Stimulus, Cash and Healthcare

The debate over how to spend tens of billions in stimulus money is getting personal, it seems.

Readers of the Washington Post may have noticed stories about the effort to use the massive stimulus legislation to jumpstart the creation of a nationwide network of electronic health record systems.

One story showed that a technology trade group called the Healthcare Information and Management Systems Society played a big role in generating support for government subsidies of such gear. The group's decade-long campaign -- including the creation of non-profit research groups -- culminated when the Obama administration included up to $36.5 billion in stimulus spending for electronic health records systems, or EHR. (They predict that spending could lead to $17 billion in savings over the next decade in healthcare costs.)

A second story showed that the trade group is urging the Obama administration to name a certain certification group to help decide what technology qualifies for stimulus spending. Some critics have questioned whether the certification group, known as the Certification Commission for Healthcare Information Technology, or CCHIT, is too close to the trade group and its vendor members. A line from that story:

"Although the group is funded through a contract with Health and Human Services, it is run by a former HIMSS executive and one trustee also is the president of the trade group. Several board members work for technology vendor."

One of those critics, David Kibbe, a physician, writer and consultant, apparently touched a raw nerve in Mark Leavitt, the head of CCHIT and the former chief medical officer at the trade group, when he told the Post:

"One has to question whether or not a vendor-founded, -funded and -driven organization should have the exclusive right to determine what software will be bought by federal taxpayer dollars...It's important that the people who determine how this money is spent are disinterested and unbiased...Even the appearance of a conflict of interest could poison the whole process."

Leavitt responded in The Health Care Blog about the suggestion that his group, the only certification group for health information technology, might be swayed by the involvement of the trade group and vendors.

"For months, I've been 'turning the other cheek' to Dr. David Kibbe because I believe in devoting my energy to solving problems rather than to criticizing other people or worrying about what others think of me. But his repeated use of falsehoods and innuendo to attack CCHIT have found an audience in the national media, reaching a level that can no longer be ignored. By implication, he demeans the integrity of everyone who has contributed to that work - and I must rise to their defense."

And this:

"Again quoting you in the Post, 'even the appearance of a conflict of interest could poison the whole process.' In support of this heartfelt concern for transparency, could you arrange for the Washington Post to append to your statements a disclosure of any possible conflicts of interest you might have? Such as financial relationships with companies that market health IT products or services? I have none."

In an interview, Leavitt said he took Kibbe's comments as "an accusation" against both his group and himself. The gist, from his perspective: "That the organization is controlled by vendors."

"It's false," he said. "We thought we should respond."

Kibbe declined the opportunity to respond to Leavitt.






By Robert O'Harrow |  May 26, 2009; 8:37 PM ET
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Comments

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While I don't know enough of the facts to comment on whether the conflict of interest mentioned in the article is improper, we should restrain our zeal to target every potential conflict of interest in the medical arena. (See http://mdwhistleblower.blogspot.com/2009/05/medical-corruption-and-conflicts-of.html)
Legitimate and proper collaboration should not be given the pejorative 'conflict of interest'label, which has a corrupt connotation.

Posted by: MKirschMD | May 27, 2009 10:50 AM

Leavitt appears to feel guilty without being accused. He knows of the deception, because he and his conflicted staff and Board was confronted with the following: that CCHIT (of Chicago)does zilch pertaining to whether the devices it "certifies" are safe and effective and it provides zilch after market surveillance. Also, the CEO of Allscripts (who is also a Chicago guy and Obama's personal HIT consultant) is on Leavitt's Board of Trustees. Congress and HHS has been deceived.

Posted by: atenolol | May 27, 2009 12:41 PM

It is certain that the intense application of electronic records would provide the best and necessary data for the evaluation of the effectiveness and costs of various forms of health care delivery. The elephant in the room is the ignorance about the timing of implementation relative to the availability of funds for the totality of comprehensive care. Hence my earlier remarks that the huge sums dedicated to them may be a "Trojan Horse". That is, there may not be sufficient funds remaining to DELIVER care as proposed. Then by default the existing tortuous, outrageously costly insurance industry model may be tacked onto the program. If this occurs and becomes established for even an intended brief period, it is difficult to imagine re-marshaling the national momentum for another change.

Posted by: wick2 | May 27, 2009 8:10 PM

It might be a bad example right now but our banking system is overseen by Federal Reserve Boards where even the consumer representatives are appointed by the Banks that they over see..

Who else but one of the vendors or one of the many consulting or support organizations in health IT would even be aware of the need for standards let alone know what ones are needed?

CCHIT is largely run by volunteers on committees and not by vendors at all and the complicated standards are a reflection of that. It doesn't explain however why you have certified products that don't talk to one another or even to clients who buy from the same vendor.

Change CCHIT's product but there is no need to assume that they are somehow corrupted. If working for a vendor or a consulting firm in health IT is a litmus test then we need to stand up new policy and standards committees for the Office of the National Coordinator (ONC) as well.

They both have senior leaders from both Epic and Cerner advising HHS on what policy and standards to adopt and they are the two biggest players in this market. Should we block doctors from helping with health care reform as well?

Posted by: Health_Advocate | May 28, 2009 4:20 PM

The decision over who gets to control the $36.5 billion of stimulus monies for healthcare IT isn’t just about proper stewardship of federal monies--it’s a decision that will have a monumental impact on the future direction of U.S. healthcare for decades. The stimulus bill mandates that these monies be spent to create a nationwide health IT infrastructure that “improves healthcare quality, reduces medical errors, reduces health disparities and advances the delivery of patient-centered medical care.” Unfortunately, the current direction of healthcare IT focuses doesn’t focus on providing physicians, nurses and other caregivers with better information in order to deliver improved patient-centered medical care, but instead focuses on improved electronic transactional documentation for billing and record keeping. U.S. healthcare IT needs a massive change of direction in order to improve patient care, and that’s a decision that ought to be delegated to a completely independent governmental organization that will act in the best interests of patients, physicians and other caregivers, and our entire healthcare industry.

Posted by: rkk1 | May 29, 2009 10:04 AM

Posted by: libing0755 | May 30, 2009 3:18 AM

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