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Keeping a Watchful Eye on Pending Legislation — More Important than Ever

June 6, 2009
by Rich Temple
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Staying on top of the “advocacy” and legislative functions has always been important for health IT leaders, but never more so than now. With HITECH/ARRA transforming the health IT landscape, there is much more activity going on the corridors of government with regard to things we have always talked about: EHRs, interoperability, HIEs, etc. And with there likely being more mandates with regard to HIT rather than less as we progress on this journey, we need to stay on top of anything that could impact our lives and be prepared to react quickly to make sure that the right legislation passes and that there are not (hopefully!) any unintended major consequences that could seriously adversely impact our provider community.

Here is a case in point. The New Jersey Chapter of HIMSS was advised of pending legislation in the New Jersey State Assembly that would mandate that ALL health information technology products sold or otherwise distributed within the State of New Jersey would have to be CCHIT-certified. This mandate would go into effect in 2011. This is a pretty appealing concept on the face of it. It would make it a whole lot easier to weave disparate pieces of the health IT tapestry together to provide a solid foundation for a true statewide health information exchange. But, “stop press” for a second…

Some questions arise. First, what if CCHIT winds up not being the certification authority that ONCHIT selects to implement the HITECH legislation? Or perhaps CCHIT might share certification responsibilities with another organization. Would providers be in trouble if they selected “certified” systems that were not explicitly certified by CCHIT? This is a very narrow and would have been a troublesome mandate.

Another biggie – the legislation mandates that all HIT systems be CCHIT-certified? What defines a HIT system? Once we answer that, though, we also have to remember that not all types of systems have certification regimens established yet, or perhaps to be established anytime soon. For instance, would long-term care EMRs, PACS systems, clinical decision support systems, critical care unit systems, and many others be rendered illegal to purchase because CCHIT hadn’t come up with certification protocols for this yet?

There were a few other issues we wanted to address in the legislation but those were the two largest ones.

To their extreme credit (and our appreciation), the sponsors of the Legislation worked closely with us as key stakeholders and worked literally right down to the wire to craft language that would address these concerns. Ultimately, the language of the bill that was presented to the Assembly Health Committee was modified to mandate certification by CCHIT, “or another entity approved by the federal government for this purpose” and the mandate was further clarified to only apply if certification for the HIT product being acquired was available by a federally approved entity. This was a great example of key health IT groups working together to take a good idea, make it truly operational in a real-world setting, and ensure that it didn’t boomerang on providers down the road.

This is one example that I just personally experienced and I am sure that there are many more of these types of things percolating in Capitols and other similar places all over the country. We must always stay vigilant and positive, and good things will happen!

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Comments

Anthony, I don't believe you are reading it wrong. I do worry about this, especially because certification is not an easy or inexpensive process to go through. The comfort level I get with this, to the extent that I get a comfort level (and some of this does kind of give me the heebee-jeebies), is that if we are to consider building an interconnected, interoperable health care system, it is quite critical that we ensure that all participants in the system are able to contribute and receive data from the system (which the legislation would address). We can't allow for gaping holes that could preclude the right information from getting into the hands of the right caregivers. The replacement language in the bill only mandates certification for particular types of systems that there exists a formal certification process for that kind of system. Given that certification protocols are likely only going to exist for big enterprise-wide systems, this shouldn't be an undue impediment to innovation or to smaller vendors trying to do something new and exciting in the health IT space.

I very much hear you on this and think that if this moves forward, we will have to watch the downstream impact VERY carefully to ensure that the positive potential is realized and that any that any unanticipated consequences are quickly addressed.

Inmate one: "What you in for pal?"
Inmate two: "Murder ... you?"
Inmate one: "Sold an uncertified EMR."
Inmate two slowly backs away in terror, "The horror. The horror."

Rich. Do you worry about competition being stifled if such a law was enacted? I mean, we're not just talking about qualifying for government incentives, we're talking about making the sale of some kind of technology ILLEGAL. I find that very disturbing. Am I reading this wrong?

Rich,
Thanks for your post.

This week, I met with multiple clients in the US and Canada, as well as presenting in a webinar on Preparing for ICD-10.

I was continually thinking about how the meaningful use definition and legislative muscle would positively impact these clients. We all know the devil is in the details and final interpretations. I deeply share your perspective. These are very exciting times, with opportunities to move forward that are rare.

Rich Temple

Chief Information and Business Intelligence Officer, AristaCare Health Services

Rich Temple is the Chief Information and Business Intelligence Officer for AristaCare Health...