Graham over at EMRUpdate found a really crazy bill being proposed in New Jersey that would make the use of non CCHIT certified EHR illegal.

Here’s the sections of the bill that seems to capture the crux of what’s being proposed:

“· On or after January 1, 2011, no person or entity is permitted to sell, offer for sale, give, furnish, or otherwise distribute to any person or entity in this State a health information technology product that has not been certified by CCHIT. A person or entity that violates this provision is liable to a civil penalty of not less than $1,000 for the first violation, not less than $2,500 for the second violation, and $5,000 for the third and each subsequent violation, to be collected pursuant to the “Penalty Enforcement Law of 1999,” P.L.1999, c.274 (C.2A:58-10 et seq.).

· The bill defines “health information technology product” to mean a system, program, application, or other product that is based upon technology which is used to electronically collect, store, retrieve, and transfer clinical, administrative, and financial health information.”
…
” 5. (New section) a. The Director of the Division of Consumer Affairs in the Department of Law and Public Safety, in consultation with the Office for e-HIT in the Department of Banking and Insurance and the Commissioner of Health and Senior Services, shall require that, on or after a date to be determined by the Office for e-HIT and in accordance with requirements established by that office pursuant to and in furtherance of the purposes of subparagraph (a) of paragraph (1) of subsection b. of section 8 of P.L.2007, c.330 (C.17:1D-1), each health care professional who is licensed or otherwise authorized, pursuant to Title 45 or Title 52 of the Revised Statutes, to practice a health care profession that is regulated by a professional and occupational licensing board within the division or by the director, shall purchase, rent, lease, or otherwise acquire for use in that person’s professional practice only those health information technology products that have been certified by the Certification Commission for Healthcare Information Technology.”

I’m really kind of speechless. If you read this blog regularly, you know that’s pretty rare. As Graham points out, why would they want to pre-empt whatever rules ONCHIT puts in place for EHR? I also wonder how they plan on enforcing this act. Plus, what is this senator really thinking? I think that each of these bills should require a full disclosure as to the impacts both good and bad and the reasoning behind even proposing such an idea. Reminds me a lot of the senator who called for an open source EMR, but this is much crazier.

Seriously, what’s the basis for this senator wanting to have it illegal for someone to use any EHR other than a CCHIT certified EHR? I’ve asked many times for some sort of study (independent hopefully) that shows that CCHIT certified EHR have a higher implementation success rate, or improve patient care, or save doctors time or any other benefit over the non CCHIT certified EHR out there. So far no one has produced such a finding. I’d suggest we haven’t found that study since the results of said study would find the opposite.

All I can say is that I’m glad that I don’t live in New Jersey and for their sake I hope this bill fails miserably.

I’ve had a number of people ask me my thoughts on this Wall Street Journal article which talks about open source EHR and in particular the open source EHR developed by the VA hospitals called Vista.

I must admit that I’ve been enamored by the concept of free EMR. One of my most popular blog posts was this guest post about Free EMR by Medicare. Turns out that Vista is one of those open source (free) emr software that keeps popping up. I imagine it will continue to pop up for a long time to come.

Let me offer three points that I keep hearing over and over when I hear people talk about open source Vista.

1. (We’ll start with the good) Those that go to the VA are quite happy that no matter what VA hospital they go to, they have their information available. I’ve heard this on multiple occasions. I’m not sure if people are saying this because they’ve actually experienced it (which is likely considering the transient nature of veterans) or because they’ve had the concept drilled into their head. Either way, this is the major perception and considering it’s all one nice package I’m inclined to think it’s a huge advantage of Vista in the VA hospitals. I’d love to hear someone address how this “EHR interoperability” using Vista would work in commercial hospitals.

2. The users of Vista really don’t like using the program. It’s clunky, unwieldy and not the friend of the user. I’ve heard this multiple places and not just from doctors, but also from nurses and the IT people supporting the software.

3. The “database” that Vista uses, MUMPS, is a piece of junk and a major anchor on what could be an otherwise interesting open source project. I’m sure there’s some really interesting history behind the VA’s decision to use this MUMPS “database” system instead of one of the current SQL based database systems. Unfortunately, I’ve seen numerous people talking about the pains of MUMPS and the problem it creates for the future of open source EHR Vista.

I’ll admit that I’m not an expert on Vista, but I’m just telling you about the common themes I’ve read over and over again. Any other ones we should know about or other perspectives on Vista EHR?

