HITECH and Funding Cuts: The Battle Begins

At "US House of Representatives Proposes to Defund Largest Non-Consented Medical Experiment in U.S. History: HITECH" I predicted this:

... I have no financial conflicts of interest regarding HITECH or health IT to weep about. Others do, and it's not hard to predict their financial interests will push them to oppose repeal "by any means necessary."

The next few months should be an interesting time in the politics of healthcare IT.

A replacement HITECH act that's "HI" on research and caution, but not so "HIGH" on stealth, coercion and euphoria (i.e., as on mind altering substances) would be welcomed.

The battle's already begun. At "Meaningful Use incentives jeopardized by GOP bill", Jan. 28, 2011 by at Dan Bowman at FierceHealthIT.com, views exactly as I expected have begun being proffered by the industry:

... All of that [possibility of HITECH funding termination] has HIMSS Vice President for government relations Dave Roberts just a little on edge, reports Healthcare IT News.

"We're trying to tell people that this process is going on. This is only one body [of Congress]. Don't let this be a concern," he said. But "if this is a new way of thinking, that could be concerning. So I think that while this particular bill may not pass, it's something that has to be watched closely."

Patti Dodgren, CEO of Hielix--which helps to facilitate electronic health information exchanges across the U.S., shares Roberts' view. [Any possible conflicts of interest towards full-speed-ahead-damn-the-torpedoes health IT diffusion in that role, I ask? - ed.]

"Just the suggestion of repealing HITECH stimulus funds for physicians...is short-sighted at best, and threatens the very progress that is already beginning to be realized within the industry to move our healthcare system into the 20^th [yes, 20th] Century," Dodgren told FierceHealthIT. "All this bill serves to do is strengthen the cynics of health IT.

[Translation: "short sighted" and "cynic" = those more interested in taking the time to do health IT "right" and in patient rights and patient well being, than in personal gain - ed.]

We work with thousands of physicians and state government healthcare officials who have worked tirelessly over the past months to achieve the benefits that healthcare IT promises [no, Ms. Dodgren, they haven't, actually; you and they have merely encouraged a rushed, cavalier and reckless rollout (of a technology even HIMSS' former Chairman of the Board, a physician, admitted is not ready), damaging - not helping - health IT's prospects. See below - ed.], and this bill is a disservice to them and to the healthcare industry."

It may be a "disservice" to those who stand to profit from the health IT industry, but it's a great service to the healthcare industry and to the patients it serves.

I didn't really need to look, as experience at HC Renewal has proven time and again about the healthcare pundits, but the credentials of someone making such claims about health IT are not impressive IMO.

From an online bio, Ms. Dodgren holds the illustrious "CPHIMS" certification that I wrote about at my April 2008 post "Is the HIMSS Certified Professional in Healthcare Information and Management Systems stamp substantive, or just alphabet soup?". After 8 years as Director Budgeting & Financial Systems at (now-defunct) Digital Equipment Corp. (DEC) and 4 years as Senior Business Analyst at Dun & Bradstreet, she has been a "change management professional" for twenty years who "co-founded a management consulting practice which specializes in the application of change management principles to health information technology." I note no medical (or medical informatics) training or experience.

My reply to these people is as follows, as posted in a FierceHealthIT comment:

By S Silverstein MD | Posted 7:09pm | January 30, 2011

Patti Dodgren and Dave Roberts seem to favor continuation of a risky and even harmful national medical experiment that does not even have the fundamental decency to seek patient informed consent.

See http://hcrenewal.blogspot.com/2011/01/maude-and-hit-risk-mother-mary-what-in.html for examples of some of the risks.

The former Board Chair of HIMSS, Barry Chaiken, MD, MPH, FHIMSS said it best in July 2010:

http://histalk2.com/2010/07/19/histalk-interviews-barry-chaiken/

... We’re still learning, in healthcare, about that user interface. We’re still learning about how to put the applications together in a clinical workflow that’s going to be valuable to the patients and to the people who are providing care. Let’s be patient. Let’s give them a chance to figure out the right way to do this. Let’s give the application providers an opportunity to make this better.

Let the industry learn the responsible way, not on patients' and physicians' blood, sweat and tears through way-too-early national initiatives that will only add to the $14 trillion national debt (http://www.usdebtclock.org/), and throw some of the money into industry pockets.

Franky, as a physician with no financial conflict-of-interest axes to grind, I am increasingly disgusted with the cavalier, money-grubbing attitudes of the health IT industry and its pundits. Their attitudes and behaviors represent a poster study of healthcare industry at its worst.

This latter fact is not lost on me as I speak with government representatives seeking to improve medical drug/device watchdog legislation, and to attorneys looking to protect patients from harm or gain recompense for those already injured as a result of faulty IT.

-- SS

Post Title → HITECH and Funding Cuts: The Battle Begins

Is the HIMSS "Certified Professional in Healthcare Information and Management Systems" stamp substantive, or just alphabet soup?

This post might be subtitled "when spending millions on health IT, why spend thousands on true healthcare informatics education when you can get a 'Certified Professional' credential to hang on your office wall, cheap?"

