Scrutiny from mainstream media and volleys of reaction in the blogosphere last month aimed a new kind of spotlight at health IT. Many, especially those involved on the consumer side of the issue, welcome the light, but they also warn against being blinded by it.
The Washington Post published two stories in May examining the health IT industry's role in formulating the HITECH Act and other parts of the American Recovery and Reinvestment Act that direct billions of federal dollars toward health IT. The stories also examine various links between interests and personnel among industry groups, the Obama administration and Congress.
Motives Beyond Money
The first story detailed how the Healthcare Information and Management Systems Society "worked closely with technology vendors, researchers and other allies in a sophisticated, decade-long campaign to shape public opinion and win over Washington's political machinery."
Consumer advocates don't argue with that premise, but they do argue with the implication that the only motive was money.
"The vendor community -- all [health IT] companies and the various organizations they've created -- has played the largest role in [health] IT policy over the past five to six years, so yes, the industry has had the dominant role in driving [health] IT," Steven Findlay, senior health policy analyst for Consumers Union, said.
"I don't quibble with the premise of the Washington Post article -- that HIMSS helped push in the halls of Congress and the White House the notion that a lot of money would help spark much more rapid adoption," Findlay said, adding, "I agree with them -- that more money was needed. Surely more money than the Bush policies provided."
In fact, Findlay and other consumer advocates point out that former President George W. Bush's administration's reliance on the private sector to lead the way helped create the situation that gave HIMSS so much influence. That understanding helps put the spotlight in perspective, consumer advocates said.
Findlay -- a member of HHS' new Health IT Standards Committee and a member of the National eHealth Collaborative's board of directors -- finds fault with the tenor of the coverage and the implication that HIMSS was motivated solely by money.
"To imply that this is all self-serving, that their only aim was to be an industry trade group and get more money for themselves, I don't accept that premise," Findlay said.
He added, "I think money is obviously a part of it -- that's undeniable, but I don't think the reason these folks advocated for more federal funds was just to line their pockets. I think it was because they believe, as we do at Consumers Union, that the use of [health IT] will improve health care in this country."
'When Federal Money's On The Table …'
Deven McGraw -- director of the Health Privacy Project at the Center for Democracy & Technology and a member of HHS' new Health IT Policy Committee -- said that it's important to appreciate how and where influence is applied but that the public interest should remain at the forefront.
"The fact that somebody's going to get paid for working out all the issues that have to be worked out should come as no surprise to anyone," McGraw said, adding, "While it's important for everyone to understand and appreciate that, it's even more important to make sure it's still the public interest that drives this."
McGraw said, "Somebody always wins when federal money [is] put on the table and that's certainly going to be the case in this situation, but we have to make sure the public also wins."
Findlay agreed, adding that the Post stories -- and the controversy they stirred up in health IT blogs -- should send a cautionary message.
"This is a reminder that the new administration and new leadership at [the Office of the National Coordinator for Health IT] need to tread carefully as they transition to a new way of doing things," Findlay said.
Certification Stirs Debate
A second Post story examined HIMSS' push for HHS to make the Certification Commission for Healthcare IT the government's official certification body mandated under the federal stimulus package, as well as the relationship between HIMSS and CCHIT.
In the story, critics claim that CCHIT's close ties to HIMSS and health IT vendors make it ill-equipped to judge health IT software. While CCHIT is funded through a contract with HHS, its chair -- Mark Leavitt -- is a former HIMSS executive, while one of its trustees is the president of the trade group and several board members work for technology vendors.
David Kibbe, a physician and senior adviser to the American Academy of Family Physicians, told the Post, "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." He added, "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."
The story sparked an angry blog response from Leavitt. In a post on the Health Care Blog, Leavitt wrote, "There have been valid observations that CCHIT's approach needs to change in this new world, and I wholeheartedly agree. But 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."
Critics also have contended that CCHIT favors large proprietary vendors at the expense of smaller companies and open-source software.
So far, CCHIT is the only organization with the government's seal of approval for certifying electronic health record systems. That may change soon. New leadership at HHS and ONC is examining certification options.
"CCHIT's future is certainly on the table, but I don't think anybody really believes CCHIT will be cut out entirely," Findlay said. He added, "There may be some directives to reorganize if they go for efficiency's sake and elect to retain CCHIT as the only certifying body. For practicality's sake, there aren't a lot of other entities out there who could do it."
More Consumer Voices Needed
The controversy over HIMSS' influence and the certification dilemma point to a need for more consumer voices in policymaking positions, Findlay said.
"There ought to be more groups representing patients and consumers," Findlay said. "There ought to be more representation of groups other than the industry. Basically, we need a lot of other voices at the table and maybe this kind of media exposure will help that happen," Findlay said.