David Kibbe & Mark Leavitt : Openness vs. Opacity

Background information:

  • The Certification Commission for Healthcare Information Technology (CCHIT) is currently in a monopolistic situation since it is, for the last few years, the only entity allowed to certify EHRs.
  • The HITECH act of ARRA mentions specifically the requirement to use “certified” EHRs to be able to collect federal money to implement EHR at both doctor offices and hospitals. The next few months Dr. David Blumenthal will have to decide who will be entitled to do these certifications (Dr. Blumenthal is the National Coordinator for Health Information Technology. In his role he is charged with the implementation of HITECH). With at least $20 Bn. at stake, CCHIT will have enormous powers, if it remains a monopoly.
  • Questions have been raised over time about the connection between CCHIT and HIMSS, the Health IT professional society, a vendor-sponsored organization.

This week the Healthcare Blog got on fire, thanks to an angry, vitriolic drive-by post from Dr. Mark Leavitt, former Secretary of the DHHS (innacurate) and current chair of CCHIT:

… I’m stunned by the level of dishonesty a few have stooped to in a desperate attempt to toss aside years of work by hundreds of public-spirited contributors.  Perhaps they want to bypass the challenge of supplying robust electronic health records and re-educating clinicians to use them meaningfully in transforming care, and just get unfettered access to some stimulus dough.

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.

David Kibbe, MD, an highly respected expert in EHRs and active supporter of patient-centered medicine responded:

“To clarify what I actually said, after a brief interview, quoted in the second of two articles in the Washington Post by Robert O’Harrow, Jr, a Pulitzer Prize finalist :

“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.”

Raising questions and concerns like these does not reach the level of “falsehoods and innuendo.”  In my opinion, it is entirely appropriate to ask tough questions about whose interests are being served when $36 Billion of tax payers’ money is involved, and the future of health IT in the U.S. will be the result of certification.”

I am not the only one with these concerns. Many other health care and health IT professionals have raised legitimate questions about CCHIT and its practices, its relationship with HIMSS, and yet to date these have not been resolved. A response that attacks me personally and labels me a liar is far from adequate, and so the questions will remain.

The stakes are too high to simply look the other way.

Dr. Leavitt, nowhere to be found after shooting his arrow, has generated 58 comments, many asking where he disappeared after attacking an highly respected expert in EHR implementation.  Dr. Kibbe’s post has generated 30 posts, 10 of which are responses from David himself.

In other words, as expected, David Kibbe, one of the doctors most actively championing Participatory Medicine (although I think he doesn’t go far enough) has demonstrated once again the value of transparency, openness and conversation, while the defender of the monopolistic & paternalistic way of thinking could only respond to public questions with vitriol. Since both these individuals do represent the decision makers and opposite visions of governance, I’ll let you decide which governance method will offer better chances to succeed in reforming the incredibly opaque healthcare system.


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18 Responses to “David Kibbe & Mark Leavitt : Openness vs. Opacity”

  1. New post: David Kibbe & Mark Leavitt : Openness vs. Opacity http://bit.ly/6pmxt

  2. RT @gfry: New post: David Kibbe & Mark Leavitt : Openness vs. Opacity http://bit.ly/6pmxt

  3. […] Article Gilles Frydman, e-patients.net, 30 May 2009 SHARETHIS.addEntry({ title: “David Kibbe & Mark Leavitt : Openness vs. Opacity”, url: “http://articles.icmcc.org/2009/05/31/david-kibbe-mark-leavitt-openness-vs-opacity/” }); […]

  4. I had to write this post: David Kibbe & Mark Leavitt : Openness vs. Opacity http://bit.ly/6pmxt

  5. Sarah Greene says:

    Appreciate the backgrounder on this. Some of us patients and patients-to-be are not up to speed on what all these acronyms mean and the implications for future implementation. An important take-home, I think, is that to engage the unengaged, we must be providing explainers every step of the way in the current health care debate. Educational content demonstrating real-life consequences is absolutely necessary to bring participatory medicine to its rightful place at the of top every patient’s agenda.

  6. Reed D. Gelzer, MD, MPH, CHCC says:

    An interesting exchange indeed.

    Please note, this statement is inaccurate. “Dr. Mark Leavitt, former Secretary of the DHHS and current chair of CCHIT”.

    The former Secretary of DHHS was Mike Leavitt, not Mark Leavitt. Dr. Mark Leavitt, before becoming CCHIT chairman, headed HIT organization Healthcare Information Management and Systems Society (HIMSS) and, before that, founded Logician, the EMR that was purchased by GE and is now marketed as Centricity.

  7. Dr. Gelzer,

    Shame on me! I knew it and completely forgot to remove the error, which I’ll do now!

    Michael Levitt, ex Secretary of the DHHS, just published an opinion piece in the Washington Times that is so violently against the current administration that he would have immediately lost his ability to function in a public/private entity like CCHIT.

