Are health IT vendors trying to pull a fast one?

Are health IT vendors trying to pull a fast one?

Summary: "This is not an evidence-based or even a market-based approach to standards," Dr. Kibbe adds, "It's a power-based approach to standards."

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David Kibbe thinks so.

He's circulating a letter complaining about the behavior of the HIT Standards Committee, formed by NCHIT David Blumenthal to advise on the next phase of his work on the HITECH Act, the creation of standards for Health IT.

What Dr. Kibbe fears is a takeover of the government process by the Healthcare Information Technology Standards Panel, an industry-led group he says has locked out innovators and disruptive technologies, even mainstream IT vendors like Google, Microsoft and Apple.

Instead, he charges, the group is dominated by pre-Internet vendors like GE, Siemens and McKesson, vertically-integrated customers of those vendors, and large insurers.

How can we get optimal health IT policy decisions if we persist in favoring people vested in old or existing approaches, and excluding the innovators? The result will predictably “lock out” the experience of other industries - e.g., financial services, e-commerce, and online publishing - which have evolved broad and deep Web-based marketplaces in which proprietary software and hardware are no longer prominent.

"This is not an evidence-based or even a market-based approach to standards," Dr. Kibbe adds, "It's a power-based approach to standards."

Mainly what Kibbe, Director of the Center for Health Information Technology for the American Academy of Family Physicians (AAFP), says he wants is an evidence-based approach bringing innovators with actual experience into the discussion.

Now, will Dr. Blumenthal listen? Did he pack his bad actors into the standards committee so he could ignore them, or did they pack into that committee so they could control him, and through him the market?

Topics: IT Employment, CXO, Enterprise Software, Health

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21 comments
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  • Not sure about your last question, i guess he would be the best person...

    to ask.

    I think that sage, GE, siemans and mckesson do have the experience necessary to make good decisions, but these are also the guys who make software for the healthcare field.

    Maybe their vested interest also includes self preservation. I wouldnt say thats too far outside the relm of possiblity though.

    I think if they are given the opportunity, they will lock it down in as many ways as possible, but do i think they currently have the hold on the standards... no. There is another large provider out there called ECW. They do have a HITS cert on their application and are not one of the big dogs. They are however starting to own sage and GE with their enginuity. They put out upgrades and updates faster than any vendor i have ever seen. The tend to listen to what the group wants and generally deliver it. I will say they have some issues with product stablity, but no show stoppers.

    We used sage software(also called Medical Manager, Emdeon, webMD) for a long time and were looking at their Intergy product. They wanted to much money and offered little innovation.

    We also looked at mckessons product, Dentrix, and decided to wait for ECW to come out with a dental program. BTW, ecw does integrate with dentrix.

    In the end, they may end up limiting software providers through requirements but the market will most likely decide who the winner is. Course thats only if the feds dont mandate a system.
    Been_Done_Before
    • Mandating a system

      You write "if the feds don't mandate a system." Do you know that CCHIT was in the process of mandating systems through functional requirements only the big vendors could meet?

      This irrational fear of government and unlimited faith in a game market is silly.
      DanaBlankenhorn
      • Irrational fear of government???

        Have you not been paying attention to what's been going on around you? Uh...whatsmore...how about a look at general world history?!? Government repeatedly overreaches and the clear lesson is that smaller government is better.
        Techboy_z
        • The opposite of government

          The opposite of government is not freedom, as you suppose. It's anarchy. Read the Declaration of Independence. That to secure these liberties governments are instituted among men...
          DanaBlankenhorn
          • Instead of the declaration of independence, read the Constitution...

            <i> The opposite of government is not freedom,</i>

            However, too much government also leads to loss of freedoms.

            <i> It's anarchy.</i>

            Why is it that, apparently for you, the lack of government is anarchy?

            I'm pretty sure that, the person you responded to wasn't implying that it's better to not have government. I'm pretty sure that the person was also not in "fear" of government.

            I believe that the person was mostly talking about "big" and intrusive government, which is very invasive and trespasses into our lives and freedoms.

            <i> Read the Declaration of Independence. </i>

            The declaration of independence does not set forth how the government and people should interact. The documents that matters are the Constitution and the bill of rights.

            If the federal government were to abide by the constitution and the bill of rights, then the federal government would keep its hands off of our private lives and our medical records or any other records.

            In fact, most social programs, including social security, are in major ways, unconstitutional. And, medicare and medicaid, and even the IRS, are in many ways, unconstitutional.

            Neither the constitution nor the bill of rights granted the federal government the power to run our lives or to dictate, for example, the kind of cars that we'll drive or the kind of health care system that we'll have.

            The 10th amendment to the constitution was deliberately written to prevent big government and to prevent it from becoming intrusive. The powers not specifically granted to the federal government by the constitution were, by default, relegated to the states.

            Unless the 10th amendment was repealed in the middle of the night and the American people haven't been informed of that fact, the federal government has taken on a lot more power than was set forth in the constitution. If the 10th amendment is still part of the constitution, then, any time the federal government takes on any issues which intrude into the private lives of the people, then that government is acting unconstitutionally.
            adornoe
          • Wrong.

