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They don't have any choices. At least in the US, any electronic medical record system has to be certified, and there are NO open-source systems certified (that I'm aware of, anyway -- check for yourself).

Besides, it's possible they DID have the schema and reporting tools, but no one currently employed there has the documentation or the expertise to do it anymore. The $2000 might be the cost it would take to have a 3rd party retrieve the data. That's only 10-20 hours of work for a consultant, which is probably about right for them to spin up an old system, search through it, and retrieve the necessary data.

I'm not big on government interference with many parts of our lives, but they are addressing a very real problem and they're doing it with kid gloves. They did not pass regulations requiring hospitals to comply, they just tied federal funding to that compliance and gave the hospitals many years in which to get their shit together. If medical providers have not done so and are rushing about now, that is absolutely not the fault of the feds.

Actually...one of the dirty little secrets here is that the final rule for meeting "meaningful use" still isn't actually final. The "interim final rule" wasn't even available to view until Jan, 2010 (link), comments are accepted through March 15th, and we should have a final rule that we can (hopefully) comply with by the end of this month.

And: We don't have "many years" to do the install. We have a few years...very few, if we want to actually participate in the government incentives. Have to be installed and in production by late 2011 to qualify for the full incentive. Any delay, and the incentives go down drastically.

In our case, this whole thing really bites. We have an EMR, fully deployed, and we haven't maintained a paper chart in years. But, because of the definition of "Certified EMR" (which at this point basically means "Must be certified by CCHIT"), we can't qualify for "Meaningful Use" under these proposed rules. So, we have an EMR, we produce escripts, we do online order entry, we can even exchange imaging information (something that this round of certification doesn't require), but because we can't fill in all of the check-boxes in a CCHIT audit, we have to scrap our homegrown EMR and pay millions to replace it with a "certified" alternative. And the government will give us some of that money back if we cram it in fast enough *and* if we are able to show that we meet whatever standards the final rule eventually mandates...all within the next 18-30 months.

Nice.

It may not be the fault of the Feds that some providers haven't transitioned to digital records, but the Feds certainly aren't making things very easy, either.

Sounds like we need a welfare program for FOSS apps to be able to play in the big leagues. How do you think CCHIT gets their operating budget? Through fees I would expect.

Sounds to me like this organization should be getting funded a better way. It's pretty commonly accepted that certification groups that get their budget from fees have a pretty significant conflict of interest wrt. properly executing their duties.

Well lets see

The Certification Commission is a private nonprofit organization with the sole public mission of accelerating the adoption of robust, interoperable health information technology by creating a credible, efficient certification process. Certification Commission

Well it seems to me that the authority of the CCHIT is self-assumed, they are a private organization, not a public one; being non-profit simply means they have to spend all their money each year, not that they are good or charitable or even that they are anything more than a "good "ol' boys" network protecting their own pork-barrel.

Healthcare is dominated by application vendors who each make their own megaplatform for healthcare records. Cerner, Meditech, Siemens, et al. are all trying to keep as much of their system closed as possible, and aren't particularly interested in opening it up to third party systems. They don't particularly want open interfaces, their goal is to keep their customer locked in as much as possible.

So the healthcare IT companies get what they want, i.e. a bigger push for electronic records, selling the software they already have.

In my experience, you are right on-target with your assertions. In fact, it seems that the "Health Information Technology for Economic and Clinical Health" or HITECH Act (PDF warning) leaves as many questions unanswered as it answers. What we do know: We involved in healthcare have the opportunity to qualify for incentive pay based on "meaningful use" of a "qualified" electronic healtcare record. Unfortunately, what "meaningful use" is, or what "qualifies" an EHR system is conveniently not addressed by the bill. We ASSUME that "qualification" means "certification under specs provided by the Certification Commission for Healthcare Information Technology (CCHIT)"...and that SEEMS to be a fair assumption.

So, what does "certification" under CCHIT consist of? Basically, it seems to be likened to a laundry-list of requirements that are best described as "what the megaplatforms already do". Funny how that works out, until you start looking at the CCHIT decision-makers, e.g. Siemens and NextGen have members on the CCHIT Commission. Allscripts has a member who is a Trustee. And guess what? The Siemens, NextGen and Allscripts products all passed the CCHIT certification without requiring major rework. And other large vendors (e.g. GE, Epic) have representation and input to the CCHIT decision making process. And to add to the pain of trying to avoid one of the "big systems", the CCHIT certification requirements can be punitive for small or one-off vendors...certification costs are start at $35,000 (PDF warning), retesting requires additional payment, and 2-year recertification is mandatory. Not a big problem for a megacorp, but crushing to a small outfit that has written a non-commercial EMR.

