Note: Also see the followup Sept. 5, 2012 post "Was EPIC successful in watering down the Meaningful Use Stage 2 Final Rule?" at http://hcrenewal.blogspot.com/2012/09/from-what-i-can-tell-epic-was.html.
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From the Histalk blog in the 8/31/12 news at this link:
Epic not only submitted MU Stage 2 comments to ONC, it even helpfully distributed them to their customers so they could submit the same comments under their own names. David Clunie noticed this and lists the hospitals who sent in the boilerplate, including University of Miami, which submitted the same comments five times without noticing the “Remove Before Submitting” headline that prefaced Epic’s explanation of why its customers should share its opinions with Uncle Sam.
From the primary source linked in the Histalk note:
Epic via University of Michigan Health System Meaningful Use Workgroup also the same Epic comments from University of Miami (who liked them so much they submitted it twice and then a third time and then a fourth and fifth time) and again from the Martin Health System and Metro Health Hospital and The Methodist Hospitals and Fairview Health Services and Sutter Health and Parkview Health System and the Everett Clinic and Dayton Childrens' and UMDNJ and NYU Langone Medical Center and Hawaii Pacific Health and finally as submitted by Epic themselves - others like the Community Health Network just stated they had read and agreed with Epic's comments - Imaging - concur that DICOM is not needed for that objective and PACS images do not need to be duplicated - concerned about single sign on if two systems - View, Download and Transmit to 3rd Party - images are not in the EHR but the PACS - patients would need DICOM viewers - size of the images is a problem - disks are better (also if you look at some copies of this, there are some pretty funny "remove before submitting to ONC" notes that say things like which versions support what and how much it would cost to retrofit, etc.; how embarrassing, both for Epic and their lackeys at these institutions)
I certainly admire David Clunie's endurance at being able to slog through all of that and appreciate his shedding some sunlight on the "remove before submitting" notes, but - I don't think it's funny at all.
Among other things, it represents taint of the submissions via ghostwriters (unattributed authors) with obvious conflicts of interests, topics often addressed at HC Renewal.
Here's an example I verified, the submission to the government from Dayton Children's Hospital:
 | |||||
| "Informational Comments for Organizations Using EPIC (remove before submitting to ONC)" - click to enlarge. At least here they say they are "in total agreement" with EPIC's concerns and recommendations. |
Another example - University of Miami:
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| A danger of dealing with incompetents: they neglect to tidy up for you - click to enlarge. (Corollary question: note the line "Our [Epic's - ed.] comments stem from the fact the we believe ..." So - what opinions belong to the 'public commenting organization', and which to the company? Likely the whole thing belongs to the latter's ghostwriters, but can anyone really tell? That's the problem with tainted submissions.) |
Others is the links above I checked such as Martin and Methodist have the same boilerplate about the "chart search feature." Some retain the "reminder" to remove; in others it has been erased. However, the boilerplate remains.
I actually find the "advice" from EPIC in the latter document stunning regarding a "chart search feature" (e.g., search note text, and probably also ad hoc clinical searches such as 'find my patients whose blood sugars have been > 100 in the past month'). These are "features" critical to quality care that should have been present decades ago ** [see note below]. Emphasis mine:
... Focus certification on the minimum floor set of capabilities required to complete meaningful use objectives.
Is this a tacit admission "certification" is a sham? Is this in patients' best interests?
and
Informational Comments for Organizations Using Epic (remove before submitting to ONC)
We’ve heard your requests for a chart search feature, and our desire to see this certification criterion removed does not mean we don’t want to develop such a feature. In a future version of Epic, we want to develop the best possible chart search feature based on your input. However, if this criterion stays in the Final Rule, we worry we’ll have to divert attention from future chart search features you’ve requested to focus on a simplified, less valuable version of the feature to meet certification.
In my opinion, this translates to: "we are already overextended, so help us stymie the experts' and government's efforts to make it a criteria for certification, and to hell with your doctors and nurses who need a search feature right now."
Can you imagine in 2012 a word processor, database or operating system without a search feature? That's the kind of antediluvian IT the clinicians have to put up with. And this industry speaks of "innovation?"
It would come as no surprise - to me, at least - if other health IT sellers were engaged in similar activities.
I am unable to judge whether stealth lobbying by sellers using their clients, which enables the sellers to then line their pockets through favorable government legislation based on echoed comments of clients, is legal or ethical. My belief, however, is that it is at best a questionable practice. It is certainly inherently unfair e.g., anti-competitive in regard to smaller health IT companies who might be able to meet more stringent MU2 certification criteria, and unfair to private citizens who have no such captive mouthpieces at their beck and call.
While perhaps not as bad as possible 'Combination in Restraint of Trade' as in my April 2010 post "Healthcare IT Corporate Ethics 101" (link), this situation should probably be brought to the attention of health IT watchdogs such as Sen. Grassley.
This May 2012 post might also be of interest: Did EPIC CEO Judy Faulkner of Epic declare that 'healthcare IT usability would be part of certification over her dead body'? ONC never responded to the questions I raised in the post.
Another question: why did ONC apparently turn a blind eye towards these "accidental inclusions"?
Yet another question: is the MU2 Final Rule invalid due to the influence the industry clearly had on the submitted "public" comments, which can now reasonably be viewed as tainted?
-- SS
Addendum:
I've informed the Senator via his email and staff voicemail lines. I've also created a short URL to more conveniently access this post: http://www.tinyurl.com/epic-stealth
Also see the followup Sept. 5, 2012 post "Was EPIC successful in watering down the Meaningful Use Stage 2 Final Rule?" at http://hcrenewal.blogspot.com/2012/09/from-what-i-can-tell-epic-was.html.
-- SS
Note:
** For instance, I had implemented a robust search feature of clinical notes, all comment fields and the comprehensive clinical, genetic and genealogical dataset in the Yale-Saudi Clinical Genetics EHR - in 1995.
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