Here's a thought that came to me while Jason and I were discussing Microsoft products and how it has come to pass that folks accept the flaws and peccadilloes of said products with (generally) little more than a groan or, perhaps, a brief tirade. My take is that we tend to overlook the shortcomings because of one great advantage - interoperability/standardization. For instance, when someone sends me a document created in WordPerfect, I can't open that document without spending my valuable time converting or otherwise manipulating it; if they created it in Word (which most people do, these days) it's quick and easy.
So, in spite of the fact that I have no great love of MS, I don't believe MS is the best suite of products available, and I don't necessarily care for the tactics/monopoly status of the corporation, I recognize the value of having one industry leader that sets the standard for any/all others out there. We all know of at least one unfortunate innovator who went out and bought the first LaserDisc player on the market and stocked up on discs - only to find that the DVD was actually the next big thing. EHR is too big an investment for that kind of a mistake to have any but catastrophic consequences.
My point is that, while I don't necessarily disagree with some of the excellent points made by the anti-CCHIT advocates (though I very much disagree with some) I take the long view and believe that, ultimately, the consolidation of the market will create a more stable, functional, and efficient environment for EHR. No, being a big vendor doesn't guarantee long-term viability; yes, some excellent products/companies will, unfortunately die out; yes, some of the certification costs will likely be passed along to consumers (though at $28K, a vendor with only 1000 users would be passing along $28 per each - fairly manageable, even on a yearly basis) - but, in the end, the industry will benefit from the standards that are imposed.
I don't expect to convince those who oppose CCHIT. They are already too heavily invested in their opposition, at this point. One sentiment I do want to address directly, however, is the idea that CCHIT kills off competition - the related analogy that CCHIT is some sort of ominous, Mafia-esque organization.
The recent death of Milton Friedman highlighted the difference between being pro-free market and believing the free market is infallible. It made me think about the CCHIT comments and how the standards are being characterized. Analogously, the airline, car, food & beverage, and pharmaceutical industries all have stringent standards and regulations place on them. The phone companies have legal obligations they must meet. Television and radio stations must adhere to guidlines and restrictions. More to the point, nearly all private enterprises that want to work with the government (i.e., Medicare/Medicaid) are held to quite stringent stipulations as to their certifications, hiring practices, work conditions, etc. . . . I don't see CCHIT as being any different - except that, for the time being at least, it is totally and completely voluntary. No vendor need seek certification, no physician need purchase a certified product.
Maybe I'm wrong, but I just can't agree with the folks who see CCHIT as an unqualified evil. I'm open to the discussion, though. If you think I'm missing something here, do let me know. Also, check out the links below to get a broader picture of the CCHIT debate.
Joseph's CCHIT Comment on Healthcare IT
Medical Strategic Planning Article
emrupdate.com
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