Software entrepreneur Paul Egerman is no stranger to the HIT industry. After coming on the scene in the early 1970s, he found repeated success in starting, building and ultimately selling some of the most well-known companies in the industry. When the HITECH legislation called for the creation of Policy and Standards Committees to help guide ONC, Egerman was very interested. After joining the Policy Committee earlier in the year, Egerman volunteered for the Workgroup on Certification and Adoption, where his purview necessarily included the fate of CCHIT. Last week, Egerman’s workgroup delivered its recommendations, which called for a major shakeup of the status quo. Recently, HCI Editor-in-Chief Anthony Guerra had a chance to talk with Egerman about the group's work.
GUERRA: Tell me a little bit about your history in the HIT industry.
EGERMAN: I entered this industry in 1971 when I graduated from college as a computer programmer at Mass General Hospital, and I wrote one of the very early computerized medical record systems in a language called MUMPS, so I was part of that whole group at Mass General. When I was 24 years old in 1974, I started what I sometimes call my first company, which is IDX (now owned by GE Healthcare IT). I’m one of the original founders of IDX. It would more accurate to call me a cofounder, I didn’t do it by myself; there were clearly other people involved and for many, many years. So I worked over 20 years in IDX. I did a lot of roles, but mainly as chief operating officer.
I was with the company at the time it went public and after that occurred, I was very fortunate, I took some time off and traveled around the world with the kids and did some political work and some philanthropic work and then somehow I found it stressful to not have any stress. I disliked not working and so in 1999, with my partner Ben Chigier, we started eScription which is a company that did speech recognition for physicians. We had a very good run with that company and actually we sold it about a year ago to Nuance.
I’ve been very fortunate in that I had two companies that turned out very well. Right now I’m doing this work for the government, for the HIT Policy Committee and I’m doing some community work also. I’m the vice chairman of the Museum of Science here in Boston. I have strong beliefs in education and technology. I’m also on the Board of the New Israel Fund which deals with social justice domestically within Israel.
Those are the three things I do. I got onto the Policy Committee because I think it’s doing critically important work, and I wanted to see if I could help. I’m not representing any self-interest or special interest; I thought I had some experience and I was hopeful I could make a contribution.
GUERRA: Are you still involved with eScription or Nuance?
EGERMAN: No, I’m not.
GUERRA: Okay, so you’re not involved with any of those private companies that you had worked on or started at this point?
EGERMAN: That’s correct. I mean, it’s ‘software entrepreneur’ on my title because somehow I hate when I’m called the “R” word – retired. Perhaps it’s just a reflection of who I am. My colleague Mark Probst (fellow committee member and Intermountain Healthcare CIO) says, “I’d love to have that title.” That guy works like a dog. Poor guy. But I’m not involved right now in business; I’m doing these things.
GUERRA: And to get on the committee, did you submit your name? How was that handled?
EGERMAN: The way it works, in general, is that there were notices published in the Federal Register. You put your name in the hat. One of the things that I learned was that there were four political appointees that were going to get on the committee — one was from the Speaker of the House, one is the Minority Leader of the House and there was the majority leader of the Senate and the minority leader of the Senate. Through my political work, I knew Nancy Pelosi, so I approached her office and put my name in the hat for her appointment and got interviewed by her, so I was actually appointed by Nancy Pelosi.
GUERRA: Was there anything specific in your mind that you wanted to do, or prevent, that spurred you to volunteer for the committee?
EGERMAN: No, there was not. It was really an issue of the fact that I had read the legislation. I was fascinated by the whole thing. I felt that here was a really good opportunity to do something very interesting for our industry, but I also read and felt that this was a great opportunity to make a lot of mistakes and screw up. I was just hopeful that I had some level of experience that I could be helpful. So there’s nothing concrete that I wanted to do or to not do.
GUERRA: I’ve listened to all the meetings and Tweeted updates from them. You seem to strike me as one of the more vocal members of the committee. Is that just a product of your personality?
EGERMAN: That’s an interesting question. I actually didn’t think of myself as particularly vocal, but I guess if you say that I am, that’s fine. I suppose it’s just a reflection of people’s personality. The members of that Policy Committee are just so impressive. I have to tell you when I first spoke to Speaker Pelosi about it and first decided that I wanted to get involved, I did it with a certain amount of fear. I didn’t know what it would be like to be on some kind of government panel. I was afraid of the thing. I know it sounds really crazy. My colleagues on the Policy Committee are just so intelligent and they’re just very insightful. I think different people reflect their personalities very differently. I tend to be vocal more on the certification side, the software side. I don’t have a huge amount, I think, to add about the content on meaningful use, some of the issues that are outside of my pay grade.When the issues relate to certification, interoperability and some of the issues with the healthcare exchanges, that’s more of the technology world where I’m comfortable, so I do have some opinions there.
