Can Japanese business wisdom improve U.S. EHR certification?

By Diana Manos
08:08 AM
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The question started bubbling up during health IT policy talks last month, and reemerged this week: Could a Kaizen study of certification — an end-to-end analysis — reveal what has been lacking so far? Can the bringing together of every stakeholder into a grand discussion of what needs improvement, actually generate that improvement?

The Health IT Policy Committee sees enough potential, in fact, that this week it voted unanimously to approve a recommendation for ONC to hold a kaizen review of the entire end-to-end certification process.

A Sino-Japanese word, Kaizen, according to multiple reference sources, means "continuous improvement." The term refers to any change, one-time or continuous, large or small, and it is frequently used to describe industrial or business improvement techniques.

ONC has engaged Kaizen before

Kaizen is also considered akin to agile or lean business tactics and, in fact, ONC has deployed them before for clinical quality measure development for Stage 3 meaningful use, and with success enough to streamline that process from as long as five years per measure down to one year or less.

As HIT Policy Committee panel members envisioned it, a kaizen would involve gathering representatives from policymakers, certification bodies, vendors, providers, privacy advocates and others related to the process to create a total understanding of how meaningful use certified products work and affect the achievement of meaningful use.

[See also: Data, it's like oxygen for interoperability.]

The Kaizen technique could help ONC make the certification process more limited in scope.

Indeed, some members of the group said certification should be limited to a "critical few" elements, which these members named as: interoperability; the "right" clinical quality measures; and privacy and security. The majority, however said the scope should be limited, but not necessarily to just these three areas.

Earlier this year, due to a barrage of industry complaints over Stage 2 requirements along with vendor difficulty preparing the technology on a stunted timeline, ONC was forced to extend the exception policy to allow for vendor delays in meaningful use Stage 2.

More recently, ONC is considering adding some leeway to the requirements, and will make that decision based on public comments from a proposed changes on May 20 and from an all-day ONC certification hearing May 7, with testimony given by panels of providers, vendors, certification bodies and others from the private sector.

Certification workgroup looks to the future

The purpose of the hearing was to find what was working and what certification challenges had developed under Stages 1 and 2.

"It was a learning experience, said Paul Tang, chair of the certification hearing and of the meaningful use workgroup. "Often times we might meet certification criteria, but it might interrupt workflow. Intent is not met, but the letter of the law is met."

The certification workgroup would like to see ONC increase collaboration between the federal government and the private sector when it comes to certification, creating a sort of "policymaking interoperability," Tang said, as he presented the certification workgroup's ideas to the larger advisory panel.

Most of what Tang proposed went over well.

The HIT Policy Committee endorsed the Kaizen process, in fact, but they said the kaizen could not take the place of decisions the federal advisory committee should make.

Rather, it should only be used as a learning tool -- a continuous one.

See also:

Update: CMS, ONC ease EHR certification requirements for MU

EHR certification: Where to steer from here?