VistA/Open Source Advocacy and eHealth Policy

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Ben Mehling

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Jan 16, 2009, 12:37:07 PM1/16/09
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During the recent VistA Community meeting, a panel discussion on "The
Open Source Community - Advocacy, Marketing and Open Source". It was
hosted by Matt King, Medical Director, Clinica Adelante and Chair,
WorldVistA Board od Directors, Edmund Billings, Chief Medical Officer,
Medsphere, and Roger Maduro, Publisher, VistA News. The topic was
focused on how diffuse groups can come together on selected issues to
benefit the entire community, Nash Economics and Open Source, Open
Source Community and the Customer Supply Chain. Prospects, marketing
and selling in the Healthcare Open Source Environment.

During the discussion, a newly formed coalition of community members
and vendors was discussed. This group, the Open eHealth
Collaborative, is drafting language that is being used in DC for
upcoming legislation so it is an excellent opportunity to voice your
opinion.

I've posted information on this Open eHealth Collaborative group here:
http://tinyurl.com/8ec55s

Thanks, Ben

Richard Schilling

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Jan 28, 2009, 3:49:13 PM1/28/09
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Greetings everyone. This is a topic which, as many of you know, is
currently being hashed around in Washington DC. During the past
several months, our collective involvement in open source health IT
issues at the federal level has quickly (and finally) demanded that we
become more involved with the new congress' and presidential
administration's efforts to provide viable IT solutions for health
care by drafting specific pieces of legislation.

H.R. 1 (American Recovery and Reinvestment Act of 2009) is currently
in the process of being marked up so it can be passed, and I have
begun to engage a lobbyist in DC to advocate for the position of not
just open source itself, but open standards transparency and market
fairness. I would like to invite you all to the party so to speak, to
work with me on the lobbying effort.

H.R. 1 is "where the action is at", and yes, quite a bit of our
feedback has been listened to on capital hill. But, there are still a
lot of fine details that are being glossed over. For example, there's
nothing in the current proposed bill that mandates that the standards
and software created or purchased by the government be released into
the public domain. And, the certification requirements that software
will have to go through remain too vague, and IMHO, endanger the
efforts of open source. And, then there's the question of how much
the NIST will charge for certification. In short, I believe these
details could block out the adoption of open source solutions.

And finally, the AHIC successor is a private company, with huge
membership fees that make the efforts of influencing health IT policy
and open source standards a "pay for play" proposition.

I want to take our great ideas to the congress in the form of a well
coordinated lobbying effort that can reach both parties. I have the
lobbyist. I just need the people to support the effort and provide
their ideas.

Thoughts? Interest?

Cheers,

Richard Schilling

JohnLeo Zimmer

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Jan 28, 2009, 4:31:07 PM1/28/09
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Cheers, Richard,
Where do you hail from?
You should meet BikerDude.

johnleo

Richard Schilling

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Jan 28, 2009, 4:36:27 PM1/28/09
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I'm in Seattle.

I know a few biker dudes, but not sure if I know this particular one. :-)

Richard

Nancy Anthracite

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Jan 28, 2009, 6:12:59 PM1/28/09
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"And, then there's the question of how much
the NIST will charge for certification."

Which certification is NIST charging for? Or did you perhaps mean CCHIT?
--
Nancy Anthracite

Nancy Anthracite

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Jan 28, 2009, 6:34:54 PM1/28/09
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Have you got a URL for the current iteration of this Act?

On Wednesday 28 January 2009, Richard Schilling wrote:
--
Nancy Anthracite

Richard Schilling

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Jan 28, 2009, 7:48:18 PM1/28/09
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From what I read in the stimulus act (which just got passed today), the
NIST is the agency that will be engaged for certification and
standardization. I didn't see any mention of CCHIT.
I don't know what that means for CCHIT.

Richard

Richard Schilling

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Jan 28, 2009, 7:50:55 PM1/28/09
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CSpan coverage: http://www.cspan.org/Watch/watch.aspx?MediaId=HP-R-14830
the text of the act: http://www.rules.house.gov/111/LegText/111_hr1_text.pdf

There's a couple billion in it for health care IT.

Richard Schilling

Nancy Anthracite

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Jan 28, 2009, 8:24:42 PM1/28/09
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CCHIT certifies electronic health records.
--
Nancy Anthracite

JohnLeo Zimmer

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Jan 28, 2009, 8:50:06 PM1/28/09
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This thing is 647 pages long.
of interest:

to IHS:
For an additional amount for ‘‘Indian Health Facili-
ties’’, $550,000,000, for priority health care facilities
construction projects and deferred maintenance, and the
purchase of equipment and related services, including but not
limited to health information technology.

NIH ~1.5 billion for buildings, another 1.5 for research, 500M for renovation on
the NIH Bethesda, MD campus.

