That prompted a sharp rebuttal from Klepper. "Nobody here has impugned anyone personally. Mark, you are unfortunately inconsequential in that part of the discussion," he told Leavitt. "What matters is there is $19 billion of federal money on the table and that the eligibility criteria will be used in some way to steer that money."
Klepper said CCHIT has "dragged its feet" in several critical areas of HIT development, especially in the push toward interoperability. He said most HIT systems are at a "Level 1, text-reading stage within CCHIT. We could be doing so much more." "Interoperability, which we have heard echoed over and over, does not exist out in the marketplace," he said. "It's a priority for everything, for coordination of care, data aggregation, pricing, performance transparency, for comparative effectiveness research, decision support, patient engagement. All these issues depend critically on the ability of one system to be able to talk seamlessly with another. Those standards have not yet been developed adequately so they are in the marketplace in a significant way. That is holding our entire system hostage."
He added that Google, Microsoft, and New York Presbyterian and Beth Israel hospitals are ignoring CCHIT and swapping data on their own. "When the market begins to ignore what you are doing because what you are doing isn't keeping up, that means you are not current," he said.
CCHIT is focusing "on features and functions," rather than on standards, security, and the rapid distribution and usability of technology at a lower cost, he said.
"We have very high cost for entry, and as a result of that, a very small minority of physician practices have health IT deployed," Klepper said. "Another very large percentage of physician practices that do have it deployed have turned off many of the features and functions. If anything speaks to meaningful use, if somebody turns something off, that says that it's not."
He said CCHIT is looking backward at "very narrow conceptions of what HIT ought to be" and ignoring Web-based technologies for moving data and providing analytics. "It's cementing in old technologies and setting us back a generation," Klepper says.