>"Mark Leavitt, CCHIT's chairman, says the group is considering adding
>the real-world experiences of end users into certification decisions.
>The stimulus legislation doesn't specify whether CCHIT should be the
>group to certify electronic-records systems, but Dr. Leavitt says the
>group is open to modifying its certification requirements."
>
>"Dr. Blumenthal wouldn't comment on whether CCHIT will remain the key
>group for certification."
>
>At this stage of the game, it doesn't appear CCHIT is necessarily going
>to be the certifying body, or that the process used will be as it is
>presently set up.
>
>There appears to be general consensus that any approach will need to be
>based on common data standards (something I am relieved by). HIPAA tried
>to do this (hence the "portability" piece), but my understanding is that
>the standards were not enforced. Note that the Veterans Administration
>has been targeted as a potential "model" system for such standards. Note
>also that there is a certain degree of standardization in how medical
>costs are billed through such programs as Medicaid and Medicare - in
>this way the medical records field has some similarities to the property
>recording field, in which common billing elements and the need to share
>across different industry players has lead to data standards that
>facilitated the transfer to electronic records keeping.
>
>Where I see a big challenge is in business processes - this is where
>standardization will achieve the greatest potential savings, yet it is
>also where individual institutions and practitioners will be most
>resistant to change. If systems need to be customized to each
>installation to a great extent, the cost savings will be eaten up by
>ongoing maintenance for the customized installations.


You're right Dwight I didn't cite the balance of the comment re: the CCHIT-
but in part that was intentional.

I was a bit perplexed when he mentioned end-users being involved in the
decisions, when I think of end-users of medical information, I think of
consumers... possibly Leavitt meant the medical profession.  But even so,
based on discussions with medical professionals, they don't seem to know or
care what formats the information is captured/gathered in, they just want to
be able to see it NOW... and they aren't thinking that it will be a problem
seeing it later, because they don't thin kin the same terms as we in RM do.

For them, it's an 'electronic chart', just like a paper chart... they tell
the nurse or office staff they need a patient's records and they don't have
a clue where it comes from, it just appears either in a bucket on the door,
or in a 'folder' on the screen when they go in the treatment room.  And it
doesn't matter to them, because in reality patients come, and patients go
(literally) and if they can't find the test results or the medical history,
they just start fresh.

And it may NOT be CCHIT, but if they've got their foot in the door, I doubt
they're be supplanted in this process because unless someone else sees this
as an opportunity to make money, they won't want to start from the ground
up. HIMSS may be a player in the process, but a lot of that may also depend
on how strong CCHIT is.  They've been involved for almost 7 years now (if my
memory serves me well) and they've only been looking at the need for
interoperability for a year now, and Project LAIKA is trying to adopt an
Apache 2.o platform, so there may be hope.  (unfortunately the CCHIT site
says they hope to release something "by Mar 2008", so no telling what's
happened there).

As I've said before, my concern is persistent access to information gathered
and elimination of proprietary formats during capture is one way this will
occur. Presently every medical device company and testing lab is working in
a vacuum because there is no impetus for them to consider the need for
interoperability, no one is saying they won't be accepted as a member
without it.  And if they aren't provided any incentives (or fear of
penalties) obviously, they won't be encouraged to move in that direction.

We as consumers of health care are going to have to take a more active role
in seeing this happen.  And now, if our tax dollars are going to be spent to
build systems, we have another incentive along with ensuring OUR (and our
children's) health care information will remain accessible.  On a personal
level, my health care costs have gone from $324/month to $709/month for me
and my family, along with co-pays increasing per visit and per prescription.
So I see this as an "investment" I'm making in my future- and I think the
rest of us are in similar situations.

If WE don't take a role in this who will?  We've seen countless formats
disappear from support (Borland apps, Supercalc, Wordstar, Volkswriter,
earlier versions of MS Office applications, etc) and obsolescence in media
forms (4 and 8 track, cassette, Beta, VHS, Bernouli, 8, 4 and 3,5 inch
floppies, floptical drives, 3480 tapes, low density CDs, etc)  and we know
if something isn't done, we lose access to information stored in these forms
and on this media.

Do we want the same for medical records of ourselves and our children?  This
will have a much more personal impact than some of what's happened at work. 

I see this as an opportunity for those of us with this knowledge to share
with those just embarking in these ventures in EMR/EHR to share our
experience and help them to avoid what we've seen... to stop the creation of
future legacy applications, systems and data forms.  

Sure, they're going to take care of the financial aspects for billing and
coding, because that's where the money gets collected and that's all serving
short term needs.  My concern is much longer term- the data gathered now
being available for treatment of medical conditions in the future, avoiding
the need for repeating tests and gathering new medical histories and
allowing for better care in the future based on the ability to evaluate
information from the past.

Larry
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...And yes, I DO respond to the writers of these article, I have for years
and I write my Congressmen and Senators when I see legislation being posed
on these issues, and post messages to whitehouse.gov, and blog post as
well... but it take a LOT OF US DOING THIS to make a difference, not just
the sound of one hand clapping

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