HITPC votes to streamline certification process
About one month after providers, vendors, accreditors and private sector representatives scrutinized the EHR certification program as overly prescriptive during an all-day hearing, the Health IT Policy Committee formally recommended a multi-stakeholder “kaizen” meeting to help streamline the certification process.
After some contentious debate, however, a second proposal to limit the scope of certification to interoperability, clinical quality measures and privacy and security was not approved. Instead, the committee voted to recommend that the Office of the National Coordinator for Health IT (ONC) look into limiting the scope of the program in a general sense.
Adoption & Certification Workgroup vice chair Paul Tang, MD, MS, vice president and chief innovation and technology officer at the Palo Alto Medical Foundation, spent some time reviewing findings from the hearing last month. Among many other comments, stakeholders told the workgroup that the scope, compressed timeframe and resource needs of EHR certification hindered their ability to delivery care and innovate. Many also called for a kaizen process, in which all affected stakeholders would meet to undertake a holistic, end-to-end look at the process of certification to cut out waste and inefficiencies.
“This is an area where there is an opportunity for improvement,” said National Health IT Coordinator Karen DeSalvo, MD, MPH, MSc, speaking on why ONC is looking to retool certification. She said she would get back to the committee on how long setting up a kaizen process would take. “The notion of creating a culture of continuous improvement is a high priority for us.”
Some areas that could use improvement include the development of testing procedures, said Jacob Reider, MD, chief medical officer at ONC. “Many test procedures are more prescriptive than they need to be. It’s a difficult balance; the more prescriptive they are, the easier it is for labs to test them. If they are not prescriptive, the lab gets confused because it’s a pass or fail test, like taking a driver’s test when you’re 16. We think there is a happy medium.”
Some committee members applauded upcoming changes to the certification program and the focus on continuous improvement. “I don’t think we’re extremely distressed about the process. I like the direction we are heading, to better coordination between the public and private sectors, and focus on end-to-end design and privacy and security. Continuous improvement is a good direction,” weighed in Neal Patterson, CEO of Cerner.
However, others, like Chris Lehmann, MD, professor of pediatrics and biomedical informatics at Vanderbilt University, said he was concerned about “weakening” the certification process, and felt that the functionality of systems needs to be protected.
Christine Bechtel, an advisor at the National Partnership for Women & Families, spoke out against limiting the certification focus. “I don’t understand what it would mean to limit the scope from all sides other than to reduce burden. I would propose that discussion would really be part of the kaizen process.”
She also expressed general concern about weakening certification, and how Meaningful Use objectives would develop if not linked to certification criteria. Tang replied that the MU program is moving to an approach in which clinical quality measures drive functionality more than certification--which he emphasized was the original vision to begin with.