AND for NCHIT:
to the Office of the National Coordinator for Health Information Technology’’
to carry out section 9202 of this Act, $2,000,000,000

alesha

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Jan 28, 2009, 9:12:22 PM1/28/09
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There have been rumbling, for at least a year that I'm aware, that NIST should be and has been asking to take over the certification activities. They are, after all, the National Institute of *Standards* and Technology.

.a

JohnLeo Zimmer

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Jan 28, 2009, 9:37:24 PM1/28/09
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alesha wrote: <<<and, apparently she knows whereof she speaks>>>

> There have been rumbling, for at least a year that I'm aware, that NIST
> should be and has been asking to take over the certification activities.
> They are, after all, the National Institute of *Standards* and Technology.

"The Secretary of Health and Human Services shall invest in the infrastructure
necessary to allow for and promote the electronic exchange and use of health
information for each individual in the United States consistent with the goals
outlined in the Strategic Plan developed by the Office of the National
Coordinator for Health Information Technology." p155

... (b) LIMITATION.—None of the funds appropriated to carry out this section may
be used to make significant investments in, or provide significant funds for,
the acquistion of hardware or software or for the use of an electronic health or
medical record, or significant components thereof, unless such investments or
funds are for certified products that would permit the full and accurate
electronic exchange and use of health information in a medical record, including
standards for security, privacy, and quality improvement functions adopted by
the Office of the National Coordinator for Health Information Technology.


jlz

Gregory Woodhouse

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Jan 28, 2009, 10:00:42 PM1/28/09
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On Jan 28, 2009, at 6:12 PM, alesha wrote:

> There have been rumbling, for at least a year that I'm aware, that
> NIST should be and has been asking to take over the certification
> activities. They are, after all, the National Institute of
> *Standards* and Technology.
>
> .a


Interesting.

Nancy Anthracite

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Jan 28, 2009, 10:05:01 PM1/28/09
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There is some development language in there, too, that might give us some
grants to apply for. Look beginning about page 440.
--
Nancy Anthracite

Nancy Anthracite

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Jan 28, 2009, 10:29:39 PM1/28/09
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Page 397 starts the section that might help.

ival...@gmail.com

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Jan 28, 2009, 10:30:42 PM1/28/09
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Are they INSANE? $2 billion for an agency that doesn't actually do
anything and with NO specific plan? Biggest boondoggle on the planet!
Hey politicians! just send $1 billion to WorldVistA for a permanent
endowment. Problem solved. -- IV

Richard Schilling

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Jan 29, 2009, 1:42:19 AM1/29/09
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From what I read, NIST has been allocated money to deal with
certification and standardization of health care IT. CCHIT is not an
organization I see mentioned. But this situation raises the importance
of a lobbyist working within congressional offices and sitting in
meetings presenting our collective views.

Yes ... it's hard to know exactly what's going on.

I've mentioned this before, but I'll mention it again because it's
another example. The AHIC replacement is now a private company that
charges $1,000 minimum as membership. And that's *if* your application
is accepted.

More questions than answers right now.

Richard

JohnLeo Zimmer

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Jan 29, 2009, 8:16:45 AM1/29/09
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Of course CCHIT was set up by NCHIT:
http://www.hhs.gov/healthit/certification/cchit/

ival...@gmail.com

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Jan 29, 2009, 10:34:32 AM1/29/09
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Cartel here we come. -- IV

On Jan 29, 12:42 am, Richard Schilling <rschill...@cognitiongroup.biz>
wrote:

Richard Schilling

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Jan 29, 2009, 1:14:46 PM1/29/09
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Well, it's more like HHS contracted with CCHIT to provide certification
services. And, by extension, HHS is supporting a certification scheme
that *can cost in excess of $70,000*.

How do people FEEL about that in the first place?!? In one foul swoop,
HHS made it impossible for the small but viable software product to be
accepted by HHS. And, now, if we read the text of the stimulus act, we
see that it's ILLEGAL for HHS to make use of non-certified products. Is
it CCHIT that "certified products" refer to? More questions than answers.

I'm sure AHIMS, HIMMS and the Alliance are FINE with the arrangement.
But that makes my point. Those three organizations had a voice down at
HHS. I can certainly have seen this community doing something similar
at the time and having a similar arrangement with HHS. We just didn't
have a voice.

What about going forward? The contract with CCHIT will eventually end.
When is that up for re-negotiation? Can we get HHS to re-negotiate?
Can we get HHS to contract with an additional organization that we
sponsor for certification?

These are all things that can be talked about in direct discussion with
HHS if we can put pressure in the right places.

This is why I'm collecting support for a lobbyist on a long term basis.
Even a very small contribution by a lot of people will gather enough
financial support to hire who we need to hire. From here on out,
whenever HHS makes a decision like this I want someone whomever he
assigns to have a discussion about things before they get finalized.

We'll get there. We'll have a voice.

Richard
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