a red herring and something easy for a politician or media personality to grasp and regurgitate.

If any media personalities are reading this column, please continue to review Chilmark’s blog and particularly “John’s” comments… These folks are tracking towards pragmatic solutions to our national health challenges. If companies like mine and others can create truly open platforms that respect our customers’ (and their patients’/customers’) needs, then MAYBE we might be able to create a truly interoperable collection of HIT tools that don’t require “INFRASTRUCTURE” to support or billions of dollars to build. The applications themselves should provide the infrastructure through web services and other rapidly evolving technologies. Don’t write stories compelling folks to spend more money than they need to or have in their accounts.

Thanks everyone for the great comments!

Alex

2) Not a big fan of certification processes such as CCHIT as that is rarely the problem with interoperability, which is a problem more related to policy and actual technology deployment. Rather than certification, how about incentives for sharing records, incentives that go directly to physician/practice. If such occurred, physicians would adopt solutions that supported such without any need for some form of certification.

3) Long-term commitment… That’s a tricky one, though it has been demonstrated by some HIEs that you can actually make them self-sustaining. Adopt their best practice models may lead to a self-sustaining model for the entire system.

Dr. Higgins,
1) As you are from Medstar, which was the IDN that created Amalga (Azyxxi) in the first place, not too surprised by your strong promotion of the Amalga platform. Yes, it is an excellent platform, yes its adoption may lead to a decrease in market dominance of large EMR vendors, but no, Amalga will not play much of a role in small ambulatory practices which is where we have the biggest issue with lack of EMR adoption. Thus, this HIE vendor offering an SaaS lightweight EMR does offer an interesting approach to achieve widespread adoption of HIT.

2) The latest news we have seen (at least as of mid-morning today) still has that $20B in the Stimulus package for HITECH Act. You are in DC so maybe you have a more accurate pulse, but as of the time of posting this piece, $20B was a good number.

3) Sure, there are plenty of well-documented studies on EMR adoption and savings, we understand that and fully support programs that will increase EMR adoption. But in he end an EMR is but a tool and if you give a sledge hammer to someone who really needs a light hammer for finish carpentry, well you end up with a mess. There are an equal number of reports, articles, studies that also show just how bad it can get in poor deployment of HIT.

First, the current EHR vendors will lose market dominance to Microsoft’s Amlaga platform.

Second, the EHR stimulus has been drastically cut through Republican intervention, and now represents less than 20% of that $20B figure.

Third, there are well documented and highly significant cost savings associated with adoption of the EHR – your audience should read the valid scientific literature before making inane and self-serving comments without understanding health infarstructure.

1. What about the cost of re-engineering the legacy workflow? My understanding is that this was a significant issue for providers participating in the MAeHC experiment.

2. If systems are not CCHIT-certified, don’t we run the risk of creating a series of islands rather than an interoperable whole? (Real question, not rhetorical.)

3. Long term commitment to funding (not unique to this proposal).