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?
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