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.