CMS and ONC eye agile, lean tactics to improve Stage 3

By Tom Sullivan
09:14 AM

Now is the time for ONC to reflect on what the office has done in terms of developing quality measures during the first two stages of meaningful use and, naturally, how it can improve moving forward.

That was the assertion put forth by Kevin Larsen, MD, medical director of meaningful use at ONC, near the end of Wednesday’s HIT Policy Committee meeting.

“We have heard from the vendors and the community that our measures could use improvement,” Larsen said. “This was an innovative process from the beginning.”

Which is why ONC is employing cutting-edge practices to clinical quality measure development for Stage 3 meaningful use — such as agile and lean development — both of which manifested out of the HHS Innovation Fellows work.

Describing lean as both process improvement and culture change that “really removes the waste out of your system,” Mindy Hangsleben, an External Fellow and Innovator in the Lean Methodology, said that among the first strategies was the Kaizen event last week involving EHR vendors, contractors, federal representatives, developers, testers, the National Quality Forum and the Office of Management and Budget.

“It was really an unbelievable commitment from a quite large number of people to make this process work so we become more efficient with a better quality product at the end,” said Kate Goodrich, MD, MHS, senior advisor in the office of clinical standards and quality at CMS.

That began with defining what CMS and ONC wanted to lean out in the measure development lifecycle, which Goodrich described as “quite broad, quite long,” in that it currently spans three to five years.

[Related: ONC standards committee urges Stage 3 menu options in lieu of core]

“So we decided we want that to be one year or less,” Goodrich said. “The first pieces of work we’re going to tackle [is] the measure concept phase where we’re putting together contracts to develop measures. And that would go through measure implementation, which we define as implementing a measure into a rule.”

Getting measures that matter into the program in a reasonable timeframe is a vision the group has had for some time, Larsen said, rather than waiting five years from a goal’s inception to having a care coordination measure specified and ready.

“We’re really applying some agile techniques, we’re using a software frame around our measures, and taking software best practices, early testing with EHR vendor partners at clinical sites, and putting that into this new way to develop measures, so that the measures we have work, and they work quickly in the places that we need them,” Larsen said.

ONC this week already started changing some processes, including discussions with vendors about how they can use data elements in the very early stages of measures, Larsen added.

“We anticipate even within the course of this year we will have shaved a lot of cycle time off of measure development and are hoping that the measures we’re getting ready for MU 3 will be of higher quality, delivered more quickly and better-tested than the ones we’ve done” for Stage 1 and 2, Larsen continued. “We absolutely plan to have a better product for the MU3 timeframe.” 

Officials on the call also noted that CMS and ONC will employ some of the tactics beyond the meaningful use program.

“I was tasked to work with CMS and ONC to really lean out the clinical quality measures,” External Fellow Hangsleben explained, “and actually to integrate lean into the culture of ONC and CMS.”


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