An Open Letter on eMRs from Hayward Zwerling MD

On eMRs Dangers and Expenses

Submitted by Darrell K. Prutt; DDS55909808

Like communicable diseases that nobody wants to discuss; eMRs are dangerous, incredibly expensive and not worth having for free.  

A Fresh Look at eMRs

A couple of weeks ago, Hayward Zwerling, M.D. uncovered a fresh look at what makes current eMRs so lame, and clinically described the underlying problem in a blunt way that only a doctor with clinical experience can do. Dr. Zwerling’s informative comment on Boston.com is in response to Lisa Wangsness’ Jan. 1 article, “Letter highlights hurdles in digitizing health records.”  

We should have known that CCHIT would draw parasites for natural reasons.   

http://people.boston.com/articles/nation/?p=articlecomments&activityId=6778798549471809193

Dr. Hayward Zweling Speaks

Under the Federal Government’s direction, CCHIT has been given the task of promoting IT (information technology) within the health care industry. Approximately half of CCHIT’s Board of Directors work for medical insurance companies, commercial medical informatic companies, physicians employed by very large group practices or eMR companies. As a result, CCHIT’s priorities have been tailored to reflect the interests of it’s Board of Directors, rather than the needs of the physicians and the health interests of our society at large.

CCHIT Force

CCHIT is now attempting to coerce physicians to purchase specific, expensive and “CCHIT certified” electronic medical record programs, which are designed to collect medical information. This information is “quantified; ” thereby creating a huge repository of all US healthcare interactions. As 16% of the US GDP is spent on healthcare, the amount of information that will be stored in these databases is massive and will eventually be available (for sale) to third parties. One can logically conclude that those organizations that have access to this information will be able to exert a hugh influence on the future of US healthcare.

Enter the Non-CCHIT Vendors

There are now several hundred non-CCHIT certified eMRs on the market which provide low cost and innovative solutions that are not otherwise available to physicians. If CCHIT’s influence remains unchecked, many small eMR companies will be forced out of business. The end result will be extremely disruptive to small medical practices, while forcing them to adopt expensive and bloated software while creating a frighteningly comprehensive healthcare database.

Unique Position

As a practicing physician who also has more than 15 years experience incorporating IT into small medical practice, I am in a unique position to understand the needs of the healthcare community and the potential of health IT. I am a firm believer that the appropriate use of health IT can improve the quality of healthcare. However, it is my opinion that the Federal Government needs to force the Certification Commission for Health Information Technology to alter their priorities so that they mirror the needs of the the majority of the medical community, rather than the interests of CCHIT’s Board of Directors and their representative companies. This can only be accomplished by replacing CCHIT’s Board of Directors, who has a financial interest in the health information technology industry, with people who have no financial connection to the medical-health IT-pharmaceutical industrial complex.

Eisenhower’s Farewell Address

In President Eisenhower’s Farewell Address, he said ” … we must guard against the acquisition of unwarranted influence … by the military-industrial complex … Only an alert and knowledgeable citizenry can compel the proper meshing of the huge industrial and military machinery … so that … liberty may prosper …”

The size of US’s medical-health IT-pharmaceutical industrial complex now rivals the size of its’ military-industrial complex and the parallel between the two industries is too obvious to be discounted. If we choose to ignore this historical precedent, then the future of healthcare in the USA will be controlled by several powerful industries, whose priorities do not necessarily parallel the health interests of our society. And once these industries take control of the health industry, their political influence will ensure that they will remain in control for many decades into the future.

Hayward Zwerling; MD, FACP, FACE

President, ComChart Medical Software

The Lowell Diabetes & Endocrine Center

Information Resources, LLC, Denver, Colorado

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13 Responses

  1. More about Hayward Zwerling and Glen Tullman,

    Do you know what Dr. Hayward Zwerling, President of ComChart Medical Software, and Glen Tullman, CEO of Allscripts have in common? Apart from their healthcare IT interests, both are fighting the good fight against diabetes – each in their own honorable and effective ways.

    Hayward Zwerling MD is professionally involved with the treatment of the disease at the Lowell Diabetes & Endocrine Center in Lowell, Massachusetts. A year ago, he was recognized by the National Committee for Quality Assurance (NCQA) and the American Diabetes Association (ADA) for his exceptional care to his patients as part of the Diabetes Physician Recognition Program.

    Mr. Glen Tullman, on the other hand, has supported important and significant diabetes research for years. He not only donates millions of dollars of hope for finding a cure, but Mr. Tullman also serves on the International Board of the Juvenile Diabetes Research Foundation.