I love when senators come out and write bills requesting for the government to fund an open source EMR. Turns out the most recent request came from Senator John D. Rockefeller has proposed a new law which would establish federal grants to develop open source software and standards for electronic medical records. You can read more about it on ars technica.

I have to admit that I strongly support the concept of open source EMR and really open source software in general. I just don’t know why government thinks that government grants would really help open source software. I could be wrong, but has there ever been a significant open source software project that was grant funded by the government? It just generally seems contrary to the open source development model.

I guess I just wonder how a senator gets it in his mind to write a proposal for open source EMR grants. Did an open source project request for him to do it? Where did the senator get this idea that it was a good idea to have an open source EMR? Did he consult the existing EMR projects to see if this is something that they would find beneficial to the cause?

Maybe he in fact did do all of these things, but I wouldn’t be surprised to hear that Senator Rockefeller knows little about open source software and in particular the challenges that open source EMR software is currently facing.

I’ve been meaning to post about the CCHIT and open source meeting at HIMSS for a while now and just haven’t ever gotten around to it. I did post my twitter thoughts on the CCHIT/Foss meeting, but I think there’s plenty more that could be said about that meeting.

For those of you that missed it, you can find the audio of the meeting on the CCHIT website and I’ll embed the powerpoint presentation from the meeting below:

My biggest complaint from the meeting was a slide that Mark Leavitt used to describe why he feels that CCHIT isn’t excluding the little guy. Basically it talks about the size and market share of the EHR vendors that have applied for CCHIT certification (you can see it as slide 12 above).

I can’t quite place why this measure feels wrong, but it does. Maybe it goes back to something one of my professors taught me when doing research analysis. He basically said, that when first looking at the numbers does it feel right. Considering what I know about the EHR and EMR market and CCHIT certification in particular, I know that something doesn’t feel right. Let me explain a few reasons and hopefully someone else smarter than me can comment on what else is wrong with this measurement.

First, the graph showing practice sizes served is misleading. I don’t know specifically how they found out which size practices a certified EHR vendor served, but I’m guessing it was self reported by the EHR vendor itself. If this is the case, most EHR vendors will say they can work in any practice size. So, that basically makes the data pretty useless. Possibly you could look at the size of the practices using the EHR system, but even then you get into trouble because how do you define “using” the system. A few EHR vendors can claim tons of purchases of their EHR software, but then you find out that very few if any of those purchases are actually implemented.

The second part of the slide shows a nice pie chart of the size of EHR vendors that are certified. The challenge I have with this chart is that it may just illustrate how small the EHR industry really is right now. The revenues of EHR companies are spread out over 300-400 EHR companies. Considering 5-15% (depending on where you look) adoption, that means that the majority of EHR companies are all small businesses with very low revenue.

I bet if we did a percentage of EHR vendors that did CCHIT certification for each of their annual revenue classifications you’d see something like this:
> $100 million – 100% CCHIT certified
$21 – 100 million – 90% CCHIT certified
$11 – 20 million – 50% CCHIT certified
$1 – 10 million – 15% CCHIT certified
< $1 million – 3% CCHIT certified

I’m just pulling these numbers out of the air, but I think you can see the principle of how CCHIT certification is being adopted by large EHR vendors and not as many small EHR vendors. CCHIT’s measure is just wrong. It should be percent in that EHR size category that are getting certified. It’s not the percentage of all CCHIT vendors that are doing it.

Reminds me of the common phrase that statistics can tell you anything you want to know. Something for all you EMR and EHR fans to chew on over the weekend.

I recently became aware of a new open source tablet EMR that was going to be offered by Medscribbler. Everyone that reads this blog should know that I’m a huge fan of open source (see my previous posts about open source EMR). It’s about time that a really strong tablet based EMR software was available as open source software.

Open source EMR purists will probably be a little disgruntled that Medscribbler is built on top of other technologies which are not completely open source. However, I give them a pass for now since the open source community has so far failed to deliver very good tablet based software.

You can find more information about the free Medscribbler EMR software here or at their sourceforge page. The following is the official press release announcement:

Medscribbler is released as an Open Source electronic medical record

Scriptnetics, the leader in Tablet PC mobile healthcare applications, will announce Monday its release of the proprietary source code for Medscribbler electronic medical record, EMR, to the open source community. Installable components and the code for programmers are available at the globally recognized open source portal, Sourceforge.net.

