CCHIT May be HITECH’s Biggest Challenge
On April 17, drjj says:

While the widespread implementation of EHR’s is a laudable goal, it doesn’t appear that the practical realities of what this means for practicing physicians has received adequate attention.

For them, this is an expensive and disruptive proposition. When businesses make this commitment, they know that any resultant financial benefit will accrue to their bottom line. When private practicing physicians make these investments in time and money, they do stand to improve their quality (which most believe is high anyway), but the financial benefits accrue mainly to the insurance companies.

I wonder how many large corporations, several of whose leadership I heard clamoring for more widespread acceptance of EHR’s by physicians @recent World Health Care Conference in Washington, would spend for IT in this model.

And all this at a time when CMS seems to think it’s a good idea to continue either freezing or reducing physician Medicare payments every year!

I commend the current administration for making some funds available for this purpose; but if the barriers are too high and the requirements too stringent along with inadequate reimbursement, it’s unlikely we’ll get to the five-year time frame goal that has been set to accomplish widespread EHR adoption.

On April 20, reefdiver responds:

Drjj speaks for many busy, practicing physicians and practices out there.

Most surveys for the past five years, which have attempted to get at the root of why EMR adoption has been so low and de-install rate so high, show that the two top reasons have been cost and difficulty to use. Will the funding now being provided by the Stimulus Bill – up to $44,000 per physicians under Medicare or even $63,000 under Medicaid – change that and quickly enable ALL practices to adopt and use EMR? How can it? It only addresses HALF the problem?

My guess...and much of the conventional wisdom in the industry...is that Stimulus Bill funding will not be successful under the current circumstances. It may increase the adoption rate initially, as the enthusiasm and momentum for “change” drive things, and under the premise of EVENTUAL reimbursement (over five years). But it absolutely WILL NOT change the success rate of implementations. And likely, billions of Stimulus money will be wasted. WHY? One simple reason. CCHIT-driven certification.

CCHIT-certified systems are basically “Government EMR”. The continually expanding 480+ criteria to be “certified” continue to ignore “usability” as a criteria for earning the credential. Despite that government-funded groups’ good intentions and hard work, results are still disappointing and adoption rate is low. With a 50+% failure rate on installations even with CCHIT credentialling up to now, why should that improve by government dollars partially reimbursing practices for the same systems? In fact, if you accept the notion that the most tech-savvy physicians are those most likely to have already implemented--- or attempted to – then the “other 80+ percent” of physicians will be even less-likely to succeed. EMR systems have no “usablility” measures for physicians to compare. Stimulus funding is betting the farm – over $36 billion (less PROJECTED savings of $17 billion – where does that come from? What if it doesn’t?) – that this will work. Can we afford to squander billions of dollars on this “bet”?

While there are several landmark studies from highly reputable institutions and firms that conclude that CCHIT-based EMR implementation has produced NO broad-market results such as documented cost savings, reduction in medical errors or improved care results, there is not ONE landmark study that concludes to the contrary. Can anyone produce such a study? Can we continue on a path of providing billions for these systems where the benefits are still anecdotal? And where the physicians and practices have to pay the cost and the insurance companies receive the benefit?

Why not take a million or two million dollars and have a truly independent, reputable institution find out some answers in this area before we spend $36 billion like it is the answer to the problem?

Lets hope Ms. Sebelius, upon her deserved approval as White House Health Reform Czar, and Mr. Blumenthal upon his ascension to ONC look a lot harder at this. Committees for CCHIT and even the nascent group being put forward for HITSP seem to ignore the inclusion of high-performance, busy, practicing physicians in deciding for that group what it needs.”