A civil penalty or civil fine is a term used to describe when a state entity or a governmental agency seeks monetary relief against an individual as restitution for wrongdoing by the individual.
I previously wrote about CCHIT in a series of linked posts that start here: A very troubling post about the CCHIT (Certification Commission for Healthcare Information Technology).
I have now written the following open letter to Mark Leavitt, MD, PhD, Chairman, Certification Commission for Healthcare Information Technology.
To: "Mark Leavitt"
Date: Sunday, June 07, 2009 02:10PM
Cc: Robert O'Harrow, Jr., Washington Post, and various AMIA working group mailing lists (CIS - clinical info systems, POI - people & organizational issues, OS - Open Source, and ELSI - Ethics, Legal & Social Issues)
June 7, 2009
Mark Leavitt, MD, PhD
Chairman, Certification Commission for Healthcare Information Technology
[6/8/09 - contact info from www.markleavitt.com removed per critique in response below -ed.]Re: NJ HIT Bill at http://www.njleg.state.nj.us/2008/Bills/A4000/3934_I1.HTM by Assemblyman Harb Conaway, Jr., District 7, and Upendra Chivukula, District 17
The NJ Bill at http://www.njleg.state.nj.us/2008/Bills/A4000/3934_I1.HTM by Assemblyman Harb Conaway, Jr., District 7, and Upendra Chivukula, District 17, calls for making it a violation of law to sell HIT not "certified" by CCHIT . Penalties are called for. The bill states:... No person or entity, either directly or indirectly, shall sell, offer for sale, give, furnish, or otherwise distribute to any person or entity in this State a health information technology product that has not been certified by the Certification Commission for Healthcare Information Technology.
As used in this section, "health information technology product" means a system, program, application, or other product that is based upon technology which is used to electronically collect, store, retrieve, and transfer clinical, administrative, and financial health information.
b. A person or entity that violates the provisions of subsection a. of this section shall be liable to a civil penalty of not less than $1,000 for the first violation, not less than $2,500 for the second violation, and $5,000 for the third and each subsequent violation, to be collected pursuant to the "Penalty Enforcement Law of 1999," P.L.1999, c.274 (C.2A:58-10 et seq.).
I and others find this bill remarkable. It really calls into focus the HIT community's concerns about CCHIT and its political connections, especially pursuant to the article " The Machinery Behind Healthcare Reform: How an Industry Lobby Scored a Swift, Unexpected Victory by Channeling Billions to Electronic Records " of May 16, 2009 in the Washington Post by Robert O'Harrow Jr.
I therefore seek answers to the following questions:
1. Do you approve of the proposals in the bill at http://www.njleg.state.nj.us/2008/Bills/A4000/3934_I1.HTM ?
2. Did you, or anyone in a governance or leadership position at CCHIT, play a role in sponsorhip of this bill, through financial contributions, lobbying, advocacy for its proposals, and/or other means to prohibit sale of non-CCHIT certified HIT?
3. Did anyone with governance or leadership roles in CCHIT's founding or affiliated organizations (e.g,, HIMSS, CITL, and others) or business associates of such people, play a role in the bill's sponsorhip, through financial contributions, lobbying, advocacy for its proposals, and/or other means to prohibit sale of non-CCHIT certified HIT?
4. Did anyone (person or company) in the HIT industry, broadly speaking, who could directly profit from such a bill becoming law play a role in sponsorhip of, or advocacy for this bill?
I believe candid and transparent answers to these questions are important in giving the HIT community confidence that CCHIT primarily serves the public interest, not interests of an HIT lobby.
