CCHIT Being Thrown Under the Bus

Posted on February 24, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

If you’ve read much of this blog at all, then you know that I’m not a big fan of CCHIT. The basis of my feeling is that it’s expensive, doesn’t measure EHR usability (despite the impression that it does), and really feels like a coalition of big EHR companies trying to secure their position in the EHR world despite having often inferior products.

All of that aside, the health care IT blogosphere has been posting some amazing accusations about CCHIT. I’ll admit that I don’t have any inside information on the organization and structure of CCHIT. So, I’ll just post all of the various information being posted about CCHIT and let you decide what might be true and what might be conjecture.

Remember that the things below may be rumors, misinformation, politically motivated, flat our wrong, mostly correct, or from disgruntled individuals.  Read everything below and judge for yourself.

See the full coverage of the CCHIT drama after the break

It looks like most of this CCHIT discussion started on a Wall Street Journal blog post about Madoff (thanks to Neil Versel for first pointing this out to me). The crazy part is the post barely related to CCHIT at all. However, the following comments were made by a CJ:

Why not pack CCHIT EHR certifications in Cracker Jack Boxes? If folks think CCHIT is a real organization and the certification is anything more then a stamp of approval from the HIMSS Circus they need to think again after looking at the facts.

Some facts are known about the Certification Commission for Health Information Technology.

The Certification Commission for Health Information Technology (CCHIT) is a defunct Illinois Not-For-Profit 501(c) 3, which operates to take money from the Office of the National Coordinator and Vendors by offering to sell a “Certification”.

DID I say DEFUNCT? Yes I said DEFUNCT…please read on.

The Not-For-Profit 501(c) 3, Certification Commission for Health Information Technology (CCHIT), operates a “Front” office located at 200 S. Wacker Drive, Chicago, Illinois.

CCHIT, as it is known, represents itself as a government recognized organization for certifying electronic health records. CCHIT has received monies from the United States Government (estimated over $2.5 million to date) and monies from vendors of electronic health records.

CCHIT was formed as a NFP in the State of Illinois and is an entity spawned by none other , HIMSS.org. CCHIT is no longer a legal entity existing within the State of Illinois effective April 11, 2008, but continues to engage business as a 501(c) 3 accepting payments as reported by J. Morrisey, Director of CCHIT Communications (February 3, 2009).

CCHIT continues to hold itself out to take money for the sale of “Certification” (a rubber stamp device the buyer can display on his product if the fee is paid), a contrived performance standards product label developed by its parent organization, Healthcare Information and Management Systems Society (HIMSS), a lobbyist, with headquarters at 230 E. Ohio St., Chicago, Illinois. CCHIT was also located within the HIMSS Headquarters at 230 E. Ohio Street in Chicago but moved to Wacker Drive apparently due to appearances of being too close to the lobbyist parent organization.

CCHIT, through the organization that spawned them—HIMSS.org, a lobbyist organization—recently asked for $25 Billion additional funds in an open letter to the Obama
administration (http://www.himss.org/advocacy/). HIMSS, through its agent H. Stephen Lieber, provided CCHT with $300,000 seed money in 2006 with which to fund a startup operation. HIMSS receives money from CCHIT as a subcontractor, as the payoff for seeding the startup. HIMSS provides public commentary through the use of its own members for certification criteria back to CCHIT. HIMSS is also the parent company for the Electronics Health Record Vendor Association (EHRVA), another Not-For-Profit housed at 230 E. Ohio St., Chicago, Illinois.

