One-on-One With Kings County Hospital Center Medical Director (and former CMIO) Abha Agrawal, M.D., Part II

GUERRA: I’ve been following CCHIT closely. I’ve interviewed Mark Leavitt recently. I’ve also interviewed Frank Trembulak who’s heading up Leavitt’s replacement. I’ve interviewed the CEO of the Drummond Group, Rik Drummond, who’s the first announced competitor.

AGRAWAL: I’m going be on the search committee, by the way.

GUERRA: Wonderful. There is so much going on with CCHIT. What can you tell me about how the organization is moving forward?

AGRAWAL: I was appointed on behalf of the American Hospital Association. So my stakeholder group was hospitals — and especially safety net hospitals — coming from Health and Hospitals Corporation. I’ve had great experience over the last few years at CCHIT. A couple of points I would particularly want to mention. In terms of Mark Leavitt, I thought he was a tremendous leader, that’s my personal opinion, for CCHIT. He took over CCHIT four years ago when we didn’t know what we should be doing and where we should be going. At that time, there was no Policy Committee. We had no incentive payments. There were no sense of direction or a sense of guidance or guidelines that were telling us what an EHR should be like or what an EHR should accomplish. So in a very confused, very vaguely defined marketplace, I think Mark Leavitt did a tremendous job of steering CCHIT over the last four years. That’s my opinion on that, and I learned a lot from him about leadership style, about how to run a group of disparate people with so many varied interests.

In terms of the commission itself, I’m very cognizant of the criticism because of the association with HIMSS and because of the vendors being represented as commissioners. Quite a few of the commissioners come from vendor groups, quite a few workgroup members come from health IT vendors and have potential conflicts of interest. Overall, I’m convinced the process was fair. I never felt uncomfortable that the interest of physicians or hospitals, the stakeholder group that I was representing, were given short shrift for the sake of health IT vendors. There was vigorous open discussion and the decisions, as I bear witness to them, were very fair and most reasonable, and not biased or driven by conflict. That’s my experience.

In terms of why we let vendors be involved, health IT is in a very different place today than it was four, five years ago. At that time, CCHIT was always a voluntary thing. EHR adoption was voluntary. Things have moved forward very rapidly over the last year or so. The risk was if you created a group with no vendor representation, the market could have completely rejected any idea of certification. Then the market wouldn’t have moved one bit forward at all. So for this to work, as important as it was that the hospitals and physicians understood the purpose of EHRs, understood the value of having a certified product, it was equally important that vendors understood the value, saw the value in getting their product certified.

So I think, at that time, the decision was very reasonable that vendors should be an integral part of the commission, so that we understand what the market can supply and not simply decide what EHR product should be like. So that’s my general thought about CCHIT. CCHIT is very interesting because of all of the things that you mentioned. I do hope we fill the vacuum that Mark Leavitt’s departure will leave. We need to find somebody who is really an equally good leader.

I don’t want to make a comment on the Policy Committee and the direction of meaningful use, but I can tell you about the reaction of physicians, our friends who are in private practice, small group practices. There is a sense of unease, which I can say is growing, with the meaningful use criteria.

The focus was on small hospitals that are doing much better in terms of adopting EHRs, even without the incentives. It was the small physician groups who couldn’t afford them, who found EHRs to be very expensive. But there is growing unease that the business of implementing a product that is certified, and meets the meaningful use objectives and everything, may become too complicated, and $44,000 for a physician over a period of five years isn’t that much money if you think about it. Overall, it may not be worth it. It may not be enough. That’s a sentiment that’s beginning to bubble up among small group physician practitioners who really needed the stimulus more than large hospitals.