GUERRA: Let’s get into the heart of the matter, at least as I see it. The big news that came out in the last meeting was twofold. It was around CCHIT and the issues CCHIT had been dealing with. One issue was separating the functions of establishing the criteria to be tested from the actual testing. That’s new. Obviously, they’ve both been done by CCHIT up to this point. The other one was not having one organization do all the testing, opening that work up to competition.
Let me go back quickly and say that when your workgroup took testimony recently, there was a gentleman named Brian Klepper listed as ‘healthcare analyst’ who said that CCHIT was too conflicted, due to its past association with HIMSS, to remain the sole body which established certification criteria and did all the testing. He was also very critical of Mark Leavitt’s past connections to HIMSS.
Tell me first about how you selected the people that were going to testify on that day and then whether or not his testimony was influential on your final recommendations, which did at least appear to take into account Klepper’s criticisms.
EGERMAN: First, I was just so impressed with all the people who presented. We got a terrific group of people who were well intentioned, they knew their stuff, they were very smart, they’re articulate, they were terrific.
For the panel you’re describing, we had Mark Levitt. Actually Brian (Klepper) was a last minute replacement. There was somebody else who had been a critic of CCHIT scheduled to testify and that person couldn’t make it, and so we looked around the Internet and we found (Klepper’s) name as somebody who had published some stuff on the topic.
I actually just gave him a call and asked him if he could, on short notice, come to D.C. What we were trying to accomplish was simply to get a balanced view. I mean, we were already aware of the criticisms of CCHIT, and we just wanted to make sure that they were aired out for the workgroup and for the public. That was the intention. It wasn’t like we were aiming for any particular person. Certainly the intention wasn’t to nail Mark Levitt or to say something unfortunate about him; we just wanted to air it out, and it was also consistent with what we had done throughout the meeting, that we were trying very hard to make sure we heard all of the viewpoints.
There was a vendor panel where we had Sheldon Razin from Quality Systems who basically said, ‘I want more of the same; I want more functionality, I want what CCHIT does.’ And then David McCallie from Cerner said something very different. That was what we were trying to accomplish. We were just trying to air out the issues to make sure we heard everything and make sure that the public had a chance also to comment on these issues.
GUERRA: So some of what you heard, some of the negative things you’ve heard about CCHIT must have resonated because the recommendations changed that model by separating out, as I’ve said, the criteria establishment from the testing and also suggesting that more than one entity do the testing. So does that make sense?
EGERMAN: It does. Although I won’t necessarily call it negative, I would call it criticisms. So there were some criticisms on CCHIT having all of this authority and autonomy. We did listen to those criticisms and there were some issues there that we wanted to address.
It’s also the case that we listened to the NIST Information Technology Laboratory presentation of (Director) Cita Furlani. She gave a great presentation and this is what NIST recommends in terms of their entire approach to certification. And then you look at the issue of separating out the definition of the criteria from the testing of the criteria. I know that’s one of the headlines on this whole approach, but it really shouldn’t be that controversial, because if you actually read the legislation, the ARRA legislation says the ONC is responsible for establishing certification criteria. It’s right there in the legislation. It’s not like what we did there was shocking, but it also made sense as it relates to the other recommendation that you mention, which is that there should more than one of these certification organizations.
In order to have more than one certification organization, you really need an independent process to develop the criteria. When we talk about certifications, it’s really very important to say we’re talking about what we call HHS Certification. CCHIT is certainly free to continue to do the types of certification that it currently does, including what’s currently called the comprehensive certification, and I believe the marketplace really wants them to continue to do that and places value on it.
Besides the day and a half of testimony, I and my colleagues in the Certification Workgroup spoke with lots and lots of people in the industry. I spoke with CIOs and a number of them said they saw a lot of value in what CCHIT does, that it gives some comfort when they do purchasing to know that somebody has gone through the processes CCHIT does.
So I’m hopeful that they continue to do that. I think the marketplace will demand it. It’s just that we propose a new HHS Certification will be what qualifies users for the HITECH payments and the incentives.