            Government is not an all or none proposition. Limited and small government is necessary. The Constitution sets out those FEW things to be done by the federal government, and delegates the rest "to the states or to the people." The alternative to anarchy is SELF-GOVERNMENT. But we can't have that when we continue to promote licentiousness and anything-goes mentalities, instead of personal responsibility and virtue, now can we? IOW, a false notion of "tolerance" and license is now the order of the day -- and that plays right into the hands of the power-hunger, who use it to promote their control structures as the answer to social ills created by poor personal choices. Our Founders understood well the dangers of overbearing government, and the relation of self-government to virtue. Apparently, their ideas are no longer P.C. enough.
            Techboy_z
  • Fingers Crossed Things'll Be OK

    I respect Dr. Kibbe and can see why he has become concerned, but I would be shocked if the work of Dr. Blumenthal's HIT Policy committee is derailed by the Standards Committee.

    The Policy Commmittee's work has been admirably results-oriented, focused where it should be on improving health care quality and reducing its costs, and decisively pro-innovation.

    Furthermore, the Policy committee's work seems to be in keeping with the general direction set forth by the Obama Administration, as frequently enunciated by Peter Orszag, Austin Goolsby and others.

    I hope I'm right, but glad Dr. Kibbe's got our backs covered in case I'm wrong!

    Glenn Laffel, MD, PhD
    Sr. VP Clinical Affairs
    Practice Fusion
    Free, Web-based EHR

    glaffel
    • Dr. Kibbe and the policy committee

      From everything I have gathered Dr. Kibbe and his allies have been quite happy with what the policy committee has done. And their argument here is mainly over the transparency of the process.
      DanaBlankenhorn
    • Providers dont' want RX ads in EHR

      Isn't practice fusion the web based EHR that sells patient data as part of its business model?

      http://www.emrandhipaa.com/tag/practice-fusion/

      "We generate revenue by <b>embedding advertising, including pharmaceutical products, into our physician tools. We also incur revenue through the sale of anonymized patient data to research groups, pharmaceuticals, and health plans"
      Alliance4Health
      • Anonymized

        That's a key word. Anonymized. Made anonymous. They are not selling patient or provider data.

        The rest of the business model is as evil as that of ZDNet. Which I don't find evil at all.
        DanaBlankenhorn
        • Easy to rematch data

          Actually almost anyone in health IT is very aware of just how easy it is to combine two different data bases and re-identify the data.

          It is a multi-billion dollar industry to sell your RX history to drug firms which simply buy the AMA physican data base and match it back up.

          There is a good thread on Ihealth beat. http://www.ihealthbeat.org/Articles/2009/6/24/DataMining-Firms-Seek-To-Block-Vermont-Rx-Data-Marketing-Law.aspx

          Large EHR vendors like cerner are already selling your data as well. "culled through data-sharing agreements with about 125 of its clients. Its data warehouse includes 1.2 billion lab results, along with medication orders and other patient data.

          Read more: http://www.fiercehealthcare.com/story/cerner-markets-patient-data-pharma-researchers/2009-06-02#ixzz0Nv3SqyR9
          "

          http://www.fiercehealthcare.com/story/cerner-markets-patient-data-pharma-researchers/2009-06-02

          If you want to really make it safe it is pretty easy to do though. You simply add some white "noise" to the data (ie shift the zip code by a digit)vs stripping it.
          Alliance4Health
  • Dominated by pre-internet vendors...

    Ok...so what? You want twitter to rule the health landscape? Seriously. Of COURSE it's dominated by pre-internet players...the ones who have actual brick-and-mortar hands in the healthcare pie...who produce medical devices and provide actual medical services, as opposed to just charging through the nose to shuffle data and "standardize your medical records".

    I seriously doubt any of these old players are loading up on the committees in order to block anything or tie up guaranteed profit streams. Seems to me they know their main revenue streams are their actual products and that standards-based IT is in their interest towards actually expanding their markets. It's probably more an issue of just being able to keep up with all the change that is being pushed. Maybe I'm just not cynical enough.
    Techboy_z
    • Maybe you're not

      When can you remember a vertical niche in the IT industry cutting prices and profits in order to reach a larger market?

      This is a natural business process. I can understand their desire to maintain their strategic advantages. But letting those advantages be written into law is, in my view, a tax on everyone.
      DanaBlankenhorn
  • HIT Standards Committee has 1 vendor out of 30 members

    David is such a great advocate for innovative inclusive solutions but I wonder if perhaps the title of the article and details in the article are a little off? Hopefully few people in the industry believe that we should just rubber stamp the work that HITSP has done but things are moving very quickly so it is a legitimate concern but that doesn't mean HIT standards is vendor dominated.

    We all want an open and transparent inclusive process for health IT standards and I personally am a strong advocate for solutions that put consumers at the center.

    Either I am confused or they changed the membership of the HIT Standards Committee. GE, Siemens and Mckesson aren't even on it are they?

    Dr Blumenthall also didn't stack the board, HIT standards and policy was called for in the ARRA legislation which was written years ago and the legislation requires a representative form of appointment that included vendors. The nominations were solicited March 12th before he was even on board March 20th although I would hope that ONC and Dr Blumenthal had some say in who sat on the committees that are set up to advise them on health IT?