    In addition to his voluntary service to the diabetes foundation, Glen Tullman, CEO of Allscripts, also serves on the Board of Trustees of the Certification Commission for Healthcare Information Technology (CCHIT) – which has been appointed control of the direction of the market for healthcare IT products in the nation – by mandate if necessary. Large government, as well as Wall Street, naturally favors large companies … like Allscripts.

    A couple of days ago, Dr. Zwerling, President of ComChart Medical Software, a much smaller, grassroots-level eHR company posted a critical comment about the commission on ModernHealthcare.com titled “An inherent conflict of interest within CCHIT.”

    http://www.modernhealthcare.com/article/20090121/REG/301229990/-1/YOURVIEWS

    It is clearly evident that Zwerling is referring to CEOs like Glen Tullman when he says,

    “Approximately half of CCHIT’s board of directors work for medical insurance companies or commercial medical informatic companies, or are physicians employed by very large group practices or electronic health-record companies. As a result, CCHIT’s priorities have been tailored to reflect the interests of its board, rather than the needs of the physicians and the health interests of our society at large.”

    By the way, dentists are not represented at all. God only knows whether the American Dental Association is involved in any part of the eHR struggle. The leadership of my professional organization is silent, yet they claim they are representing our patients’ interests. How can we trust the organization when it supports rationalization over evidence for the need for eHRs in dentistry, as described in Dr. Robert H. Ahlstrom’s testimony to DHHS?

    (See “HIPAA and Dentistry – About Ahlstrom’s Controversial HIPAA Testimony.”)

    https://healthcarefinancials.wordpress.com/2009/01/08/hipaa-and-dentistry/

    Like Glen Tullman, Dr. Robert Ahlstrom is a nationally recognized expert on paperless practices. And like Tullman, politicians like what he says more than doctors. He’s got game.

    Sorry; I just had to slip that in. Like Dr. Zwerling, I sense that these are critical times.

    I truly find Dr. Zwerling’s character historically interesting, and encouraging. His timing is perfect. He is a rebel at a time when the President of the United States won an election on the promise of meaningful change.

    This is from Zwerling’s software website. ”ComChart eMR: The advantages of a comprehensive eMR, without the hassles/bloat that come with all CCHIT certified eMRs.”

    http://www.comchart.com/

    See what I mean? It is like a dentist saying, “I’ll tell you what you can do with your HIPAA paperwork…”

    So now that we know that Dr. Hayward Zwerling has little respect for board members of CCHIT, how much respect does CCHIT board member Mr. Glen Tullman have for doctors? The truth is not hard to uncover. As always, to find allegiances, sometimes it is as simple as following the money.

    Over a month ago, Alex Nussbaum of Bloomberg.com posted a story titled, “Insurers, Costs Spur Rise in Online Medical Records.”

    http://www.bloomberg.com/apps/news?pid=20601109&sid=aX4cYX.5J0pg&refer=home

    Nussbaum writes:

    “Pressure from insurers such as Aetna Inc. and WellPoint Inc. and the need to cut hospital costs are speeding a move by doctors to computer recordkeeping, said Glen Tullman, chief executive officer of Allscripts-Misys Healthcare Solutions Inc.”

    Tullman was speaking at a forum sponsored by NASDAQ OMX Group Inc. and Leerink Swann & Co.

    So how credible is Tullman on Wall Street? Like Zwerling, his timing isn’t bad, but in addition, he backed the right candidate in meaningful ways. He’s got game.

    In October, as the last question of an interview on HIStalk blog, Glen Tullman, a major player in the healthcare IT industry was asked if he would accept a cabinet position should Obama be elected.

    http://histalk2.com/2008/10/14/live-chat-with-allscripts-ceo-glen-tullman-wednesday-1015-700-pm-et/

    Tullman coyly evaded the question, but conveniently allowed that he has always been an Obama supporter. Americans should know that if worse comes to worse, and Tullman’s appointment comes down to a selection committee approval, be aware that Tullman’s support can be worth millions of dollars to his favored charities. He’s got game, and you can bet he also has Obama’s ear.

    Two months following the interview and Obama’s election, at the NASDAQ forum in December, Tullman’s confidence was obviously hard to control, and he became reckless – in my opinion. Pride does those things. He found it easy to humor the already eager investors by pronouncing that federal spending on the eHR system should be tied to doctors’ use of the eHR system, which he sells. He added that if doctors find themselves short of available cash, the funding could come in the form of loans,

    “to ensure doctors have some skin in the game.”