The Facts:
1. The Chairman of CCHIT is Mark Leavitt, MD, PhD. Mark Leavitt is also Chief Medical Officer with HIMSS.org. It is believed Mark Leavitt may be a relative of Mike Leavitt, former HHS Secretary.
2. CCHIT takes federal money, and money from vendors, in exchange for the sale of “certification”. CCHIT does not have a legitimate physical address where it conducts its testing. CCHIT has a “front” office at 200 S. Wacker Drive, Chicago, Illinois, with previous headquarters at 230 E. Ohio St., Chicago, Illinois. CCHIT is, in fact, now defunct.
3. CCHIT has no legitimate registration certificate of good standing with the State of Illinois, the state in which it is purportedly chartered as a 501(c) 3. It is, in fact, listed as “involuntarily dissolved” effective April 11, 2008, file# 65254336. Illinois State listing here: http://www.ilsos.gov/corporatellc/
4. CCHIT does not provide independent inspections of its facility or 3rd party reviews of its findings. “Certification” status of vendor products granted by CCHIT after the Illinois State’s involuntary dissolution date of April 11, 2008 appears to be without merit or bogus, and CCHIT operates deceptively to convey legitimacy.
5. CCHIT operates fraudulently within the State of Illinois and in the United States to take money from vendors of electronic health record systems and from taxpayers; the CCHIT business practice presents as a Pay-For-Play scheme; if the vendor pays, CCHIT certifies the product conveying a competitive advantage in the marketplace. There is no transparent certification testing for 3rd party review. The costs to certify are in the many tens of thousands per vendor. Officers and Directors of CCHIT have taken money in exchange for “Certification”, knowing its 501(c) 3 operational status to be defunct.
6. CCHIT, a dissolved entity and defunct 501(c) 3 Not-For-Profit, receives funding from the Office of the National Coordinator (ONCHIT) and is tied to a lobbyist organization that claims to be a Not-For-Profit, HIMSS.org—the organization that spawned CCHIT and which formerly housed the entity in its corporate headquarters located at 230 E. Ohio St., Chicago, Illinois.

Why does CCHIT continue to certify vendor products when its own corporation has been involuntarily dissolved? Does the word “MONEY” ring a bell?

CCHIT continues to hold itself out as a certifying entity when it can’t even certify to the state of its incorporation that it does in fact exist.

Closing thoughts:
The certification process and testing should be reviewed carefully, and those vendor companies whose products were certified after CCHIT’s involuntary dissolution should be contacted. Money should be returned to the vendors and the taxpayers- CCHIT is a bogus operation.

CCHIT should NOT be allowed to receive future Federal grants and monies from the United States Government as part of the stimulus package. CCHIT is defunct , moreover the cozy relationships between CCHIT, ONC, CMS, HITSP and others are bankrolled with taxpayer money and money from HIMSS.org and its others.

Through all the smoke and mirrors we the people are supposed to trust these Bozo’s and they actually think we are buying it?

There is no point in CCHIT holding itself out as a legitimate entity at HIMSS Annual Conference either, CCHIT is a defunct organization and has been since the beginning of 2008…DUH!

CCHIT has flown under the radar for a year and a half, the jig is up and the whistle has been blown.

CJ
Comment by cj – February 13, 2009 at 2:10 am

In response to CJ, Sue Reber, Marketing Director of CCHIT responded with the following comments:

The “facts” in the previous post are deliberate misinformation from an anonymous source.
1. Mark Leavitt, chair of the Commission, is not employed by HIMSS as CMO nor is he a relative of Mike Leavitt, previous Sec. of HHS.
2. CCHIT conducts jury-observed and technical testing of vendor-submitted products, requiring that the products meet 100% of the compliance criteria published at http://www.cchit.org/certify/index.asp. It’s current administrative offices are at 200 S. Wacker Drive, Suite 3100, Chicago, Illinois.
3. CCHIT was founded originally as a LLC but has subsequently transitioned to a private, nonprofit 501(c)3 organization. That is its current status.
4. CCHIT operates with the oversight of both its board of trustees – managing its business functions – and board of commissioners, which provides oversight of its certification development programs and inspection processes.
5. CCHIT’s trustees and commissioners receive no compensation; they serve in a volunteer capacity. CCHIT operates with a paid staff of about 20 personnel who support the work of the Commission and it’s 15 volunteer work groups, administer the certification inpections and provide outreach to its diverse stakeholders
6. CCHIT now operates independently of HIMSS, AHIMA and NAHIT – its founding organizations – and no money provided by ONC for developent or by vendors for the conduction of inspections is returned to those organizations.

Any questions about CCHIT’s operations may be directed to me at the following email address.

