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: Based on what you’re saying, if CCHIT wants to truly stay relevant, they’ll have to offer HHS Certification.
EGERMAN: That’s right. They might offer HHS Certification as a subset or as just one of their offerings. That’s what I picture. There’s a lot of demand for certification. One of the issues that people want help with is, for example, how do specialists know what constitutes a good system for their specialty, because each specialty clearly has its own set of requirements.
I’m certainly hopeful that CCHIT or somebody else steps forward and does that kind of certification for those medical groups because it’s a clear need, but it’s not a need that I think the government should try to fulfill. I don’t think the Office of the National Coordinator should try to say, ‘If you’re an orthopedic practice, this is how your medical records should be organized.’ Or, ‘If you’re an ophthalmologist, this is what you need,’ because it doesn’t relate directly to the legislation. I think the marketplace and private industry is better suited to addressing those kinds of issues.
GUERRA: So you are looking to inject open market dynamics into the testing function, thus CCHIT would be one of multiple entities. It sounds like you’re thinking that vendors might select which testing body to go to based on the specific product they’re offering?
EGERMAN: Yes, I think that’s right. I suspect that most vendors who are already doing their work with CCHIT will continue to do that, but it’s hard for me to know for sure. At least it’s my personal opinion that competition is healthy. It will be good for everybody. It will be good for CCHIT because I think competition always makes organizations better. I also think it would be good for the industry.
One of the concerns that was expressed by a number of vendors about CCHIT was their fees, as to whether their fees were too high. I looked at their fees; I personally didn’t think they were too high. I didn’t get a sense that they were outrageously high. But if there’s competition, that answers the issue about fees. If somebody can do HHS Certification and do it well at lower fees, then that’s reasonable. Competition is a solution for a number of things.
GUERRA: Just to be clear, when we talk about establishing criteria, where did you stand in terms of the specialties? There’s a lot of talk that the specialties are being left out because there’s a definition for an EHR, but not a definition for an obstetrics EHR, for example. Do you think that those kinds of requirements should also be developed by HHS and ONC? Or do you think that it’s better to stick with a general EHR definition?
EGERMAN: What we are saying so far, and it’s really important for me to say ‘so far’ because as I’m answering all your questions, I’m telling you what I’m personally believe, which at least for now seems to be consistent with what the workgroup believes, but it’s actually hard to know. We’re still a work in progress. Things can change rapidly.
On the issue of specialties, the approach that we’re taking for certification is that HHS certification should be oriented towards establishing a baseline, the fundamental aspects of how these medical record systems should work. So if it needs to do computerized physician order entry, then we should certify that. If it needs to do electronic prescribing, then we should certify that. But then if there are things that specialists need to run their offices correctly, but are outside of ARRA's scope, then somebody else should be involved. That is our view. Again, you can picture an ophthalmology group, where they probably use all kinds of drawings of the eye and they have to deal with all kinds of very special issues within their practice; well, that’s very important stuff to them. At least for now, those are the kinds of issues that the workgroup is saying the marketplace should address.
GUERRA: I commented during one of the meetings that as the group worked to define what certification should entail, those criteria tended to get close to actually proving that the technologies were being used meaningfully. As far as I understand the legislation, those two areas are supposed to be separate. Where should the line be drawn separating certification from meaningful use?
EGERMAN: If you look at the legislation, meaningful use is equally as important as certification. From the standpoint of a physician or a provider or a hospital, to get the incentive payments they really have to do two things. They have to have a certified system and they have to demonstrate meaningful use. So they have equal importance within the law, and the way we decided to deal with this issue is to ask, ‘What do we want to accomplish with certification?’ We said what we first want is for the meaningful use concepts to drive our certification process. That’s what you described as ‘drawing the line,’ that was our concept, meaningful use should be the driver for certification.
But then we also realized this certification process is a very powerful incentive by itself to vendors. You can accomplish a lot by saying this can or can’t be certified. And so what we said is that one the one hand, certification is going to be limited to a high level of meaningful use. On the other hand, we want it very aggressively expanded as it relates to privacy, security and interoperability.
During the discussions on Thursday (July 16) what I said was that when it comes to defining meaningful use and functionality, less is more. In other words, what we’re saying is that instead of an entire comprehensive medical record, we’re talking about defining just those things necessary to meet the meaningful use objectives, and to do it actually at a high level which I want to talk about in a minute.
When it comes to interoperability, privacy, and security, we’re saying more is more. It’s the exact opposite. We want a lot more standards, a lot more specification. We want it to be a lot more explicit. I've got to say that everybody in our industry, everybody who has ever worked in our industry, ought to be embarrassed about the status of interoperability. We’ve talked about it for years but we’ve done so little. This is a tool. We can do a lot, and it’s time to get cooking.
GUERRA: You talked about using the meaningful use definition as a target of your work, but that definition is just as much of a work in progress. You seem to be using a moving target to chart your course. Is that an accurate description of the situation?
EGERMAN: Well, it is unfortunately an accurate description, and what we’re doing is we’re doing as much as we can to provide clarity. I think we’ve taken two giant steps forward on the meaningful use side, in terms of what happened in the meeting before the last, I think people have a much clearer view of what we’re trying to accomplish with meaningful use.
On the certification side, by putting forward the five basic principles that we did at last week’s meeting, we’re also hopeful of providing clarity, and hope that by the next meeting, which is Aug. 14, we can have these things be firmer. And so our intention is to clarify all of this as fast as we can. People need to understand that the time pressures we’re working under are difficult, and we’re doing our best to provide clarity while doing everything in a transparent way to get a lot of public comments, and then react to the public comments.