    Those words must have boosted the mood of the audience to giddy, because immediately upon hearing that providers would be gambling with their own “skin,” they were still giggling and barely maintaining continence when they sent the text messages that immediately goosed the stock price of Allscripts.

    -Darrell K. Pruitt; DDS

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  2. Dear Hayward and Darrell,

    Q: What gives with HIT security?

    According to an article by Alice Lipowicz, Jan 20, 2009, in the HiMSS trade industry magazine – Government Health IT – HHSD must become a leader in identifying and fighting medical identity theft and should make it a central part of health information technology initiatives.

    The article also states that medical identity theft poses serious dangers to patient-consumers because false information in a person’s health record could affect treatment. It cited, for example, that false information could lead to a patient receiving the wrong medicine in an emergency room, resulting in the patient’s injury or death. Health identity theft could also lead to financial costs for individuals, payers and providers and the loss of privacy for individuals.

    Yet, I thought this Obama HIT initiative was so secure; or is it? Just what gives? It seem like we are getting mixed messages from Uncle Sam on this issue, aren’t we?

    -Peter

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  3. Chairman Leavitt Speaks,

    In a parallel thread about CCHIT elsewhere, I warned readers that it is my bet-the-farm guess that things are going to get dicey for Allscripts and CEO Glen Tullman really soon.

    http://community.pennwelldentalgroup.com/forum/topics/dr-hayward-zwerling-meet-mr

    I even went so far as to say “I predict that within a week, CEO Tullman will feel the start of a prolonged media backlash because of his close relationship with CCHIT.” That would be six days from today; Feb. 2-3; or so.

    If one occasionally wonders if I am simply full of it, note the timing of events I describe as history unfolds before us. It is my opinion that from this forum, we have a wonderful vantage point. What’s more, it may occur to some that we are not completely independent of the action. I think my credibility will soon be vindicated … or not.

    Either way, I call this an adventure.

    Look at tomorrow and allow me to share with you a peek over the horizon. Following reading this comment, decide for yourself if what we are witnessing is not a few steps into the future of healthcare IT; I do.

    It was on the “Zwerling meet Tullman” thread that I mentioned that Dr. Zwerling’s critical assessment of CCHIT was posted on ModernHealthcare.com on Jan. 21, early in the morning. Today, Jan. 27, Mark Leavitt, MD posted a scathing response to Dr. Zwerling’s criticism, also on http://www.ModernHealthcare.com

    http://www.modernhealthcare.com/article/20090127/REG/301279962

    The title of Levitt’s piece is “Unfounded claims threaten dedicated work at CCHIT”. Dr. Leavitt pleads:

    “Dr. Hayward Zwerling’s claims attempt to disparage the work of hundreds of volunteers who have contributed to the mission of the Certification Commission for Healthcare Information Technology.”

    He terminates his defensive message with what sounds like a plea for merciful compassion: “I hope Dr. Zwerling will think about his oath to ‘first, do no harm’ and learn the facts before making false claims that threaten the constructive, dedicated work of so many individuals.” Ouch.

    And so; who is this Dr. Leavitt, and why is he so passionate in defending over-worked volunteers, including CCHIT board member Glen Tullman, CEO of Allscripts?

    Why; Dr. Mark Leavitt is none other than the Chairman of CCHIT. Do you find it odd that someone in a position like Leavitt’s would risk opening up on a common stakeholder on the Internet? I do. I find it shocking and wonderful entertainment on a day far too cold to golf.

    Please hang with me a little longer. I promise it gets really better soon. You have to admit that it is obvious that Dr. Leavitt’s ill-advised defense based on pitiful misdirection is so lame.

    Remarkably, it is even less creative than the usual committee-approved talking point. Don’t these command-and-control types have PR people who warn them what not to try on the Internet? This isn’t the first time that it has occurred to me that insulated good ol’ boys have been drinking their own hooch in the dark for decades – often making them blind to their stupid stuff. Then when they finally venture out into the transparency of the Internet, they are soon stunned by freedom of speech in a small town, and fall easy prey to uncontrollable gossip.

    For example, CEO Tullman, the CCHIT board member, has squeezed off a couple of special faux pas of his own over the last few months. Here is his latest, in which he describes the origin of his respect for President Obama:

    “Imagine-the most influential person in the world says everyone has to have your product in five years. You can’t paint a better picture.”