  8. […] Of course the bigger issue is the play by a NJ state assemblyman who is trying to create a monopoly for an organization that has a very serious image problem (see my previous post). […]

  9. […] to the Healthcare Blog.  The feud broke out while I was in China. The folks at e-Patients Net have a good rundown of the feud, and the issues involved. posted by Dana Blankenhorn June 18, 2009 @ 8:14 […]

  10. […] There is some evidence the industry is feeling some heat. CCHIT chair Mark Leavitt (above) took out after reformer David Kibbe by name last month, on a blog Kibbe contributes to, claiming he demeaned the integrity of “everyone who has contributed” to CCHIT’s work. Other bloggers got out the popcorn. […]

  11. […] [almost met IRL at the Health 2.0 conference in Boston a month or so ago] framing of the debate at e-patients.net and John Moore’s [IRL] take at Chilmark […]

  12. […] their approach right, or was it too rigid? Was it really helping buyers, or just pointing them toward expensive solutions from members of the HIMSS industry […]

  13. […] has been a long, strange trip for CCHIT, with harsh words exchanged. But the destination has at last been […]

  14. Chris says:

    The new NIST Standards org is calling all the shots and
    The whole health IT standards mission has now been
    Grossly distorted and only John Halamka to keep us all up to date.

    Chris Bickford MD

    • Hi, Chris – sorry, I’m lost – what on earth are you talking about?

      • Chris Bickford says:

        e-Patient Dave,

        Before ARRA things at CCHIT had been moving along
        and the ccr vs cda debate was resolving to a CCD
        version of ccr that was cda compliant(all exotic
        xml stuff). Now that Mark is retired, Drummond is an alternative to CCHIT for certifying and
        Meaningful use is only partially based on Cert.
        The other part requires the eval of ONCHIT and
        nist deciding whether the individual hospital
        or eligible professional is doing the necessary
        15 to 20 items to qualify.
        But neither David Kibbe or Steve Waldren or
        Mark Leavitt or Carolyn Clancy are making any
        daily remarks about how things are going.
        The Hospital systems get more confusing the
        interfaces needed for any kind of system seems
        to go up by the day and John Halamka’s blog seems
        to be one of the only ongoing updates on the
        relative state of the chaos.

        I thought that Epic users were at least getting
        a little interconnected, at least at Kaiser, but
        they are not even connected for N and S California.

        How are things from the patient perspective?>
        are you with MS healthvault or Google Healht
        or some other?

        Chris Bickford MD

        • Chris,

          When I was employed in a day job I tried getting into a PHR (my famous “data transfer gone wrong” adventure) as part of my healthcare hobby. What happened threw me for such a loop that I haven’t touched a PHR since: I’d imagined that the data was of COURSE in some well managed neatly organized repository, where great brains (like the best of NASA) could be running analytics, automatically routing information where it needed to be, etc.

          Ha! :–) The reality was so different that I stopped dead in my tracks through 2009. My September keynote at Medicine 2.0, “Gimme My Damn Data,” was originally subtitled “…because you can’t be trusted with it.” But I removed that before publication. :–)

          In 2010 during my business startup, I put zero priority on having a PHR – I needed to scramble intensely, no time to survey the landscape. I’d decided to advocate for patient engagement, and needed to find how to make a living, while finding people who are in a position to help change the world – meanwhile trying to get myself more firmly attached to reality. (That’s why I like talking to clinicians & street-level HIT geeks at conferences.)

          The “data transfer gone wrong” episode led to thinking about a slew of issues, including (as you know) that all that data at my hospital & doctor’s office is unstructured, so what am I gonna do with it once it’s in a system? Certainly not what I’d imagined.

          Lately I’ve been thinking it might be time to explore PHRs again. One thing’s certain: I’m only interested in systems and providers that let me manage the data, including taking it elsewhere. I want to be able to show it to any provider in any state or country anytime, and I don’t want to work with any provider who wants to block that.

          It’s super-juicy ironic that during the meaningful use talks so many providers wanted to block patient access because “patients can’t handle it” when there’s abundant evidence that much of the data is either mismanaged (as in the *providers* really can’t handle it responsibly) or is not heeded as we’d expect – the many many cases of medication errors, missed allergies, orders that are never fulfilled, and so much more. And that’s a workflow and business process issue.

          It became obvious that a lot more needs transforming than just access to our data. BUT, having said that, access can be a huge first step, because while clinicians have hundreds of pressures and priorities every day, patients & families are pretty well focused on the output of all that – what happens at the point of care, dribbling out the end of the process pipeline. Whether the data is in error or the care processes, the patient stands to suffer, and informed engaged patients & families are literally in a position to catch errors.

          It’s hard to believe we’re commenting on a post that’s 20 months old. I love a post that has staying power.

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