Imagine your reaction to a web page for a major HC organization that said this:

Certification as an expert in medical devices available. No domain-specific, specialized educational requirements. Short multiple choice test where many wrong answers "forgotten" is only requirement. You will be identified as an elite member of the healthcare device team after receiving our certification. Send $xxx dollars to ...

Such a scam would likely invite a governmental investigation.

Electronic medical records and other clinical IT are, in fact, virtual clinical devices that happen to reside on computers.

Their impact on medical care and education can be profound, as pointed out in papers by Ross Koppel at Penn, Pamela Hartzband, M.D. and Jerome Groopman, M.D. at Harvard, and many others around the world such as at Bad Health Informatics Can Kill and my own growing aggregation of HIT stories at "Sociotechnologic Issues in Clinical Computing: Common Examples of Healthcare IT Difficulties."

Yet, the vendor-friendly organization HIMSS (The Healthcare Information and Management Systems Society) offers such a certification in health IT. HIMSS identifies itself as "the healthcare industry's membership organization exclusively focused on providing leadership for the optimal use of healthcare information technology and management systems for the betterment of healthcare."

Here are the details on their certification as a Certified Professional in Healthcare Information and Management Systems (CPHIMS):

The Healthcare Information and Management Systems Society (HIMSS) has launched a professional certification program for healthcare information and management systems professionals. An individual who meets eligibility criteria and successfully completes a qualifying examination is designated a Certified Professional in Healthcare Information and Management Systems (CPHIMS).

CPHIMS status provides both internal and external rewards. As a Certified Professional in Healthcare Information and Management Systems, you:

• Distinguish yourself from your peers as certified in healthcare information and management systems;
  
• Expand your career opportunities;
  
• Signal that you have mastered proven, broad-based concepts through successful completion of the Certified Professional in Healthcare Information and Management Systems Examination;
  
• Provide yourself with skills and tools to help you make a difference in your career, your organization, and your community;
  
• Enjoy the pride of recognition of knowing that you are among the elite in a critical field of healthcare; and
  
• Have a premier credential based on a sound assessment to distinguish yourself in an increasingly competitive marketplace.
  
  

Here are the eligibility standards:

• Baccalaureate degree plus five (5) years of associated information and management systems experience*, three (3) of those years in healthcare.
  
  
• Graduate degree plus three (3) years of associated information and management systems experience*, two (2) of those years in healthcare.
  
  
• *Associated information and management systems experience includes experience in the following functional areas: administration/management, clinical information systems, e-health, information systems, or management engineering. [Is that vague and non-specific enough? - ed.]
  

And now, the certification instrument:

The CPHIMS credential is awarded to individuals who demonstrate eligibility for the Certification Program and who successfully complete a qualifying examination. The examination consists of 115 multiple-choice test items, presented during a 2-hour session. Scoring is based on 100 items pre-selected for desirable psychometric characteristics. The additional 15 test items are included as pretest items. Performance on pretest items does not affect a candidate’s score.

It is remarkable to me that there are no specific educational requirements relevant to HIT, such as a certificate in health informatics, informatics fellowship, or clinical medicine experience of any kind. In my humble opinion a 115-question multiple choice test does not qualify a person as an expert in anything. Further, it seems to me that any "15 test items" a test taker got wrong might simply be discarded, further diluting such a test's relevance at best, and a rather dubious manner of scoring an exam in healthcare at worst.

Also omitted is the calibre of one's "experience." What, exactly, did you do? Were you successful? Were you an asset? Or, did you set projects back? Did you contribute to failure?

I'd though the importance of formal education in healthcare had been resolved by the 1910-era Flexner Report. I guess I am mistaken.

The sequential FCC exams I took to achieve a ham radio license - a mere hobby - were far more exacting. And at the time there was an applied exam as well; I had to be able to receive Morse Code at twenty words per minute to achieve the "Extra class" license.

I won't even compare to medical board exams.

To this NIH postdoctoral fellowship-educated HIT professional, CPHIMS certification sounds more like a "credentials mill" operation than a legitimate eduational and certificational process.

An attempt to introduce such a certification process at any institution of higher education, such as the one in which I teach about clinical IT, would get laughed out of a Faculty Senate's Committee for Academic Affairs or similar curriculum-approval body. It might even harm the school's accreditation.

Could you imagine such a certification process for some other medical process or technology, e.g., fluoroscopy equipment or EKG machines?

Discouraging pursuit of formal informatics education increases HIT problems and delays, raises costs, and facilitate failures. Does the availability of "instant credentials" discourage acquiring a substantive health care informatics background, diluting the availability of true expertise in this difficult field?

Is such health IT certification somewhat of a fraud, a ploy to allow undereducated people an opportunity to add "alphabet soup" to their resume in order to secure positions in health IT, or is it legitimate certification?

I report, you decide.

-- SS

Post Title → Is the HIMSS "Certified Professional in Healthcare Information and Management Systems" stamp substantive, or just alphabet soup?