Sue Reber, Marketing Director
CCHIT
sreber@cchit.org

MedInformaticsMD posted some interesting analysis about CCHIT and the allegations listed above:

I have observed unseemly things about health IT in my nearly two decades in medical informatics. For example, my dealings with health IT vendor HBOC (no relation to HBO and now merged into McKesson) whose erstwhile CEO was cooking the books, and a-little-too-cozy relationships between hospital CIO’s and health IT vendor CEO’s.

Even considering those observations, the matter below is quite unsettling if its allegations are valid. It is additionally unsettling considering the many well-intentioned volunteers who give of their time in CCHIT activities, whose reputations might be unfairly tarnished if there are significant undisclosed problems. (I applied to be a volunteer some years ago, in fact, but was not selected initially, and did not reapply due to my work schedule).

I utilized Illinois’ online corporation/LLC search utility at http://www.ilsos.gov/corporatellc/CorporateLlcController and did indeed find this puzzling entry for CCHIT as “involuntarily dissolved” on 4/11/2008. I could not find other entries even under the full name “Certification Commission for Healthcare Information Technology.”

Another private nonprofit lookup of unknown reliability, Melissadata.com, shows CCHIT as a 501 (c)(3) in Chicago listed as “exempt” from taxes since October 2008, last 990 form (“Return of Organization Exempt from Income Tax”) filed Dec. 2007, form 990 amount $4,740,146, as shown here. This would have been before the involuntary dissolution. No 2008 form 990 data is shown.

A number of reasons for involuntary dissolution of a nonprofit in one state can be seen here.

This certainly raise concerns and questions such as:

  • Why was this not for profit “involuntarily dissolved” in April 2008? For what reason(s)?
  • By whom?
  • What replaced it?
  • Why was this dissolution not widely known?
  • What is CCHIT now? Is the Illinois online corporation/LLC database faulty? Does it remain a non-profit?
  • If the Illinois database is not faulty, where is CCHIT now registered? Is it registered?
  • Is it a subsidiary of HIMSS or other organization?
  • Where do CCHIT monies go?
  • Who controls the funds?
  • Who assures that it is indeed impartial in its assessments?

I find these allegations potentially very troubling regarding an organization that is supposed to be “impartial” and a judge of the suitability of electronic health records products for sale here in the U.S. The answers may be simple and straightforward. I hope they are.

MedInformaticsMD followed it up with a post containing documents about the “involuntary dissolution” and the reason being CCHIT “failed to file an annual report as required by the provisions of “General Not for Profit Corporation Act” of the State of Illinois.” MedInformaticsMD also posts this list of interesting questions:

  • Why did they fail to register? Surely they were informed of the dissolution.
  • Why did they continue operating without registration?
  • Who was doing business with them during the period of non-registration?
  • What is the status of certifications performed during that period?
  • What happened to the monies received from HIT firms seeing certification, and/or any monies received from government if any, during the period of non-registration?
  • What are the penalties for operating a business without registration “as required by the provisions of the General Not For Profit Corporation Act” of the State of Illinois?
  • Are there any IRS implications?
  • If the failure to file over ten months or so was due to carelessness, is this an organization that should be “certifying” complex information systems upon which lives depend?
  • Finally … haven’t we had enough of politicians and businesses that “forgot” to file their papers?

Here’s Neil Versel’s comments on the CCHIT drama above:

Here’s what else I know:

  • The “J. Morrisey” that the accuser refers to likely is John Morrissey (note the different spelling), communication manager for CCHIT. Morrissey previously worked for NAHIT. That does not necessarily mean NAHIT has any control over CCHIT.
  • Mark Leavitt no longer works for HIMSS, nor is he related to former HHS Secretary Mike Leavitt.
  • CCHIT received a three-year, $7.5 million contract from the Office of the National Coordinator for Health Information Technology in October 2005. That means the contract expired in October 2008.
  • Though the procurement process for the certification contract ostensibly was open, CCHIT was the only bidder. Given that HIMSS, NAHIT and AHIMA originally started CCHIT, it does seem like this was a de facto no-bid contract.
  • Although HIMSS did provide seed money for CCHIT, I am not aware of any current “subcontractor” relationship.
  • The HIMSS EHRVA changed its name to the HIMSS EHRA last year, dropping “vendor” from the title. I’m not sure whether this is relevant to any of this discussion, but “CJ” mentioned it.
  • The relationships between HIMSS, CCHIT, NAHIT, HITSP, ONC, CMS and others may be “cozy,” and that’s something definitely worth looking into. HIMSS CEO Steve Lieber and John Loonsk, M.D., director of the ONC Office of Interoperability and Standards are on the HITSP board, but that does not necessarily mean anything.
  • There has been some pushback against the CCHIT certification process of late from smaller vendors, provider organizations and critics of the ONC strategy in general. But those are criticisms of the process, not CCHIT itself.