    – Allscripts CEO Glen Tullman, January 26, 2009.

    http://money.cnn.com/2009/01/26/technology/allscripts.fortune/?postversion=2009012611

    Contrary to what Dr. Leavitt would have us believe, I am fairly certain that hurting the feelings of volunteers was neither an intention nor a concern of Dr. Hayward Zwerling when he wrote his comment. I think Zwerling was after something more strategic. Even though Zwerling never mentioned Leavitt by name, they both know very well that it is ultimately Leavitt’s “skin” that is in the game. That is undoubtedly the reason that Leavitt found he could no longer remain silent. Did you notice the panicky tone of Leavitt’s voice? I have to assume that he must have been feeling a tremendous amount of pressure to respond because he noticeably lost his composure and was careless in his response.

    I don’t think Dr. Leavitt is the only one trapped in CCHIT.

    “CCHIT, a not-for-profit, 501(c)(3) organization with a public mission, has worked diligently to create an open, transparent collaboration among all healthcare and health IT stakeholders. Hundreds of volunteers have given countless hours in service to its mission.”
    -Dr. Mark Leavitt, January 27, 2009.

    For those who still may not believe how close I am bringing us to the edge of history in healthcare IT, let me point out that I posted Dr. Zwerling’s letter on the PennWell forum, three days before it appeared on ModernHealthcare.com. Now let me review with you what happened over those three days. I think you will find this revealing.

    1.18.09
    I found Dr. Zwerling’s critical January 2 comment on Boston.com which he wrote in response to an article which questioned the value of EHRs in healthcare.

    http://people.boston.com/articles/nation/?p=articlecomments&activityId=6778798549471809193

    That same day, I copied and posted his comment on this PennWell forum under the title “Bad CCHIT” as the focus of the discussion.

    1.19.09
    A friend suggested I send the Certification Commission for Healthcare Information Technology (CCHIT) a copy of Dr. Hayward Zwerling’s critical comment about the Commission. I liked the idea and I was provided with this address: http://www.cchit.org/about/contact/index.asp

    I left a message on the CCHIT website announcing that I posted the question “Where are you taking us, Mark Leavitt?” here on the PennWell forum, and I invited a response. That would be the same Mark Leavitt who yesterday, took out his frustration on Dr. Zwerling.

    To my surprise, I almost immediately received a response from the CCHIT staff – informing me that questions are handled on a first-come, first-served basis but nevertheless, I was promised that I would receive an email reply by January 25.

    1.21.09
    I wrote “It only took two days for CCHIT to respond to my question that they didn’t receive.”

    Latrice Knight, Executive Assistant at CCHIT (233 N Michigan Avenue, 21st Floor|, Chicago, IL 60601, 312.233.1582 – voice, 312.896.1466 – fax, lknight@cchit.org), emailed me this message:

    “Darrell, We did not receive your question. Please resubmit your question at http://www.cchit.org

    After visiting the link she suggested, which required intricate registration steps before demanding the appropriate “line numbers” from legal documents somewhere, I gave up and resubmitted my question to Dr. Mark Leavitt, once again including Dr. Zwerling’s comment, in the tried and proven link to Executive Director Latrice Knight on the same day, Jan. 21.

    That means that if it takes CCHIT five days to respond to emails, I should at least hear something by tomorrow, Jan. 28. If I don’t, I’ll remind Latrice Knight that I am patiently waiting for a response.

    Did you notice that this time, I did not receive an immediate response CCHIT confirming receipt of my question?

    Do you think that some who work hard at CCHIT Headquarters recognized the Zwerling article titled, “An inherent conflict of interest within CCHIT” on ModernHealthcare.com as the same one that arrived early that morning?

    If you don’t find this adventure exciting yet, just wait until tomorrow. Either Ms. Knight will be contacting me or I will be contacting her. She is trapped along side Dr. Mark Leavitt. They are in my neighborhood now, and beyond the rescue of traditional command-and-control PR techniques.

    I really should be golfing.
    -Darrell Kellus Pruitt; DDS

    Editor’s Note: Note: Dr. Pruitt blogs here and at others sites where this comment first appeared.

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  4. Hello Darrel, Mark, Peter and all ME-Post Readers and Subscribers,

    RE: Disingenuous, Ironic; or Both? You decide.

    The VA just settled a $20 million class action privacy lawsuit for exposing 26.5 million veterans them to possible identity. The lawsuit came the VA analyst admitted an analyst lost a laptop computer and external drive containing the names, birth dates and Social Security numbers of the vets and active-duty troops.

    Of course, if the US government and the DHHS can’t secure private healthcare info and eHRs; how does Uncle Sam, Tom Daschle, Mark Leavitt and Barack Obama etc, expect private doctors and hospital to achieve same; and at what cost? Just ponder how many kids could be immunized, uninsured patients treated, new pharmaceuticals developed, or medical RD pursued with this money. The system is just not ready for eHRs right now; but perhaps in the next generation?
    We don’t need to use an A-bomb, when a fly-swatter will do.