What is truly galling, though, is a myopic refusal to realize that yes, there is life outside of a monolithic EMR. Example: In the CCHIT requirements for clinical testing, there are requirements that lay out in annoying detail how e.g. Lab tests must be ordered, tracked, commented upon, and displayed directly in the EMR itself. There is no recognition that there is any other way to accomplish this outside of the EMR. However, for decades -- long before we moved our health records to electronic format -- we used our Practice Management (scheduling, billing, etc.) system to order Lab, to check for duplicate orders, to ensure that referrals exist when required, to enforce insurance eligibility requirements, etc. NONE of which qualifies for ANYTHING under the CCHIT rules -- under those rules, your EMR must do the order, the tracking, the duplicate checking, etc. So - in order to make our EMR comply with these CCHIT requirements, we would have to pull these activities out of our Scheduling system, and force them into an EMR system which does not, and can not, handle all of the insurance- and billing-driven requirements that our Practice Management system easily fulfills. Patient satisfaction, and ultimately Quality, will be negatively impacted by such a move. But we have little choice but to do so under these CCHIT "requirements" if we are to qualify for any of the HITECH incentives (or more to the point -- avoid the penalties that kick in later in the project).

Another thing that gripes me is the way that this inc

Healthcare is dominated by application vendors who each make their own megaplatform for healthcare records. Cerner, Meditech, Siemens, et al. are all trying to keep as much of their system closed as possible, and aren't particularly interested in opening it up to third party systems. They don't particularly want open interfaces, their goal is to keep their customer locked in as much as possible.

So the healthcare IT companies get what they want, i.e. a bigger push for electronic records, selling the software they already have.

In my experience, you are right on-target with your assertions. In fact, it seems that the "Health Information Technology for Economic and Clinical Health" or HITECH Act (PDF warning) leaves as many questions unanswered as it answers. What we do know: We involved in healthcare have the opportunity to qualify for incentive pay based on "meaningful use" of a "qualified" electronic healtcare record. Unfortunately, what "meaningful use" is, or what "qualifies" an EHR system is conveniently not addressed by the bill. We ASSUME that "qualification" means "certification under specs provided by the Certification Commission for Healthcare Information Technology (CCHIT)"...and that SEEMS to be a fair assumption.

So, what does "certification" under CCHIT consist of? Basically, it seems to be likened to a laundry-list of requirements that are best described as "what the megaplatforms already do". Funny how that works out, until you start looking at the CCHIT decision-makers, e.g. Siemens and NextGen have members on the CCHIT Commission. Allscripts has a member who is a Trustee. And guess what? The Siemens, NextGen and Allscripts products all passed the CCHIT certification without requiring major rework. And other large vendors (e.g. GE, Epic) have representation and input to the CCHIT decision making process. And to add to the pain of trying to avoid one of the "big systems", the CCHIT certification requirements can be punitive for small or one-off vendors...certification costs are start at $35,000 (PDF warning), retesting requires additional payment, and 2-year recertification is mandatory. Not a big problem for a megacorp, but crushing to a small outfit that has written a non-commercial EMR.

What is truly galling, though, is a myopic refusal to realize that yes, there is life outside of a monolithic EMR. Example: In the CCHIT requirements for clinical testing, there are requirements that lay out in annoying detail how e.g. Lab tests must be ordered, tracked, commented upon, and displayed directly in the EMR itself. There is no recognition that there is any other way to accomplish this outside of the EMR. However, for decades -- long before we moved our health records to electronic format -- we used our Practice Management (scheduling, billing, etc.) system to order Lab, to check for duplicate orders, to ensure that referrals exist when required, to enforce insurance eligibility requirements, etc. NONE of which qualifies for ANYTHING under the CCHIT rules -- under those rules, your EMR must do the order, the tracking, the duplicate checking, etc. So - in order to make our EMR comply with these CCHIT requirements, we would have to pull these activities out of our Scheduling system, and force them into an EMR system which does not, and can not, handle all of the insurance- and billing-driven requirements that our Practice Management system easily fulfills. Patient satisfaction, and ultimately Quality, will be negatively impacted by such a move. But we have little choice but to do so under these CCHIT "requirements" if we are to qualify for any of the HITECH incentives (or more to the point -- avoid the penalties that kick in later in the project).

Another thing that gripes me is the way that this inc