“Releasing a Medscribbler Open Source EMR is the next logical step to drive the innovation that is needed to get to a point where the majority of physicians and other health care providers take up electronic medical records,” said Michael Milne, Chief Executive Officer of Scriptnetics. “We hope to encourage a stable, widely available and affordable entry level EMR that uses cutting edge technology with the mobility of the Tablet PC,” he continued.

To provide focus and stability to move the project forward Scriptnetics has assigned programmers to manage and contribute new programming code on a regular basis. Other programmers wanting to contribute but needing help in understanding the considerable amount of code that already exists can access live help and support. For programmers looking to maximize their skills, project suggestions are posted in a forum.

The new Open Source EMR is called Medscribbler Community and is the first vertical, enterprise level open source project to be designed specifically for handwriting recognition on the Tablet PC. Medscribbler Community is already being used by many healthcare providers both in stand alone computer situations and client server multi computer offices. This cutting edge EMR is also being used in Internet WAN mobile remote access situations.

Scriptnetics is the largest vendor of penable Tablet PC designed medical software in the world. The company’s flagship product, Medscribbler, has been distributed since 2003 and is being used by healthcare providers in the United States and Canada. Its offices are located in Wilmington, Delaware and Moncton, New Brunswick. www.scriptnetics.com and www.medscribbler.com

SourceForge’s web sites connect millions of technology professionals and enthusiasts each day. Combining user-developed content, online marketplaces and e-commerce, SourceForge is the global technology community’s information exchange network and the world’s largest open source software development and distribution environment. Its offices are located in Mountainview, California.

For more information on Medscribbler Community see: www.emrfreesoftware.com and sourceforge.net/projects/medscribbler/

Press Contacts:
Michael Ferguson
Scriptnetics
(506) 859-9271
prnews@scriptnetics.com

Full Disclosure: Medscribbler is a an advertiser on EMR and HIPAA.

So many good things to post about and so little time. This one I couldn’t wait any longer. I first saw this on Fred Trotter’s blog, but the picture’s been making the rounds. I got his permission to post it here.

I can’t think of a better image to portray the difference between Big EHR vendors (I call them jabba the hut EHR) and small/open source EHR vendors. Check it out.

Source: http://twitpic.com/2xe18

The meeting between CCHIT and FOSS at HIMSS was really interesting. I have a lot more to post about it, but I thought I’d start with a quick picture (see above thanks to Twitpic) and my real time thoughts on the presentation that I posted to my Twitter account.

Listening to the CCHIT webinar, it really seems like CCHIT has overworked their EHR certification.

Facts about CCHIT by Mark Leavitt. This should be interesting.

Mission of CCHIT “Accelerate adoption of HIT” not “Accelerate adoption of proprietary HIT” -Mark Leavitt Uh huh

I’d like to know which self developed open source EHR is CCHIT certified.

CCHIT Session: Licensing costs of the datasets are a challenge for open source EHR. Problem since CCHIT requires them.

Town halls,reports, online discussion as the means of CCHIT communication. There missing so many ways to get feedback from people

Even though it’s a certified EHR system, can’t guarantee a successful implementation -Mark Leavitt

CCHIT’s goal is to help small practices that don’t have time to research EHR. Where’s the data that CCHIT actually is achieving this goal?

@dschach Agreed. That’s why CCHIT shouldn’t make claims/goals to improve adoption/success since certification doesn’t help and may hinder

Fred Trotter’s list of reasons CCHIT and FOSS don’t match is great. Definitely doing a post with some of the ideas. [Definitely a future post on this blog]

It’s obvious that there are a lot more issues with CCHIT that need discussion than just open source

CCHIT has plans to measure the success of certified EHR in implementation. Will expose numbers to users, but not require a success rate for certification

“CCHIT wants to think about certifying versions. It’s backwards for FOSS EHR. So they have to think about it.” It took 3 years to think about this?

@oneofthefreds I wouldn’t call it nonsense. Mark sounds sincere, but just uninformed.

