What has been your proudest achievement as chairman of CCHIT?
The proudest achievement is the fact that it did involve that large number of people. It’s the fact that it’s a volunteer-based organization, and we were able to provide an environment where several hundred volunteers from diverse backgrounds and diverse viewpoints were able to come together to collaborate and produce a practical product. In fact, they produced it on time. They produced it with credibility. And, we were able to turn it into an actual certification program that we’ve been operating for years successfully. Leading volunteers is a completely different skill from work I’ve done before, where people were paid a salary to do the work. I’m very proud of learning the new skill it took to facilitate that process.
How do you envision CCHIT’s role going forward?
We think we’ll still have a comprehensive program that exceeds the government criteria, and we’ll also run a government program because some people don’t need us protecting them. They know what they want. They just want to put it together and it just needs to pass the government requirements. So I see that as persisting in the future.
A big area is the concept of site certification, which is for organizations that didn’t go out and buy a complete certified EHR package for everything they do – which, by the way, is probably most hospitals. You know they’ve got a little bit of a mix of products – some may be certified, some not. Or maybe they built some of the functions themselves or got them from a certain non-certified vendor or they have an older product and can’t get a certified version in time. Their technology may still meet the requirements and they need a way to get that stamped, saying it’s certified in order to get paid, and we’re developing a program to do that. And the fact that it says site certification doesn’t mean that people physically go on site the way they would for a Joint Commission inspection. We want to use the technologies we developed, which is a virtual inspection using Web conferencing and technical testing of the interoperability, and some of it is just document review. I think the challenge is to develop a cost effective way to get them certified so they’re not locked into throwing everything out and buying a system from scratch, which is completely impractical. So it think that will be an exciting area and a big area for CCHIT this year and beyond.
Is the government’s concept of having several certifying bodies a good idea? How do you envision it working?
I think it’s fine that they have chosen not to make it an exclusive arrangement with one organization. If they are to set a number of requirements for accrediting a certifying body – the neutrality of the board, the thoroughness of the inspection process – all of the things that the certifying body needs to do to make its certification reliable and credible – and then say, ‘O.K., if you want to do it, come and take this test that accredits you,’ I think that’s fine. We’ve been preparing for that in various ways, for example going through ANSI, American National Standards Institute accreditation. We took some initial steps just to evaluate ourselves. We haven’t moved completely forward, but we could if necessary. And, we found that we were able to meet all those requirements. I think that’s very reasonable. I think there are some risks if they make the accreditation too loose so that anybody and everybody can become a certifying body. Then the certification might become meaningless – kind of like states that instead of having control over inspection of cars for smog, they say any corner gas station can do it, and they don’t monitor that. You can imagine what happens in terms of enforcement of the smog regulations. So, I would not like to see it degenerate into that where vendors certify themselves or form their own little bodies that certify things so loosely that they can get through. But I think that’s going to b up to ONC to develop that and to make sure that that’s credible.
How would certification work with several certification bodies? The vendor chooses one?
You would choose one. The problem is you might confuse the providers who are buying the systems. Say, well “this is certified by A, but the other guy says, “well, this is certified by B, and that’s better.” So, instead of accelerating adoption by giving providers more confidence, you actually inject another unknown. And that would be a bad outcome. That would be an unintended consequence of multiple certifying bodies, or vendors might feel they need to go to each and get certified, which raises the cost and the effort that they have to go through. While I don’t think they need to limit it. I think the market will probably determine the right number of certifying bodies. We expect to be one of them. We don’t necessarily expect to be the only one. We expect to be one of them because we’ve been doing it for quite a while – successfully. If you check the satisfaction of vendors with the process itself in terms of do we take their application and process it smoothly. Are we competent at doing that and are you comfortable that you’re getting a level playing field and that you’re getting tested the same way as any other vendor. There’s not a hint that there have been any concern with that. We get a lot of kudos actually that it’s well managed. The credit actually goes to our certification program staff.
CCHIT has been criticized because it was founded by HIMSS and other professional associations that are at least partly vendor-driven and therefore your work has been called into question. How do you respond to criticisms?
It’s really good to look at the evidence as opposed to claims. It’s a fact that the organization was founded by three professional associations. The organization got its start there, but the organization was required to evolve and has evolved to become a completely independent organization. It is a nonprofit 501C3. It has been since 2007. It has no financial ties to those organizations – no money received or sent back. We have designed and enhanced all of our processes to ensure independence and prevent undue influence from any sector whether it be vendors or providers or payers. We look for balance. So the number of commission seats available to vendors is really only 20 percent of commission seats – nothing close to a majority. The number of workgroup slots that can be occupied by people with any relationship to a vendor is one-third or less. Again no majority. Every workgroup has to be chaired by two co-chairs that have to come from different stakeholder groups. All of our meetings are documented. The minutes are published on the Web. All of our work goes through multiple stages where take public comments and respond to every one as we update the material. And then our actual certification program, one the criteria are finished and approved, no ties to vendors are allowed by any staff member or juror. Any financial tie is an immediate disqualification, and that area has never been questioned. When you look at the facts, the facts show an organization that is highly balanced, highly open and transparent and does not have undue influence from vendors.
What are you reading?
I read constantly. I’ve never been interested in politics before. I’ve read a few books recently to attempt to understand the political process, which is something very new to me and understand why sometimes the decisions that come out of the political process aren’t the ones that come out of scientific or technology or engineering processes. I’m trying to understand it better.
