Hi Tim, You and I both know no commercial providers will publish their source code - so I am sorry your plan does not seem realistic to me.
The CCHIT is functioning as a "trusted" intermediary and as such the fact that so many vendors have agreed to certification seems to be doing an reasonable job. I have reviewed the functionality plans and scripts and they seem pretty reasonable to me - covering most of the bases and having an improving evolutionary path (i.e. continuous improvment). Not perfect but way better than nothing in an imperfect world. The 2006 certification criteria and scripts can all be reviewed - for free - at: http://www.cchit.org/vendors/learn/CCHIT+Ambulatory+EHR+Certification+for+2006.htm At least they are being pretty open about the goals etc. I see the CCHIT as a pretty cheap, well thought out, and practical approach to improvement of the software available to the health sector and would like something similarly practical to be done in Australia - tailored to our market etc. We obviously agree on the need - I am just keen to see a path that will work practically to get us there and Government or a surrogate to get on with it! Cheers David ---- Dr David G More MB, PhD, FACHI Phone +61-2-9438-2851 Fax +61-2-9906-7038 Skype Username : davidgmore E-mail: [EMAIL PROTECTED] HealthIT Blog - www.aushealthit.blogspot.com On Sun, 25 Feb 2007 10:37:26 +1100, Tim Churches wrote: > David More wrote: >> Hi Tim, >> >> 3 points: >> >> 1.. The fees go to allow certification to continue - not anywhere else - are certification bodies not allowed to recover their costs? >> > > Yes, but only the absolute minimum of costs i.e. they need to do their > business in the most efficient way, with minimal overheads. And thus no > modern offices, no hierarchy of staff, just a Web site and some email > accounts in a small back office hosted by an existing organisation. That > will do. And rely on modern, automated testing methods - see below. > >> Is Standards Australia meant to do it all for >> free? (They a'int! and we are all being ripped off as best I can tell) >> > No argument there. > >> Frankly you need to >> recognize this is the way our Government and the US seem to insist things >> are organised these days... >> > > The recognition that Bush and Howard want to screw up the world doesn't > make it right, or that we should just roll over and acquiesce. If > something is wrong or stupid, we have a duty to say so. > >> my preference would have been for a totally government funded body to do all this...but..when was the last time any government entity did this sort of >> stuff for free (think TGA and its fees etc) >> > > And NGO or QUANGO is fine for accreditation, but an efficient, lean and > mean one, which leverages modern technology and the power of the network > to achieve its ends (which are to ensure software quality, not to build > its own little empire). > >> 2. This, very inexpensive effort in national US terms, is so far ahead of >> what is happening here (in OZ) is it grumpifying as far as I am concerned. >> > > Yes but they spend $450 billion each year on the military in the US, and > everything else there looks cheap by comparison. > >> 3. Note - At least one open-source solution is going for it..sorry it has to >> pay but that is the world a majority of us (under Howard and Bush) voted for - >> so what can I do.? I sure didn't vote for it! >> >> The CCHIT is happening, its working and there is 'stuff all' happening in OZ >> along the same - very important - lines. Ostrich all you like - this is >> fundamentally good stuff CCHIT are doing and it is being done on the 'smell >> or an oily rag' in a relative sense. >> > > I am told that the US govt happily pays Haliburton and other contractors > $5000 each for oily rags to be delivered to Iraq to help with the > reconstruction. > >> Seems you want to have poor quality non-interoperable GP software to go on >> forever in OZ - or have I got it wrong and you really would like some decent >> quality control etc? >> > > No, I am absolutely in favour of formal quality assurance programmes > and/or accreditation for health-related software - more the former than > the latter but they start to merge if done correctly - iff (if and only > if) the process is both effort and financially efficient and completely > transparent. > > Here is how you achieve that: > > a) establish a *small* unit to develop the accreditation standards in a > consultative and transparent fashion, using email and the Internet > (wikis etc), and not endless secretive meetings in capital cities with > people who don't really have much of a clue, or who have a barrow to > push (or both). Allow one year to develop Version 1.0 accreditation > standards. > > b) Design the accreditation standards/tests to be automatable wherever > possible - and this is most places - so the software vendors/producers > can write automated, scripted tests to demonstrate the conformance of > new versions of their code with minimal re-testing overhead. In places > where automation is not possible, then "screencast" movies, made by the > vendor, of the software performing some specified set of actions or > tasks or demonstrating a required feature should be able to be > submitted. software to record screencasts (eg Camtasia) only costs a few > hundred dollars. Any cheating by the vendor in such screencasts will be > obvious, because end users can replicate the steps shown in the > screencast themselves and call teh vendor's bluff. > > c) All automated test scripts, other test code, test data, the test > results and screencasts etc must all be submitted to the accreditation > body, which runs the tests, views the screencasts, checks the > documentation and then publishes the lot on their Web site for public > scrutiny. This allows end users, public interest groups, competitors,, > busy-bodies and do-gooders to independently verify that the tests are > correct and legitimate and that no cheating has occurred. There is a > formal complaints process by which the accreditation body can be asked > to investigate evidence of cheating or anomalies or mistakes given some > prima facie evidence that such has occurred. > > Given the modest size of the Australian health software market, all of > the above should only require a handful of staff to run. It leverages > the power which the Internet brings to consumer groups and end users to > help the accreditation body do its work. > > Of course, software vendors may object to having their testing source > code published on the Internet, but to such an objection the answer has > to be that only test source code is required to be published - there is > *no* requirement to publish the source code of the actual software. If > they object that even such test code may reveal trade secrets, then the > response has to be that we are talking about health and medical software > here, malfunctions of which can have serious impacts on patient's lives, > and thus the public interest must override any commercial concerns over > possible exposure of trade secrets, so tough! > > That's the way to do medical software accreditation. > > Tim C > >> On Sat, 24 Feb 2007 20:32:16 +1100, Tim Churches wrote: >>> David More wrote: >>>> Hi Oliver, >>>> >>>> They are about 2 years into the program. >>>> >>>> They are also about 1 year into certifying hospital systems. >>>> >>>> Now that they have 40+ systems certified (at $US28,000 per time) >>>> >>> There has been much discussion of these fees on the international open >>> health list - fees of such magnitude effectively exclude open source and community- >>> based >>> >> solutions. Not only that, they want the US$28k for every new version >>> to be re-tested. So, if a vendor puts out a minor point release, ka-ching >>> (sound of cash >>> >> register), another $28k please. And their justification is that it >>> takes person-time to re-do the tests. Seems they've never heard of an >>> automated test - >>> >> write the tests once, re-run at the push of a button, which is how all >>> software should be tested as it is built these days. Thus, CCHIT is a farce >>> in practice >>> >> (Horst can supply some suitably colourful epithets here). A bit like >>> accreditation of general practices here in Oz, perhaps? >>> >>> Tim C >>> >>>> On Sat, 24 Feb 2007 17:10:27 +1030, Oliver Frank wrote: >>>>> David More wrote: >>>>>> Hi Oliver, >>>>>> >>>>>> If you want to know how it can be done properly for ambulatory care >>>>>> (i.e. GP and >>>>>> >>>> specialists) I suggest you browse www.cchit.org. They have it sorted for >>>> >>>>>> the US and it is pretty impressive how they plan to move forward I >>>>>> reckon. >>>>>> >>>>>> Pity GP systems is not a focus for NEHTA so this could be replicated >>>>>> here. Imagine if >>>>>> >>>> there was a decent standard for functionality and interoperability >>>>>> that Australian providers had to meet. They might not be all that >>>>>> supportive of such >>>>>> >> a >>>> sensible move I fear as it might cost a few $$ and so on. >>>>> http://www.cchit.org/physicians/overview.htm >>>>> >>>>> tells us: >>>>> >>>>> "CCHIT is the recognized certification authority in the United States for >>>>> EHR products >>>>> >> - >>>> an independent, private-sector organization that sets the Gold >>>>> Standard for EHRs." >>>>> >>>>> I hope that I never hear that overworked expression 'gold standard' used >>>>> again, >>>>> >> because >>>> its orginal meaning is no longer known by most people. >>>>> Their PDF: "Physician's Guide: CCHIT Certification for Ambulatory >>>>> Electronic Health >>>>> >>>> Records 2006" >>>>> tells us: >>>>> >>>>> "CCHIT was founded by the American Health >>>>> Information Management Association, >>>>> the Healthcare Information and Management >>>>> Systems Society and the National Alliance >>>>> for Health Information Technology. >>>>> The U.S. Department of Health and Human >>>>> Services (HHS) awarded CCHIT a three-year >>>>> contract to develop and test certification >>>>> criteria and manage an inspection process >>>>> for certifying EHRs. At the end of the >>>>> contract, CCHIT will transition to a selfsustaining >>>>> certification agency." >>>>> >>>>> So they have three years of federal government money to kick start the >>>>> process, then >>>>> >> it >>>> has to become self-funding. David, do you know when their three >>>>> years of government funding will be up? >>>>> >>>>> "CCHIT works in collaboration with the >>>>> American Health Information Community, >>>>> the Department of Commerce's National >>>>> Institute of Standard and Technology, and >>>>> with several other organizations awarded >>>>> HHS contracts to harmonize standards, >>>>> develop prototypes for a national health >>>>> information network architecture, and assess >>>>> privacy and security laws and practices. >>>>> The work of CCHIT has been endorsed by a >>>>> number of physician professional organizations, >>>>> including: >>>>> - The American Academy of Family Physicians" >>>>> >>>>> OK, so their equivalent of the RACGP is supporting it. Good. >>>>> >>>>> Let's also go for three years of government funding for an organisation >>>>> indepenedent >>>>> >> of >>>> government, run by the profession and software industry jointly. >>>>> Maybe we can save some time and money by using or adapting some of the >>>>> standards that >>>>> >>>> CCHIT has developed for GP computer systems in the US, keeping in mind >>>> >>>>> the very different way that medical practice is organised and funded >>>>> there. >>>>> >>>> ------------------------------------------------------------------------ >>>> >>>> _______________________________________________ >>>> Gpcg_talk mailing list >>>> [email protected] >>>> http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk >>>> >>> _______________________________________________ >>> Gpcg_talk mailing list >>> [email protected] >>> http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk >>> >>> __________ NOD32 2078 (20070223) Information __________ >>> >>> This message was checked by NOD32 antivirus system. >>> http://www.eset.com > > > __________ NOD32 2079 (20070224) Information __________ > > This message was checked by NOD32 antivirus system. > http://www.eset.com
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