Dr. Leavitt has candidly responded. I take his word on these issues at face value, having done business with him a bit over a decade ago (supporting the purchase of his company's EHR, Logician, for Christiana Care over the opposition of the IT department which preferred another vendor):
From: "Mark Leavitt"
Date: 06/08/2009 02:51AM
cc: email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com,firstname.lastname@example.org
Subject: RE: Bill to make illegal the sale or use of non-CCHIT "certified" systemsScot,Here are the answers to your questions:1. No, I do not approve of this legislation -- which I'm reading for the first time in your email. Our goal, stated in almost every presentation I've given, and to which I've adhered in my leadership of the Commission, has always been to unlock positive incentives for health IT adoption. The bill does not fit that model at all, and it is a bad idea.2. Neither I personally, nor CCHIT as an organization, have lobbied, advocated, sponsored, or had anything to do with that bill. We were unaware of it until it started showing up on listserves Friday. The bill has never been mentioned in any of our Trustee, Commission, or staff meetings.3. Trustees, Commissioners, and Work Group members serve in a volunteer capacity at CCHIT. We require disclosure of conflicts of interest, but we do not monitor all activities in their 'day jobs' or other volunteer roles. "HIMSS, CITL, etc" are not affiliated with CCHIT, and we don't know about all their advocacy activities. I'm not privy to the information you seek.4. This question presumes that I would know everything that "anyone in the HIT industry, broadly speaking" has done regarding the bill. Naturally I do not have that knowledge either.Now that I've responded, the AMIA listserve members can stop reading here, while I go on to chat with Scot.Scot, in 15 years of medical training and practice followed by 25 years of healthcare informatics, I've encountered very few people -- and certainly no university professors -- who acted so disrespectfully toward me. Being a veteran of health IT, it's easy to find people who have worked with me or know me well, and to ask them about my integrity. Or to talk to some of the other 50 or so Commissioners who've served or the hundreds of work group volunteers. Shouldn't an informatics scientist do a modicum of research before undertaking a potentially harmful procedure such as attacking a person's or organization's reputation? Reading a news article by Mr O'Harrow does not qualify as due diligence. Would you let your informatics students get away with that before recommending a major, potentially disruptive or destructive IT project?From your own blogging I see that your "early medical mentor, cardiothoracic surgery pioneer Victor P Satinsky, MD, believed in public embarrassment as a tool to fight bureaucracy and discrimination ." Well, that helps me understand. And your blogging about your frustration when you sought employment with a commercial EHR vendor http://hcrenewal.blogspot.com/2009/02/nextgen-and-vendordoctor-dialog-yet.html explains even more. Knowing that, I forgive you for your tone and for inappropriately disclosing my home address and cell phone to everyone on these lists. I would be pleased to engage in a civil, rational debate with you along the lines of "EHRs -- do the benefits outweigh the risks?" C'mon out to the farm here sometime -- you know the address, and the dog's friendly -- or we could do it on the web.Finally, my apologies to everyone on the mailing lists that Dr. Silverstein chose to include in his investigative journalism broadcast. If you object to his use of AMIA mailing lists for this kind of activity, you could let him know.Mark Leavitt, MD, PhD
My response was simple:
To: "Mark Leavitt"
Date: 06/08/2009 05:24PM
email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com,firstname.lastname@example.org
Subject: RE: Bill to make illegal the sale or use of non-CCHIT "certified" systems
I thank you for the answers to my questions.
> Knowing that, I forgive you for your tone and for inappropriately disclosing my home address and cell phone to everyone on these lists.
Mark, that information came from your page at http://www.markleavitt.com/ which I found on a google seach for "Mark Leavitt." Image attached. I believed that to be your professional contact info.
As to the rest of your response, you appear to attempt to discredit my arguments through ad hominem. I refer you to this page:
http://www.nizkor.org/features/fallacies/ad-hominem.htmlTranslated from Latin to English , "Ad Hominem" means "against the man " or "against the person."
An Ad Hominem is a general category of fallacies in which a claim or argument is rejected on the basis of some irrelevant fact about the author of or the person presenting the claim or argument. Typically, this fallacy involves two steps. First, an attack against the character of person making the claim , her circumstances, or her actions is made (or the character, circumstances, or actions of the person reporting the claim ). Second, this attack is taken to be evidence against the claim or argument the person in question is making (or presenting). This type of "argument" has the following form:
- Person A makes claim X.
- Person B makes an attack on person A.
- Therefore A's claim is false.
The reason why an Ad Hominem (of any kind) is a fallacy is that the character, circumstances, or actions of a person do not (in most cases) have a bearing on the truth or falsity of the claim being made (or the quality of the argument being made).
Ad hominem, sadly, is not debate.
Neither is appeal to authority .
Truth be told, I actually offered no arguments in my email message. I was asking very probing questions with concern they would be ignored, or responded to with "spin" as here, and their tone offended him. Fair enough.
I was a bit disappointed, however, by the "The lady doth protest too much, methinks" ad hominem embellishments to an otherwise candid and convincing response.
Such are the risks of directness and disruptive innovation, however.
Additional views on the NJ Bill are at ePatients.net at "David Kibbe & Mark Leavitt:Openness vs. Opacity" and "Dossia, Microsoft HealthVault & Google Health: Illegal in NJ?". There are some now-familiar themes regarding CCHIT civility in those posts.
As a result of a link sent by a commenter, I am adding the post "The Kibbe/Leavitt Rumble in the High Tech Jungle!" to the list of interesting views in the 6/9 addendum above.
This bill is so far out to pasture that, as you query, there must be a subterranean gold mine. What a story and how admirable of these two lawmakers....just two learned New Jersey Assemblymen wanting to have their state's HIT be "certified" by the HIT industry's trade group CCHIT. Hmmm (not HIMSS).