    And so, since it seems this reply from Dr. Leavitt preceded the VA settlement; my vote is for irony. No doubt Leavitt is a genuine guy; just wrong and too far removed from the trenches. Candor – Intelligence – Goodwill to all.

    Fraternally,
    Dave
    Dr. David Edward Marcinko; MBA
    [Editor-in-Chief]

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  5. 20 Billion Dollars – minus – 20 Million Dollars,

    In the best of circumstances, when an aircraft remains trapped in a tailspin in spite of the pilot’s determined and exhausting efforts at commanding control, simply pouring on more gas may just hasten the abrupt, messy arrival – way ahead of schedule and way short of the runway.

    However, having the courage to let go of the stick early enough – allowing time-tested, built-in aerodynamics to resume functioning according to natural laws can mean the difference between life and death.

    In my opinion, it is time for Dr. Mark Leavitt, Chairman of CCHIT to start listening to doctors instead of Wall Street. Wall Street has been known to crash a time or two because of natural laws and fingers like potatoes.

    If after blowing through all 20 billion dollars, there floats an unsubstantiated rumor that it is unsafe to allow personal information to enter eHRs, a significant number of patients will lie about their health histories. The distrust will not only ruin meaningful research, but it could cost more peoples’ lives than eHRs save. As bad as it sounds, that is as good as it gets if Americans cannot “opt-out” of perceived harm from eHRs. Consider it a natural law.

    If after the money is spent, it is not a rumor, but a well-known fact that eHRs cannot be trusted with patients’ personal secrets, doctors will do the lying for them. Consider it the Hippocratic Oath.

    Let’s call the 20 million dollar payout to victims of the VA breach an unexpected, but really clever part of the 20 billion dollar economic stimulus plan, and move on in a more secure direction that involves fewer attorneys, more doctors and more cures.

    How about this idea: Let’s return to basics before we spend any more money. Since we are arguably heading in the wrong direction, the last thing we need is more momentum.

    -D. Kellus Pruitt; DDS

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  6. Dear Latrice Knight,

    In our last exchange of emails, I was attempting to obtain a response to a question for CCHIT about a comment made by Dr. Hayward Zwerling. His comment appeared January 2 on Boston.com, and he was very critical of your organization.

    If you recall, Dr. Zwerling’s comment caused me to become understandably concerned about the direction CCHIT is taking healthcare. Dr. Zwerling suspects that the CCHIT board members represent stakeholders rather than doctors and patients. I looked over the list of board members. I find Zwerling’s arguments credible and alarming.

    Per your encouragement, I resubmitted my question both as an email to you, as well as through the “Contacting the Certification Commission” link on the CCHIT website, which initially brought us into contact.

    http://www.cchit.org/about/contact/index.asp

    However, this time, I failed to get a response from either, and it has already been seven days. What happened?

    In the meantime, Dr. Zwerling’s comment was independently picked up by ModernHealthcare.com, and a couple of days ago, and Dr. Leavitt himself responded (badly) to Zwerling’s concerns. Let’s move on.

    I now have a new question. It is simple, and not at all controversial: How is dentistry being represented by CCHIT?

    Since I didn’t see a single dentist listed anywhere in the organization one wonders who CCHIT is depending on for information about my profession. I think you can understand my concern in light of Dr. Zwerling’s accusations.

    In order to save time, I prefer to submit this message both to you as an email, and to the CCHIT website. I hope I am not kept waiting form more than five days for a response this time.

    Sincerely,
    D. Kellus Pruitt; DDS

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  7. Bad News,

    Dr. Pruitt sent us an email regarding the above and said he’s received a reply from C Sue Reber the Marketing Director for CCHIT. It turns out that nobody in CCHIT has considered dentistry. It could have been worse news.

    http://community.pennwelldentalgroup.com/forum/topics/bad-cchit

    Ann Miller; RN, MHA
    Executive-Director

    How to Demand Accountability?

    As noted previously in this thread, an answer from CCHIT concerning issues brought up by Dr. Hayward Zwerling is overdue. So, today I sent a follow-up email to CCHIT Executive Assistant Latrice Knight that I copied above.