All of this makes the rumors of Healthcare Information Technology Standards Panel Chairman John Halamka, M.D., being under consideration for CMS administrator all the more delicious. But we’re still waiting for the president to nominate an HHS secretary, so it could be months before we get a permanent CMS administrator.

Finally, Neil Versel offers a few interesting points in a CCHIT follow up post where he identifies the CCHIT critic as well:

On the most recent set of allegations, I believe CCHIT has never hid the fact that it was created by HIMSS, the National Alliance for Health Information Technology and the American Health Information Management Association. Whether Steve Lieber personally spawned CCHIT, I don’t know and don’t think is relevant.

The questions about the involuntary dissolution of CCHIT as a 501(c)(3) not-for-profit corporation under Illinois law are valid ones. The questions about possible conflicts of interest involving CCHIT and other organizations are valid ones. The charge of a “scheme” full of “artificial transactions” is a serious one, but I don’t see any evidence to support it.

One more thing I’ve discovered since the original post: CCHIT’s previous office before moving to 200 S. Wacker Dr. in Chicago was at 233 N. Michigan Ave., the same location as AHIMA, not the 230 E. Ohio St. building where HIMSS is based.

You can bet this is not the last we’ll hear on this subject. I can’t wait to see if CCHIT has another “town hall” at this year’s HIMSS conference. That ought to be fun.

HISTalk posted a very different perspective on CCHIT. I like this a lot, because the writer actually dives into how CCHIT is spending the money they’ve gotten:

More About CCHIT

People still insist on posting absolute drivel about CCHIT for some reason, some of it so clearly wrong that I’ve heard that HIMSS has loosed its lawyers to ask (some have called it “threaten”) bloggers to remove some of the more hysterical comments posted by the same, anonymous person (and often duplicated word for word on multiple sites). You know you need a twit filter when a major investigative point of contention is that Mark Leavitt and Mike Leavitt share the same last name even though they are not related.

For all the time the conspiracy theorists have spent writing up their imaginative speculation, you would think that maybe they could have done a little bit of research. The question about CCHIT’s incorporation status has been endlessly pontificated upon, with relevance unclear (Would be it be a travesty if they weren’t actually incorporated? Does anyone really lose sleep wondering in which state it’s incorporated)?

Well, all the Internet nimrods had to do was look. Within 60 seconds (literally) of deciding I’d look for myself, I had both CCHIT’s corporate records and their federal tax filings (from October) in front of me, maybe another indication that these aren’t exactly geniuses out there riding the comments trail.

I figured CCHIT was, like many organizations, probably incorporated in Delaware. Looked it up online, bingo. Incorporated as an LLC in 2004, reincorporated as a non-profit C-corporation in 2006. I e-mailed Sue Reber at CCHIT and she confirmed that the Illinois incorporation was accidentally allowed to lapse, which is why those records show “involuntary dissolution.” OK, is everybody happy that they’re really incorporated? The only question I couldn’t answer is why they filed for domestic residency, which according to the Delaware department of state, means “this entity is domiciled in Delaware.” I’m sure they have a registered agent in Delaware, so that may be adequate to claim that category. I find it hard to get excited about it one way or another. They’re legal, not a big shocker since they get government contracts and Uncle tends to check those things (unlike when paying Medicare claims).

