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: You mentioned the five high level recommendations that were adopted. When Dr. Blumenthal asked for consensus approval on your entire presentation, there was push back specifically from Neil Calman (the Institute for Family Health) and Gayle Harrell (former Florida state legislator). Ultimately, only the five high level recommendations were adopted. What happens now? Do you have to lobby the rest of the group to approve your overall plan?
EGERMAN: First of all, we got actually farther than I expected. I was surprised that we got approval of those five general concepts. I thought that what we were simply going to be doing was put this forward and get comments and then come back next month. So this was actually much farther than I expected. We will be doing exactly what you’re talking about, which is we will be having discussions with people on the Policy Committee who had concerns about these issues.
The fundamental challenge we had was that there was no time for us to brief the group before the meeting, so we took a lot of people by surprise. That’s not the way you’re supposed to do things. Realistically, they need time to absorb it, and so we will be getting their reactions, we will be refining the process. We’ll be looking to see how other people look at this. I had originally wanted the recommendations published in the Federal Register so we could solicit comments, but I don’t quite understand that process, and they told me there is something that has to happen first, and it’s all complicated, but I guess you have to give a notice that you’re going to give notice. (laughing)
So what we’re going to do next is we are going to have discussions, we’re going to refine the process and then, if we’re lucky, if there’s consensus among the workgroup, then at the next meeting we’ll put forward our recommendations again with all the specifics and see if we can have a consensus. Then we’ll probably go through a process of publishing that and getting public comments. So we’ve probably got a few more months of refining this.
GUERRA: One of the main criticisms — I think it was from Gayle Harrell — was basically that your plan creates a disruption in current processes, which she found to be very problematic given the industry’s current thirst for clarity. What were your thoughts of that objection?
EGERMAN: Actually that was Neil Calman’s comment but regardless of who it was, it’s a legitimate concern. The thing to keep in mind is that what we were trying to do was develop a long term picture as to how this thing needs to work. That’s why recommendation number five calls for a transition period.
The transition period is what we’re going to do right away, because the basic concepts we’re putting forward are concepts that can’t be addressed immediately. I don’t know exactly how long it’s going to take to go through the federal regulatory approval process or to get these kinds of systems set up. I wouldn’t be surprised if it took us a year to do it.
So in the meantime, how are we going to operate? The transition plan says, ‘Well, CCHIT really has done a wonderful job,’ and so we’re just having this concept of the gap analysis to make sure that the current certifications really do what we want them to do, and we believe that there is a gap, but it’s not a very large one.
The gap analysis is actually going to be done by CCHIT; it’s not my workgroup or the Policy Committee that’s going to do it. We asked them to help us do the gap analysis. So we’re going to come up with this gap analysis and some sort of gap certification process which we think is going to be a small thing. We don’t think it’s going to take months to complete and, most importantly, it’s not going to take months and months for vendors to do. What that will do is when we get that all put together — hopefully by Labor Day — we’ll have clarity as to what people need to do to be HHS Certified, and also make sure they have a simple process to do it.
I think the short term is fine. I think in terms of process, Neil’s comments about making sure that the industry understands the changes are right on. I have to tell you most of the vendors I’ve talked to so far are comfortable with the change and the approach we’re taking.
GUERRA: Quick procedural question. As I mentioned, Dr. Blumenthal wanted to go with a consensus, head-nod type approach in determining if something was approved or not by the group, as opposed to taking a roll call vote. Do you have any thoughts on whether you prefer one method or the other?
EGERMAN: I think Dr Blumenthal’s approach is wise. The issue here is we’ve got to keep in mind that this is a process by which we are giving advice to Dr. Blumenthal. We’re not a board of directors. I don’t know for sure why he’s taking the approach he is, but we don’t want to have a situation around particular issues where you have one or two people who view this as a way to posture and get a little bit of ink with their name on it. That’s not what we’re trying to accomplish. He needs to know what people think and why they think that way, so I’m completely comfortable with the consensus approach.
GUERRA: As we said, some of Neil’s concerns and Gayle’s concerns were that there wouldn’t be much movement in the market because of the changes. What would your advice be to – let’s take the two segments one at a time – one would be the vendor community. What would your advice be to the vendor community that is obviously very interested in your work on certification? And also what would your advice be to the CIOs at the hospitals in terms of what they should be doing?
EGERMAN: Well, first is the vendor community. What I would be telling any vendor is to look at the meaningful use objectives; don’t just look at the measurements, look at the objectives. That’s what we’re looking for your software to do. The second thing I’d say is to take seriously the comment about interoperability, privacy and security.
On the privacy side, make sure you’ve got your act together in terms of whatever you need to do internally. On the interoperability side, realize we’re very serious about that. That’s where you should be thinking about moving your development activities more and more — towards standards-based exchange of information and less and less on individual functions and features of the system.
On the CIO side, they should also take privacy and interoperability very seriously. Fundamentally, if you look at the interoperability side, everybody blames everybody else. They say, ‘Well, you know, it’s because the vendors are doing something, it’s because the providers don’t have incentives, it’s because the standards aren’t there.’ We’re taking everybody at their word, thinking all of that is true. So in terms of interoperability, they should be sure that they’re exchanging information according to standards, demanding that the vendors adhere to the standards.
I guess the other comment I give for everybody is to keep their seatbelts on. It’s going to be a little bumpy for the next month or so, but we’re really going to do this and it’s going to be good.
GUERRA: That’s perfect.I think you've answered all of my questions.
EGERMAN: Actually, there is one other point that I want to make. One of the major things that we said about certification is that less is more. We also said that, in this new certification approach, we want things done at a higher level when it comes to functionality, less explicit. That’s also a change.
In other words, the current stuff reads like a very detailed RFP. We’re saying, for example, that if certification calls for an alert for an abnormal test result, then in this new approach we’ll simply say you have to have an alert for an abnormal test result, but we won’t say explicitly how that alert has to occur. We want to describe the functional things at a much higher level, and what we’re hoping is that this approach will create opportunities for greater innovation. So people can say, ‘I’m going to do my alerts by doing text messages or by blinking the lights on and off in the physician’s office,’ who knows what it is, but the idea is that describing a higher level gives us more innovation. This is also going to shorten up the work that’s involved in getting HHS Certification, at least on the functional side.