Will they also introduce a bill to only allow stores in New Jersey to sell cigarettes that were reported to be safe by The Tobacco Institute? Just wondering.
State Rep. Conaway speaks at (? $ for) HIMSS conferences. Is he invited and does he partake in the HIMSS parties, parties know to be of legend?
Leavitt claims that CCHIT is independent of HIMSS.
Yet, he refuses to address requests for transparency, but takes every opportunity to bully his critics and those making these simple requests of him.
It would behoove Dr. Leavitt to recognize that the issue is patient safety and not ego and money. But CCHIT does not concern itself about patient safety.
Great thread, Dr. Silverman! Dr. Leavitt, thank you for openly discussing CCHIT with all of us mere mortals. Now, some problems with what I've read:
>>> Neither I personally, nor CCHIT as an organization, have lobbied, advocated, sponsored, or had anything to do with that bill. We were unaware of it until it started showing up on listserves Friday. The bill has never been mentioned in any of our Trustee, Commission, or staff meetings.
Oh really? Have you read my investigative reporting that I did this past weekend on this issue, in particular on Representative Conaway that I posted at emrupdate ( http://www.emrupdate.com/forums/t/19877.aspx?PageIndex=1 )? Over the past 2 years HIMSS has wined and dined him, showering him with awards and even paying him money. Here are some facts:
-- In HIMSS 2008 The Honorable Herb Conaway, MD was presented with the HIMSS State Leadership Award.
-- In HIMSS 2009 he was also a major speaker on the "State Officials Legislative Forum"- http://www.prolibraries.com/himss/?select=new_speaker&speakerID=25947&conferenceID=7
-- On 2/2009 Conaway is featured in HIMSS HIELights webpage- http://www.himss.org/HIMSS_HIElights/HIMSSHIElights.asp?date=200902.
-- If you look at his NJ financial disclosure sheets he states that he has received money from HIMSS, from the "State Alliance for e-Health", from the "Healthcare Information Management Soc":
1) in 2008: http://www.njleg.state.nj.us/ethics/FinancialDisclosure/ConawayH2008.pdf
2) in 2007: http://www.njleg.state.nj.us/ethics/FinancialDisclosure/ConawayH2007.pdf
You should know this, unless you are trying to be "opaque" as Dr. Silverstein has mentioned.
>>> Reading a news article by Mr O'Harrow does not qualify as due diligence.
That article was well written and appeared in the Washington Post. It was powerful enough to get you to lash out to Dr. Kibbe later, no? (Check out my MDNG article here- "The Kibbe/Leavitt Rumble in the High Tech Jungle!", http://www.hcplive.com/mdnglive/The_HIT_Realist/05-2009 ).
CCHIT simply needs to be dissolved, and those politicians like Rep Conaway who write laws such as this should be strung up by their toes! Just my thoughts...
Dr. Borges, as you noted (and as in pharma and other aspects of healthcare that we cover on this blog), the conflicts of interest in HIT often appear complex and opaque.
My only conflicts of interest are having co-written a few EHR-related grant proposals with a PI associated with major academic medical center, that may or may not get funded. As I sometimes write, "I report, you decide."
Reading a news article by Mr O'Harrow does not qualify as due diligence.
That patronizing statement assumed that reading the WaPo was all I and my like-minded colleagues based our concerns on, of course.
"Strung up by the toes" is, of course, used figuratively in the comment above.
>>> Leavitt claims that CCHIT is independent of HIMSS.
Great points anonymous # 2!
CCHIT's far from being independent. For one, Histalk noted a few months ago that HIMSS/CCHIT share the same physical building in Chicago. Dr. Leavitt's salary supposedly comes from HIMSS.
The NJ bill has been shelved and not acted upon by the NJ legislature.
On the NJ Bill listing, all that is seen for Bill A4062 is: "6/8/2009 Introduced, Referred to Assembly Health and Senior Services Committee"
To get at it, you have go to this list here- http://www.njleg.state.nj.us/bills/BillsBySponsor.asp, type in "Conaway", then among the 191 bills, select the A4062.
Two things helped kill the bill:
-- The fact that the HHS finally threw the Sherman Antitrust Act busting CCHIT "under the bus" on 7/16/2009 leaving CCHIT's future murkey in 2010 and beyond as EMR vendors will flock to the new ONC certification.
-- The bad press that started all over the 'net with nothing but the bad facts about this bill and its main sponsor, Assemblyman Conaway, who had HIMSS associations and had received corporate lobbying money.
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