On with the tax records. CCHIT’s address on the tax form is 200 S. Wacker Drive, Chicago, IL 60606. That’s a 41-story building that includes CCHIT’s Suite 3100, which is actually a Regus/HQ Business Center that will rent you a “virtual office” for $225 per month or a mail box for $80 per month. In other words, I could share a suite with CCHIT if wanted (along with about a zillion companies that use same suite number). I wouldn’t plan a field trip during the HIMSS conference since I’m pretty sure there won’t be any certification activities happening there, just some people sorting mail into roomful of boxes. It is a cool building, though — I bet I would get some good HIStalk writing inspiration there.

Anyway, here’s the money story: CCHIT took in $4.7 million in FY2007, spent $3.6 million of that, and banked $1.1 million, bringing its fund balance up to $2.7 million and total assets of $3.4 million (they’re running some pretty heavy AR at $750K, so someone’s not paying their bills on time).

Of the $4.7 million in income, $2 million was from certification fees, $2.7 million was from government contracts. CCHIT got an HHS contract in 2005 to develop and a certification program, which it says is “transitional” and will be followed by a self-sustaining model (all the more reason to bank some of its income). That’s dead on with earlier announcements that pegged the HHS award at $7.5 million over three years, plus a $1.4 million extension that runs through April 2009, so it would appear that CCHIT’s only income will very soon be from certification, which means it will need to do some cost-cutting (current spend $3.6 million, current income $2 million).

CCHIT’s biggest expense by far was for consulting – $1.9 million. There are some mildly interesting expenses there:

  • ISIS Health Informatics Resource Group was paid $243K. That’s a Canadian company owned by Guy Paterson, who was previously CCHIT’s director of certification development according to his LinkedIn profile (although it also lists him as currently employed by CCHIT, so it’s not entirely clear). According to CCHIT meeting minutes, he left in July 2007. Perhaps he’s contracting back to CCHIT at a handsome rate.
  • Public Communications, Inc. received $184K. That’s a Chicago PR company that also has HIMSS among its clients.
  • Soloman Appavu was paid $166K. A Google search shows him as a former Stroger Hospital and Cook County employee who served on CCHIT’s security and reliability work group. He has also listed in his biography as being President of Center for Healthcare Automation Ltd. whose address appears to be a residence (he lists that employment for a HITSP article planned for a June printing by HIMSS) and whose Illinois corporation has been dissolved. He is listed on CCHIT documents as “staff.”
  • Reber Marketing got $157K. I assume that’s my contact Sue Reber, who is CCHIT’s marketing director.
  • Merril Prager was paid $152K. Her LinkedIn profile shows her as an independent consultant specializing in helping organizations turn around their financial performance. She is listed on CCHIT documents as “staff.” Her name is on the tax form as the contact for financial records.

Salaries totalled $356K for officers, $382K for staff. CCHIT reported having four employees. The highest paid non-officer made $110K with benefits, but that doesn’t count those folks above, I assume, since they are paid as contractors. Alisa Ray, executive director, made $192K.CCHIT reported $866K transferred to AHIMA in a category that includes sharing of equipment, facilities, or employees. HIMSS received $196K for a category that includes performance of membership services.

The tax records indicate that CCHIT chair Mark Leavitt is still a HIMSS employee, “on leave from his position as HIMSS’ Chief Medical Officer while serving as Chair of CCHIT. CCHIT pays HIMSS an hourly rate for Dr. Leavitt’s services that is intended to cover the portion of his salary and benefits allocable to those hours.” That’s at odds with both his CCHIT bio and his LinkedIn write-up, which say he’s finished with HIMSS and working full-time for CCHIT (he put on LinkedIn that he left HIMSS in September 2005). I don’t know which is correct, but he is shown as being paid $164K for 40 hours a week at CCHIT and I would bet he’s making more than that.

I’m not finding any smoking guns here. Everything looks entirely above-board, although Mark Leavitt’s employment status probably should be clarified by CCHIT.

All of this drama makes me realize why I don’t want to ever work in Washington. I’ll stick with good old EHR implementations. I’m afraid that far too much of this stuff is happening all over the world and not just CCHIT.

What’s the answer to all this? Well, I’ve never thought it was CCHIT, but all of the above just adds fuel to the fire. I have a feeling were going to hear a lot more about this before it’s all over.

Let me know if there are other sources that I missed. I want to cover as much of what’s happening as possible.