Feline Foot-Dragging: Three Non-Innovative Aspects of HITECH

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What do cats (incumbent EHR vendors and their supporters) have to smile about over HITECH?

A lot.

…and it’s not very complicated.  HITECH directs $17 B to the cat community, and leaves scraps for the dogs.

(As a refresher, the cat POV is that HITECH stimulus funds should simply pay directly for electronic health record (EHR) technology — that providers will figure out how to use the technology to improve quality and outcomes; the dog POV is that HITECH should pay for improved quality and outcomes — change incentives and IT will naturally follow. See the first post in this series for more detailed explanations.)

There are three aspects of HITECH that are particularly favorable to cats:

  1. HITECH Provides Direct, Massive Funding To EHRs
  2. HITECH Requirements for Certification of EHRs Limit Competition and New Entrants
  3. HITECH “Promises” to Enfranchise Existing, Cat-Friendly Groups into the Federal Hierarchy

But first, a few prefatory remarks.

Disclosure

This post was written by a dog trying to describe a cat’s POV.  By nature, dogs are not always empathetic with cats. But facts is facts — I’m a dog, not a journalist.

Of course, cats are free to add their comments as they wish.

Cats are Attached to Their Existing Environments

Whereas dogs get more attached to people, cats get attached to places.  They don’t like to see their existing environment change.

I’ll share a personal story.  When we moved into our house, the previous owners told us to keep an eye out for their cat (don’t remember the name, but I’ll just refer to him as “Fluffy”). In the scuffle of their moving out, Fluffy had laid low and was nowhere to be seen.

Sure enough, Fluffy showed up at “our” new house a day later.  With much resistance, I corralled Fluffy into a pet-carrier cage and put him into the back seat of my car. I drove six miles to the new house of Fluffy’s owners and handed him back to his rightful keepers.

Guess who showed up at the doorstep of “our” house two days later? Somehow, Fluffy had navigated back to his previous domicile, thinking that his old house is home.  How he figured out to get back to his old house is beyond me, but he did.

So what do cats see in HITECH that preserves things the way they are today?

Catcash 1) HITECH Provides Direct, Massive Funding To EHRs

…and only to EHRs.

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Let’s recap: How does HITECH resolve the issue of direct funding for a range of potentially useful health IT?

Certified EHR Technology: $17 Billion

Everything else: $0

Dog’s ask “Why limit the funding to EHRs? why not provide support for a range of arguably more ‘shovel-ready’ technologies and services?”

But this post is about the cat POV, so we’ll leave answering these questions to another day.
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2) HITECH Requirements for Certification of EHRs Limit Competition and New Entrants

Cats are pleased to see that HITECH provides funding only for “certified” EHRs.

The standard feline line here is that certification provides protection for buyers of EHRs — that you can’t just label any old piece of dog poo an “EHR” and get away with it.  No sirree, doctors need to have a Federal agency to certify that an EHR is what it is, and not dog poo in disguise.

Are there other effects of certification?  Well, you can pretty much forget open source EHR software as competition — who would come up with the $30K required to go through the process (at least under current CCHIT certification requirements)? and what about innovative new market entrants such as Clinical Groupware — gotta keep them out, too. …and so on, and so on….

3) HITECH “Promises” to Enfranchise Existing, Cat-Friendly HIT Groups into the Federal Hierarchy

Cats like having friends in high places. For example,

Cats would like to see the Healthcare Information Technology Standards Panel (HITSP) codified as the national standards harmonization body.

Cats would like to see the Certification Commission for Health Information Technology (CCHIT) codified as the group that “certifies” EHRs.  …and they see the existing CCHIT certification requirements as being just fine  (certification requirements that include only 200+ elements of EHR functionality, never mind other factors like user-friendliness, customer satisfaction, vendor financial viability, or customer support).

Many cats see these groups as highly sympathetic to the cat cause.

However, the wording of HITECH is a bit puzzling. It specifically establishes a standards committee and a certification process, but does not specify HITSP or CCHIT as the designated entities. Cats are comforted that HITSP and CCHIT seem to be heirs apparent to these roles, but are somewhat nervous about finalizing the details.  Stay tuned.

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2 thoughts on “Feline Foot-Dragging: Three Non-Innovative Aspects of HITECH

  1. Well done. I’m not sure I understand all the cat dog stuff, but your points are dead on. I’ve actually written about a lot of the things you said.

    I wrote the following post about why choosing CCHIT certification will basically exclude open source EMR software: http://www.emrandhipaa.com/emr-and-hipaa/2009/02/26/hitech-basically-excludes-open-source-ehr-if-they-select-cchit/ I’m looking forward to CCHIT and open source people meeting at HIMSS. It’s said to be broadcast online as well.

    Also, I think we can all agree that the biggest winners of this stimulus money is the EHR vendors (specifically I call them the jabba the hut EHR vendors). I wrote about all the various winners from the HITECH act. Sadly, doctors and patients aren’t really found on the list.

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