    Since CCHIT Chairman Dr. Mark Leavitt responded to Dr. Zwerling online on ModernHealthcar.com – answering my initial question – I asked Ms. Knight how dentistry is represented in CCHIT’s decisions. If I get a response, I expect the worst. I am afraid we will hear that the CCHIT is in close, daily contact with Dr. Robert Ahlstrom and/or the ADA Department of Dental Informatics. [See “HIPAA and Dentistry – About Ahlstrom’s Controversial HIPAA Testimony]

    https://healthcarefinancials.wordpress.com/2009/01/08/hipaa-and-dentistry/

    It would be a more reassuring to get no response at all, or even to hear Ms. Knight say, “Oh my! We completely forgot about the dentists!”

    Anyone can see that I’m going through CCHIT to prod the ADA into surrendering to accountability. I am fond of this unconventional PR tool, and there are an unlimited number of portals I can use.

    I regularly go through the ADA’s for-profit partner, Intelligent Dental Marketing and CEO Trajan King to poke a sharp stick into a tender spot. I do it between checking hygiene patients – just for grins.

    Shy good ol’ boys who cannot do a thing about it, hate to hear me broadcast that anyone can demand accountability from any traditional command-and-control bureaucrat these days using the Internet. It may take a while to flush out hard-headed and entrenched leaders, but accountability in any organization, including CCHIT, always begins with trouble that otherwise simply will not leave and gets progressively worse.

    D. Kellus Pruitt; DDS

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  8. A Smoking Gun?

    This scenario, if true, is so unreal that I have asked our Executive Director, Ann Miller, to keep all ME-P readers, visitors and subscribers abreast of this evolving situation. Although this may be a slight breach of conventional blogging protocol, it is well worth the effort. Nevertheless, we include the email attributes below, for added journalistic clarity.

    Dr. David Edward Marcinko
    Publisher-in-Chief

    From: Sue Reber [mailto:sreber@cchit.org]
    Sent: Thursday, January 29, 2009 10:57 AM
    To: pruittdarrell@sbcglobal.net
    Cc: Latrice Knight
    Subject: RE: New question – it’s easy

    Dr. Pruitt:

    I apologize for our failure to respond as quickly as you may have liked.

    When HHS contracted with CCHIT in September of 2005 to develop an inspection and certification process for health information technology, ONC specified primary care physician offices – where most Americans get their care – followed by acute hospitals in year two, and health information exchanges in year three. That contract ended in September 2008. Our initial development process was largely dictated by that contract. ONC also specified a range of shareholder groups that should be included in our Commission and volunteer work groups. Dentistry was not among them.
    However, since the launch of our first inspection program in May 2006, we have seen demand from many other care settings, patient populations and professional specialties. In response to that we have conducted open calls for requests for expansion, in November 2007 and December 2008. Those calls were published in press releases and carried in the health IT trade press. We also included the calls on our Web site and in our own electronic news letter, CCHIT eNews. We have never had a response to those calls from dentistry. In fact, I think I can safely say that your comments are among the first we have ever had from dentistry.

    In both cases, the Commission has reviewed and prioritized the submissions and added programs to our future development cycles. As a result, child health, emergency medicine and cardiovascular medicine programs were launched in 2008. Long term care and behavioral health will be added in 2010. And our current proposed roadmap is open for public comment until Feb 5. You may review that work and respond by following the instructions at:

    http://www.cchit.org/expansion/

    Regards,

    C Sue Reber
    Marketing Director,
    CCHIT: Certification Commission for Healthcare Information Technology
    503.288.5876 office | 503.703.0813 cell | 503.287.4613 fax
    sreber@cchit.org

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  9. New Question for CCHIT,

    “The electronic health record may not be the result of changes of our choice. They are going to be mandated. No one is going to ask, ‘Do you want to do this?’ No, it’s going to be, ‘You have to do this.’ That’s why we absolutely need the profession to be represented in the discussions about EHR to make sure our ideas are enacted to the greatest extent possible.”

    President-elect Dr. John S. Findley, September 2008, ADA News.

    http://www.ada.org/members/resources/pubs/adanews/081006_findley.asp

    Oh Really; Dr. Findley?

    In the last comment thread above, we shared an email that was sent to CCHIT, requesting information about who is keeping the commission informed of the needs of dentists.

    We speculated about three possible results to our efforts:

    The first was that a CCHIT rep would assure me that the ADA’s experts are all over it – just like Findley promised they would be.

    The second was that there would be no response at all – that was proven wrong quickly by the email from Sue Reber, Marketing Director of CCHIT, whose reply we copied below.

    And the third was, “Oh my! We completely forgot about the dentists!” — Oh my!

    How could CCHIT overlook our needs with someone from the ADA “making sure our ideas are enacted to the greatest extent possible”?

