The new stimulus bill is huge in terms of dollars, winners and losers.
Once again, big corporations are the winners and the little guys can't get in the game.  I take this personally, because I work for a small start-up that provides IT solutions to small physician practices at low to moderate pricing.

Frankly, I do not see how this bill will encourage us to spend tax dollars wisely.

One provision of the bill mandates that federal funds only be used for health information technology that is certified by the Certification Commission for Healthcare Information Technology, or CCHIT. Mandating that physicians use bloated CCHIT certified emrs will only aid large vendors who have the deep pockets to fund CCHIT certification. 

Certification does nothing to encourage innovation. Instead, it erects roadblocks to fresh and frugal ways for small physician practices to adopt software systems. Members of Congress, before signing this bill, please ponder these questions:

1. What happens when large corporations influence decisions where they have a conflict of interest?

(Have we forgotten the subprime mortgage lending crisis already?)
CCHIT's board includes stakeholders from GE (NextGen), Siemens, McKesson, BlueCross Blue Shield – all big players in healthcare or healthcare IT. 

2. What value does the CCHIT certification process provide to providers or patients?

Why not just mandate standards that are already in place, such as HL7?

3. Are physicians so feeble-minded that they cannot make IT decisions without CCHIT’s help?

(I mean, they did make it through med school)

Mark Leavitt, MD, PhD, CCHIT chair,  has been quoted  as saying the benefit of CCHIT certification to physicians is that it will “simplify the decision-making process…for physicians starting from scratch, this will be a tremendous help because they know that those products (on the Web site) meet the certification standards.”

4. Do barriers to entry in the marketplace enhance competition?

With an initial price tag of about $36,000 just to participate in the certification process, competition is limited to large corporations with deep pockets. Less competition does not promote lower prices, but somehow Leavitt thinks it does:

"Our goal at CCHIT is to see the market, and the value of the EMR, accelerate with certification in place. When this happens, vendors can sell at a lower price and invest more in research and development or attract more capital."

5. Will large corporations offer affordable healthcare IT solutions?

As Clayton Christensen from Harvard Business School says, "Direct competition among U.S. automakers did not give us more affordable, quality cars - disruption by Japanese (and now Korean) companies did. Breaking up AT&T to induce competition among the Baby Bells did not bring more affordable telephone service - disruptive technologies like Voice Over IP (VOIP) did."


6.  Is certification in anything necessary in a Web 2.0 world?

Give me user reviews any day over a rating by a quasi-private organization. What are the real users of the product saying? Is it useful? Is it expensive? Is it worth it? Recommendations by trusted sources, even if those sources are online, are invaluable in making IT decisions.

7.  $36000 just for the first year of certification, really?