    Most people don't realize it but last year before we had the stimulus bill, ONC spent months via a public process to create an public private advisory board - The National eHealth Collaborative (NeHC). Many of the people involved in that process as well as nine NeHC board members are now on the standards and policy committees. http://www.nationalehealth.org/ShowContent.aspx?id=269 (stars next to names)

    When you look at the actual membership http://healthit.hhs.gov/portal/server.pt?open=512&objID=1271&parentname=CommunityPage&parentid=3&mode=2&in_hi_userid=10741&cached=true of the Standards committee it includes people like *Jonathan Perlin, Hospital Corporation of America; John Halamka, Harvard Medical School; *Janet Corrigan, National Quality Forum; *Martin Harris, Cleveland Clinic Foundation; *Linda Dillman, Wal-Mart Stores, Inc.; James Ferguson, Kaiser Permanente; *Steven Findlay, Consumers Union; Linda Fischetti, Department of Veterans Affairs; James Walker, Geisinger Health System and the only real "vendor" is David McCallie, Jr., Cerner Corporation.

    ARRA stimulus money is really just seed capital (we had a multi-billion dollar industry before ARRA) and its primary focus will be on small individual providers (most large systems already have a vendor) and people or organizations (public health) who lack resources to do this on their own. Most large vendors don't even have a product for that market yet and some won't even talk to smaller hospitals let alone single providers.

    Clearly however there is a growing need for a bi-partisian, public private organization that is not caught up in the day to day battles of standards, specs and certification to help broaden the reach and engagement of this project to be more inclusive (ie consumers only have 1 voice on the committee)and bring employers, consumers, payers, providers, as well as existing solution providers and allows disruptive new ones together. There will still be space for privately funded consumer facing applications (like PHR's, wellness apps) but the focus of ARRA is on the clinical EHR in the providers offices and it is great that both private and public are working to provide interoperability.

    The stimulus isn't meant to be the only HIT investment happening and given the tight time line if a new player has a EHR solution I am sure it will be considered by the purchasers as long as it is interoperable. (In the past 20 years the private sector has failed in that regard and only now are some large vendors - Epic even able to talk to get their own clients to share data.)

    It will take all of us working collaboratively to listen, educate,and communicate with patients (I call them clients), providers, and even entire communities. No one should worry that they don't have a place at the table or that this is an adversarial process but we need to proactively build a process that is inclusive.


    Sherry Reynolds
    Alliance4Health
    Alliance4Health
    • HITSP vs HIT Standards "Committee"

      I think that you have combined two different organizations into one Dana. 1) Health Information and Technology Standards "Panel" (HITSP)vs the Health Information and Technology Standards Committee. (HIT Standards)

      1) HITSP
      http://www.hitsp.org/
      which is where the link in the article goes to was set up in 2005 by the Bush administration (which was outsourcing pretty much everything) and is a voluntary organization and is not a "FACA" - federal advisory committee

      The HITSP Chairman is Dr. John Halamka
      Chief Information Officer - Harvard Medical School

      2) The Health Information Technonology Standards Committee was called for in the ARRA legislation and was started in May of 2009.

      http://healthit.hhs.gov/portal/server.pt?open=512&objID=1271&parentname=CommunityPage&parentid=1&mode=2&in_hi_userid=10741&cached=true

      Just to confuse things further the HIT Standards Committee Vice Chair is * John Halamka, Harvard Medical School (the HITSP chair!)

      Don't even get me started on the acryonyms and interlocking relationships between the various committees, CCHIT, HITSP, HIMSS, but to be honest almost anyone who cared about the industry in the past decade had no choice but to volunteer or work with these groups since the government failed to take the lead.

      Now that govt realizes that they are paying for 1/2 of all medical care in the country (VA, Medicare, Medicaid, teachers, police etc) they have stepped up and started to demand applications that can share data and that meet some of the most basic standards.

      HITSP and CCHIT did what the previous administration and were set up to be vendor driven and they did what they were asked to do - advocate on behalf of their members.

      Things have changed
      Alliance4Health
  • HITSP

    HITSP?
    ahier
    • Not CCHIT

      Actually Brian this is a different letter and according to David Kibbie as of 4 pm today it isn't public yet and he wasn't aware of the article.

      If you read the thread and the replies (including mine above yours) you would see that they did probably mix up HIT Standards Committee (advises ONC - 1 vendor) and HITSP (started in 2005 - vendor heavy)
      Alliance4Health
      • Not CCHIT

        Thanks for the info Sherry. Please post a link if
        the letter referring to HITSP is released - this
        should be interesting...
        ahier
        • THE LETTER

          Check out this report

          http://www.nextgov.com/nextgov/ng_20090812_9123.ph
          p

          Here is a copy of this letter:

          http://kibbeandklepper.blogspot.com/2009/08/letter
          -to-national-coordinator-for.html
          ahier
  • CCHIT not alone

    CCHIT is the current certification body, but the
    HIT Policy Committee has indicated there will be
    other bodies as well. Including open source :-)
    ahier