CCHIT should really use uStream for these town hall meetings rather than the GoToWebinar. Much better user experience

CCHIT and FOSS meeting’s gone way over, but I’m glad they did. Plus, we only covered a small share of CCHIT discussion

“We think CCHIT certification being the certified EHR is likely, but we don’t know.” -Mark Leavitt

Summary of CCHIT and FOSS Meeting: Lots of unanswered questions about CCHIT. FOSS just complicates it even more

I also think that tonymaro (Twitter username) offered some good insights on the event:

tonymaro: The more he[Mark Leavitt] talks the more it beomes available that CCHIT isn’t evil regarding OSS, they just don’t get it!

tonymaro: I’m afraid the obvious disappointment by the OSS community has simply caused CCHIT to turn defensive

As a side note, the first CCHIT meeting at HIMSS was a big disappointment. It was described as a CCHIT roadmap and ended up being a Laika project demo and roadmap (kind of). I’m not trying to discredit Laika since I don’t know too much about their work. I’m just saying that the expectation of CCHIT roadmap wasn’t met for me.

The CCHIT and FOSS meeting was a little scattered, but a good start to the conversation. I look forward to seeing how the discussion continues. Much more to come on what was talked about at this meeting.

I’d been meaning to post this for a while, because I hope that it will be well attended. CCHIT and various open source EMR groups, advocates and friends will be meeting with CCHIT during HIMSS. I first read about this from Neil Versel where he said this:

Healthcare FOSS guru Fred Trotter and Linux Medical News editor Ignacio Valdes, M.D., are leading the event, Monday, April 6, at 2 p.m. in Room 10d at the Hyatt Regency McCormick Place at 22nd Street and South King Drive in Chicago. Trotter called the encounter “like offering to meet with the Rebel Alliance at the annual Death Star conference,”, but I imagine they intend for things to be civil.

I love the Death Star reference. This should be a pretty interesting meeting. I was talking to someone today who suggested that they were going to come to some sort of consensus at that meeting. I suggested that they probably wouldn’t come to a consensus, but at most agree to disagree. However, I’m a strong advocate for communication and understanding between parties. So this is a good thing.

The best part for those who can’t attend HIMSS is that they’re planning on doing a webcast of the event. Here’s the details:

Date: Monday, April 6, 2009

Room 10d, Hyatt McCormick Conference Center, Chicago

Session #1 1:00 – 2:00 PM CDT

Interoperability 09 and Beyond: a look at CCHIT’s roadmap for the future

Session #2 2:00 – 3:00 PM CDT

Open Source Forum: a dialogue on certification for open source EHRs

Here is the link to register for the webinar:

https://www1.gotomeeting.com/register/429901059

After registering you will receive a confirmation email containing
information about joining the webinar. We will also be recording
these sessions, and plan to make the media files available on the web
for later downloads.

There’s actually 2 sessions and I’m really interested to see how it goes. I wish I could be present, but I’ll definitely be at the webinar and posting my thoughts on twitter. I do wish that CCHIT would add a ustream video feed of it as well.

The HITECH Act and EHR stimulus has become one of the most popular topics on this blog (for obvious reasons). Today I came across someone who did a good job summing up much of the HITECH act in 3 simple phrases (a few minor modifications on my part):

1. HITECH Provides Direct, Massive Funding To EHRs [this is EHR vendors]
2. HITECH Requirements for Certification of EHRs Limit Competition and New Entrants
3. HITECH “Promises” to Enfranchise Existing Groups [HITSP and CCHIT] into the Federal Hierarchy

You can read the full description of these 3 points here. I don’t quite understand the cat and dog stuff the post talks about, but the 3 items above are dead on. The post also agrees with me that CCHIT Certification excludes open source EHR software.

These 3 points also reminds me of my list of HITECH Act winners. I wonder what would need to change to add patients and doctors to that list of winners.

I previously posted about how the selection of CCHIT as the certification criteria for the HITECH act excludes open source EHR. I took more of a practical look at why an open source EHR product wouldn’t ever pay for CCHIT certification. I recently found a different angle about why CCHIT is not good for those interested in open source EHR.

Understand that CCHIT currently provides NO benefit to open source, in fact the CCHIT certified edition cannot be the one provided as open source, that is how the certification works. We have to have a commercial relationship with the customer in order to provide the certified edition. You can get the same feature set (that is already the case) but can’t call yourself CCHIT and would probably no be eligible for most funding/reumbursement if using the open source edition. So if you are interested in using our commercial edition of ClearHealth no problem but if you want a CCHIT certified open source system, none will exist until they adjust their process. Read the fine print on WorldVista, same deal.

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