    Since the Certification Commission for Healthcare Information Technology is where the most important decisions are being made about the mandated eHRs that Findley warned us about, where is the ADA?

    Friends, we are rudderless, our leaders are nowhere to be found, and a storm is approaching fast. What are we going to do?

    -D. Kellus Pruitt; DDS

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  10. So what does it take to change the direction of a dinosaur?

    I’ve learned that part of the insulating design of having a committee as a central nervous system means that the ADA is excusably insensitive to its own errors, and therefore never has to correct itself. Unquestioned support of the NHII was a huge mistake at the wrong time in history for slow-moving dinosaurs to be posting things on a website – even before the downturn in the economy.

    Here is another over-ripe news bite that smells worse every day: In the “Advocacy” section of the ADA website, there is a part called “ADA National Oral Health Agenda” which lists dentistry’s six highest priorities for Congress.

    http://www.ada.org/prof/advocacy/agenda.asp

    The introduction to the section invites the reader to “Learn how the collective voice of dentistry is changing American health care for the better.”

    “Reducing the Cost of Dental Care” is one of the priorities. As a means of achieving that goal, “Health Information Technology” is the ADA’s first tool listed. Following HIT, are insurance reform, medical liability reform and regulatory reform.

    Since everyone knows that HIT will never save money in dentistry, I wonder how we are doing with the reforms, and if we will be told more jokes.

    D. Kellus Pruitt; DDS

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  11. Zwerling Responds to Leavitt

    Do CCHIT-Certified eHRs Advance Care or Just Enrich Industry Stakeholders?
    Sent in by Darrell K. Pruitt; DDS

    I thank Dr. Mark Leavitt for taking the time to respond to my comment, discussing CCHIT’s influence on the healthcare information technology industry and on healthcare in general.

    In his reply, Dr. Leavitt states that I have impugned the efforts of the people who are working to advance CCHIT’s goals. My letter makes no such accusation. It states that those goals have been created by CCHIT’s commissioners and that some of the commissioners are employed by companies/industries/organizations that have a financial interest in the future shape of the “digitalization” of healthcare delivery. One can see a list of CCHIT commissioners and their affiliations and decide for oneself if these commissioners have an inherent conflict of interest.

    I do not believe that any person should be permitted to become a CCHIT commissioner if they have a financial interest in the end-result of CCHIT’s endeavors. No reasonable person would conclude that it was appropriate to allow a military contractor to have a vote on the Senate’s Armed Services Committee [SASC].

    President Barack Obama has instituted policies that prohibit lobbyists from working for the federal government. I believe it is in the best interest of healthcare that CCHIT prohibit people from being CCHIT commissioners if they have a financial stake in the outcome of CCHIT’s endeavors.

    Dr. Leavitt disagreed with my conclusion that CCHIT’s efforts will reduce competition in the electronic health-record marketplace. He stated that the current presence of many small EHR companies proves that CCHIT’s certification process has not reduced competition. While this is true, at this moment, CCHIT has only been “certifying” EHRs for a couple of years. We have not seen the full impact of CCHIT’s certification process on the EHR industry. In the not-too-distant future, most knowledgeable observers of the EHR industry expect to see a consolidation, in which many small EHR companies will be forced to shut their doors—and with that, low-cost and innovative EHRs will be lost forever.

    Dr. Leavitt stated that my letter contravenes my oath as a physician to “do no harm.” While there is some data to suggest that a few features of an EHR will be beneficial to the public’s health (e.g., e-prescribing will reduce medication errors), there is little data to demonstrate that the institution of a national and intraoperable EHR will raise the quality and reduce expenditures on healthcare. Clearly, at this moment, there is insufficient data for a Centers for Disease Control and Prevention [CDC] medical statistician to conclude that the health of the public would be improved if all physicians used a CCHIT-certified EHR. Maybe there will be data to support this proposition in the future, but not at this time. I strongly subscribe to the “do no harm” oath. By this, I mean that when there is an absence of data to demonstrate that an intervention will help my patient, the oath “do no harm” should apply, and the intervention should not be foisted upon my patient in the “hope” that the treatment will work. Similarly, CCHIT EHRs should not be foisted upon today’s healthcare providers, as only future studies will determine if CCHIT-certified EHRs advance healthcare and reduce healthcare expenditures, or if they only enrich the owners and shareholders of the involved industries.

