HIT Panelist Bashes CCHIT as Legacy Vendors' Puppet

The commission charged with certifying health information technology is unduly influenced by legacy vendors whose concern for their own welfare is threatening the success of the national HIT initiative, a healthcare analyst told a federal workgroup Tuesday.

Brian Klepper, a panelist at Tuesday's HIT Policy Committee Certification/Adoption Workgroup hearing in Washington, DC, said the Certification Commission for Health Information Technology is led by people with strong ties to legacy software vendors and their trade group, Healthcare Information and Management Systems Society.

"CCHIT was founded by HIMSS. The executive director came from HIMSS. The chairman of the board is president of HIMSS, and it is dominated by a vendor mentality," he said. "CCHIT gives HIT legacy vendors inappropriate influence over policy and it threatens to facilitate a national HIT approach that would fall short of healthcare reform's goals. Whether or not it is actually conflicted, it certainly gives the appearance of being conflicted in a way that would not be tolerated throughout most of the private sector."

Klepper suggested that the CCHIT's role in defining certification rules be reduced, and that other certifying entities be brought in to perform those functions. He also suggested that CCHIT's executive leadership "should be replaced."

That idea didn't sit well with CCHIT Chairman Mark Leavitt, who was sitting a few feet from Klepper on the same panel.

Leavitt, the former CMO at the HIMSS, denied the assertion that legacy vendors are running the show at CCHIT. However, he said it would be unrealistic to exclude vendors from the process.

"Some people have said 'You are certifying products. You should not allow any vendors to participate in your program or be on board', " Leavitt said. "That is like saying 'Let's create a system to test cars and not have anyone who's has ever designed or built cars on the board.' If you exclude the vendors, you probably exclude two-thirds or three-fourths of the people who've been involved in HIT."

He also bristled at Klepper's conflict of interest charge. "I've got 25-30 years in healthcare IT. Those who sit on public stage and impugn the integrity of an individual should at least;before they do it, talk to some people who know that person," Leavitt said.

That prompted a sharp rebuttal from Klepper. "Nobody here has impugned anyone personally. Mark, you are unfortunately inconsequential in that part of the discussion," he told Leavitt. "What matters is there is $19 billion of federal money on the table and that the eligibility criteria will be used in some way to steer that money."

Klepper said CCHIT has "dragged its feet" in several critical areas of HIT development, especially in the push toward interoperability. He said most HIT systems are at a "Level 1, text-reading stage within CCHIT. We could be doing so much more." "Interoperability, which we have heard echoed over and over, does not exist out in the marketplace," he said. "It's a priority for everything, for coordination of care, data aggregation, pricing, performance transparency, for comparative effectiveness research, decision support, patient engagement. All these issues depend critically on the ability of one system to be able to talk seamlessly with another. Those standards have not yet been developed adequately so they are in the marketplace in a significant way. That is holding our entire system hostage."

He added that Google, Microsoft, and New York Presbyterian and Beth Israel hospitals are ignoring CCHIT and swapping data on their own. "When the market begins to ignore what you are doing because what you are doing isn't keeping up, that means you are not current," he said.

CCHIT is focusing "on features and functions," rather than on standards, security, and the rapid distribution and usability of technology at a lower cost, he said.

"We have very high cost for entry, and as a result of that, a very small minority of physician practices have health IT deployed," Klepper said. "Another very large percentage of physician practices that do have it deployed have turned off many of the features and functions. If anything speaks to meaningful use, if somebody turns something off, that says that it's not."

He said CCHIT is looking backward at "very narrow conceptions of what HIT ought to be" and ignoring Web-based technologies for moving data and providing analytics. "It's cementing in old technologies and setting us back a generation," Klepper says.