Ignacio Valdes thread from the American Medical Informatics Association Open Source Working Group Listserv on Healthcare under the Obama Framework

<ed.note>Ignacio edits LinuxMedNews.com, where he is also posting on this meme.</ed.note>

'Rockefeller Amendment' for Studying Open Source in Stimulus Bill

About page 701 of the
http://finance.senate.gov/sitepages/leg/LEG%202009/020209%20complete%20legislative%20text%20of%20American%20Recovery%20and%20Reinvestment%20Act.pdf
stimulus bill  is a provision for studying Open Source: "…(A) the
current availability of open source
6 health information technology systems to Fed
7 eral safety net providers (including small, rural
8 providers);
9 (B) the total cost of ownership of such sys
10 tems in comparison to the cost of proprietary
11 commercial products available;
12 (C) the ability of such systems to respond
13 to the needs of, and be applied to, various pop
14 ulations (including children and disabled indi
15 viduals); and
16 (D) the capacity of such systems to facili
17 tate interoperability…'

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Brief Analysis: American Recovery and Reinvestment Act of 2009

After reading the parts of the American Recovery and Reinvestment Act
of 2009 that relate to health IT, here are my conclusions: 1) More of
the same. The current plans and all the same players for Health IT as
before only now there is a lot more money involved and a brief time to
accomplish all of this in terms of health care time: 2014. 2) A
chicken in every pot approach, everyone gets money: education, Health
IT schools, some physicians get money for implementation on a
descending rate. Some talk of free/open source but the usual political
favorites AHIC, etc. are all still there as well only they get a lot
more money now. 3) No clear plan as to how to do all this. No clear
plan for dealing with issues such as 20 year veteran clinicians and
nurses with no computer experience. No plan for enabling the
proliferation of innovative software with existing systems. No penalty
or plans for dealing with proprietary software stonewalling.

Complete brief article: http://linuxmednews.com/1234372142/index_html

# # # #

Brief Analysis: American Recovery and Reinvestment Act of2009

Well, I didn't want to say some of the things that are in the HIMSS
analysis, especially given the near silence of AMIA on any of this. I
cannot argue with its conclusions. The ARRA of 2009 appears designed
to remove competition, unfortunately all competition, even healthy
competition except for a select few who will form a cartel or a
monopoly. It looks as though legalized robbery and absolute control of
medical data at great expense by a few wealthy corporations may be at
hand. I will not be surprised when doctor and personnel scapegoating
will begin when much of this doesn't work very well and billions have
been spent. Then comes the criminal penalties for non-use of CCHIT
certified systems. If all this occurs, then goodbye privacy, goodbye
rapid innovation, and the traditional role of physicians as custodians
of medical data. That nearly everyone except a select few were shut
out of the debate on this in Congress and how quickly it has been done
so that organizations like AMIA can only stand by in stunned silence
speaks volumes.

>From the HIMSS analysis:
"e)    The shrinking number of vendors that are capable of meeting CCHIT
certification exposes a fundamental flaw in its current organizational
structure – CCHIT is funded by the very vendors it certifies. In order
for it to maintain revenue, it needs to provide a reason for vendors
to continue to either:
i)    re-certify on a regular basis
ii)    apply for new certifications
The problem with this model is that, in order to justify ongoing
re-certification, CCHIT must continue to add new certification
requirements year-to-year. The driver for more requirements is not
necessarily the needs of customers or the best interest of the
healthcare system, but the need to have new requirements against which
to certify vendors. This is illustrated by the fact that CCHIT has
recently reduced the length of the certification from three to two
years, and is adding numerous supplemental certifications in areas
like child health, cardiovascular, etc. There is no end to the number
of requirements to which this could lead, but there is no evidence it
will serve anyone well in the long run, other than the few large
vendors with the resources to keep up with this process, and CCHIT
itself.
f)    Although in theory vendors can apply jointly for CCHIT
certification, in practice the monolithic certification process will
limit the ability for vendors to provide component solutions from
which customers can choose to create best-of-breed, low cost solutions
that best fit their needs. For instance, in the ambulatory arena, this
might typically be a combination of Practice Management, EMR and
e-Prescribing solutions.
g)    Certification of Practice Management systems in other markets
(e.g., UK) has arguably reduced innovation and investment, increased
the total cost of ownership and consolidated the market to such a
point that there is limited choice and the barrier to entry for new
entrants into the marketplace is unaffordable."

— IV

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Brief Analysis: American Recovery and Reinvestment Act of2009

Item 3 pretty much says it all: "CCHIT works to the benefit of a small
number of large EMR vendors that can command a high price from the
relatively small segment of the market able to currently afford their
products. It is essentially anti-competitive, and establishes a major
barrier to entry by new vendors and open source projects (where the
majority of innovation will take place)."