    Finally, Dr. Leavitt’s letter fails to address my chief concern that CCHIT is in the process of creating a “medical-pharmaceutical-insurance industrial complex.” The creation of such a powerful alliance of industries will have an unstoppable influence on the future of healthcare, and there is no reason to believe that the industry will put the public’s health as its No. 1 priority. Further, the power of this industry will rival the “military-industrial complex,” and will come with all the baggage that President Dwight Eisenhower had warned us about in his farewell address. An editorial in the New York Times reveals the beginning of the healthcare IT industry’s attempt to influence the future of healthcare; per the editorial, the healthcare IT industry is insisting that they be allowed to sacrifice the “privacy” of the healthcare record, for the sake of the healthcare industry. In fact, this is a bald-faced attempt to ensure that the healthcare industry retains the right to sell medical information to the highest bidder. And this is only the beginning of their attempt to influence the direction of the healthcare industry.

    Link: http://www.modernhealthcare.com/article/20090127/REG/301279962

    For the sake of healthcare in the US, CCHIT should be restructured immediately.

    Hayward Zwerling; MD
    President
    ComChart Medical Software
    North Chelmsford, Mass.

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  12. ME-P Subscribers,

    Dr. Hayward Zwerling responded to Dr. Mark Leavitt on ModernHealthcare.com.

    After reading Dr. Zwerling’s latest comment, which I copied above, please re-read CCHIT Chairman Dr. Mark Leavitt’s plea for mercy in which he appealed to Zwerling’s sensitivity for hard working volunteers like Glen Tullman, CEO of Allscripts – pointing out the principle of the Hippocratic Oath to “do no harm.”

    The title of Dr. Leavitt’s letter is “Unfounded claims threaten dedicated work at CCHIT.”

    I think after reading Leavitt, anyone can recognize that Dr. Hayward Zwerling is a compassionate man. Zwerling could have justifiably impaled Leavitt on the cheap remark about the Hippocratic Oath. “To do no harm” is meant to protect patients, not Allscripts CEOs who understandably volunteer to stake out some turf.

    If you recall, Glen Tullman was the one who suggested that providers should take out loans to buy his CCHIT-certified products so that they would “have some skin in the game.” Those types need no protection at all, in my opinion. Bring out the cold steel and sunshine, and let’s see what gives.

    Dr. Zwerling proves his confidence with a level of restraint that I admire. I am not that strong at resisting temptations. I suspect that some day my impatience with bozos like Dr. Mark Leavitt will get in the way of any possible political chances.

    http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090203/REG/302039990

    Oh, well.


    Darrell Kellus Pruitt; DDS

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  13. A Time Out For Health IT?

    A politically-incorrect article titled, “A Time Out For Health IT?” by Hayward K. Zwerling, MD, was posted recently on The Healthcare Blog.

    http://thehealthcareblog.com/blog/2013/03/17/commentology-a-time-out-for-the-federal-promotion-of-health-information-technology/

    Dr. Zwerling’s conclusion:

    “Before physicians consider prescribing a new therapy, physicians demand that the scientific community ‘prove’ that the benefits of the therapy exceed its risks. When the therapy effects an entire population (e.g. vaccinations), the level of scientific proof must be overwhelming before the medical community recommends that the therapy is utilized by the entire society. In the case of HIT, society has assumed a great risk (e.g. great cost, disruption and restructuring of physician practice patterns and many, potential unknown ‘side effects’) without a priori demonstrating the putative benefits.

    As a profession which is grounded in science, I think it is time that physicians mandate a pause in the Federal Government’s promotion of ‘certified’ EMRs until there are numerous, unbiased and scientifically rigorous trials which convincingly demonstrate that the widespread use of HIT will benefit society by either improving the quality of healthcare or reducing the cost of healthcare.”

    Unlike physicians’ criticism of the cost and safety of electronic medical records – which as one can tell is becoming increasingly loud and frequent – criticism of dentists’ electronic dental records is almost unheard of. Look for yourself.

    So do you think the dearth of complaints about dental software is because dentists are 100% satisfied?

    Today, Dr. Zwerling commented following his article: “Of course, all the dollars which have been thrown at the HIT issue has now created a powerful vested interest, the HIT-PBM – health Insurance conglomeration, which has and will use it’s political muscle to promote its own interests, in the name of the ‘public’ good. And while their proclamations to the general public and politicians might sound reasonable, their arguments cannot be refuted by a sound-bite. Thus, the complexity of the problem makes it exceedingly difficult to have a rational public discussion about the pros/cons of HIT.”

    HIT has also become a scam in the dental industry – involving traditionally-respected dental leadership and the highest levels of government. Yet virtually all dentists remain clueless about the malfeasance Dr. Zwerling describes. This won’t end well.

    Darrell

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