— IV

# # # #

For the record, I am not anti-corporation, anti-big corporation,
anti-business or anti-government. I am for real solutions that will
solve these problems with fairness, and without needless, massive
expense, disenfranchisement, or loss of rights. I agree that there are
massive opportunities, but it looks like the federal government has
already essentially picked who gets the massive opportunities, who
gets crumbs and who gets nothing. That specifically appears to be the
incumbents who get the massive opportunities. That there is little
public rhetoric or any meaningful public vote or say at all on such
massive unfocused Health IT spending bill, good or bad on this is
concerning to me. Three to five billion dollars were floated around in
very recent years for doing this and it was considered a
insurmountably large sum of money to spend by the government. It is
now a fait accompli that we will quadruple that and this is being done
with little or no public discussion vote or consent on a crash basis
with little in the way of guaranteed or even reasonably researched
results. The bill is very vague or things not addressed at all for
solving difficult, crucial problems that I see on a daily basis in the
trenches. Who is driving the language in the bill? I do not know. I
can only conclude that large health IT corporations with lobbyists or
'board members' are driving it by its language. Physicians, patients
and small innovative companies like Webreach that have done wonderful
things for interoperability without any federal money appear to be
utterly disenfranchised in all of this.  The historic propensity of
the US to form expensive corporate cartels whether they are needed or
not and that become government favorites is of great concern as well
as this being HMO's all over again? I can easily see a massive
bureaucracy accomplish very little, then throw this into the hands of
the 'savior' larg
e corporations. It has happened many times before.

Someone else said that this is a "Hurry up and pass this before things
get better on their own" bill.

— IV

# # # #

Links to: American Recovery and Reinvestment Act of 2009 text.

Original Link: http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bi…
TinyURL: http://tinyurl.com/h1as2-pdf

I'm not sure that this will be the final. I am told that the final
will be out possibly Friday.

— IV

# # # #

Links to: American Recovery and Reinvestment Act of 2009 text.

The health IT stuff begins about page 230.

Page 249:

''(iii) The utilization of a certified electronic health record for
each person in the United States by 2014."

This is a extraordinarily provocative clause with very large
ramifications. That means that essentially the US government has just
taken over Health IT and is now in complete control. As I understand
it, it means that if an entity cannot pony up $70K every 2 years to be
re-certified until everyone that cannot do this is driven out of
business. That means the only ones that can survive this are the
Epic's and the Cerner's. Along with the reporting requirements, your
privacy and your records especially in a proprietary system is now in
the hands of both a large corporation and subject to what a large
government bureaucracy thinks is the definition of your medical
privacy. Joy.

Comfortable? I am VERY uncomfortable with this. This appears to be a
very invasive action by the federal government that, by the way, you
must have permission to sue.

— IV

# # # #

Links to: American Recovery and Reinvestment Act of 2009 text.

Page 252:

''(x) Any other technology that the HIT Policy Committee finds to be
among the technologies with the greatest potential to improve the
quality and efficiency of health care."

Hmmm, how is that going to work?

Next, check out Page 253 on what the Policy Committee is composed of.
I will describe it only in one word: vast.

— IV

# # # #

Links to: American Recovery and Reinvestment Act of 2009 text.

I will close with apologies to Arthur C. Clark when I say:

I for one welcome our multi-billion dollar spending, bureaucratic,
vast policy committee, cartel favoring, certification-wielding
overlords.

— IV

# # # #

Links to: American Recovery and Reinvestment Act of 2009 text.

That is: Original Link:
http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h1as2.txt.pdf

# # # #

Links to: American Recovery and Reinvestment Act of 2009 text.

Others have pointed out that the certification is now no longer CCHIT
that it is in flux with NIST and somewhat unclear if that will be son
of CCHIT or what? The Free Medical Software Foundation (501c3 pending)
director Fred Trotter has discussed with me the possibility of it
having its own certification for F/OSS systems.

A Canadian friend has said: "…we are setting up some group therapy
clinics for American socialism-dodgers in Niagara Falls…probably one
of the casinos… we will accept American dollars and any rounding
errors from your multi-billion dollar socialist makeover." I replied
that I'm in as long as it uses standards-based slot machines that pay
double whenever government committee meetings run overtime.

— IV

# # # #

How is the US Experience Going to be Different than the UK?

A little food for thought on how the British are doing with their
multi-billion effort:

http://www.computerweekly.com/Articles/2009/01/27/234448/public-accounts-committee-criticises-npfit.htm