What is Kaizen?
Kaizen, or continuous improvement, is a long-term approach to work that systematically seeks to achieve incremental changes in order to improve efficiency and quality. It focuses on removing process waste and maximizing value to the customer (in this case the patient).
Who participates in Kaizen?
Kaizen involves stakeholders from multiple organizations and functions working together to address a problem or improve a process.
What happens during a Kaizen event?
During a Kaizen event (a multi-day, in-person meeting), participants:
- Map out the current process
- Identify waste in the current process
- Create a future state of the process
- Develop success indicators
- Build out a project roadmap for implementation
What happens after a Kaizen event?
After the in-person convening, individual workgroups on key issues related to eCQM development and implementation identify and conduct activities designed to push the field closer to the future state. Activities may include developing solutions to reducing waste or improving the quality of current processes, preparing guidance or explanations of best practices, or organizing technical assistance for other stakeholders.
Why did CMS and ONC choose to use the Kaizen approach for eCQMs?
- Importance: eCQMs are used by CMS to monitor the success of healthcare delivery programs and are directly tied to payment, quality improvement, and public reporting.
- Deficiencies: There was a high defect rate in released eCQMs.
- Variation: The eCQM development process varies widely. By standardizing the way eCQMs are developed, the likelihood of downstream defects and rework is decreased.
- Automation: The future of quality measurement is electronic as the country adopts Health Information Technology (HIT), and processes need to adapt to this new reality.
Who participated in the CMS and ONC eCQM Kaizens?
Federal agencies and measure stewards (e.g., CMS, ONC, NLM, AHRQ, HRSA, and SAMHSA); health care organization representatives (e.g., providers, quality officials, and IT staff); health IT vendors (e.g., EHR vendors and quality improvement system developers); measure developers (e.g., AMA, NCQA, The Joint Commission, and Mathematica), professional societies (e.g., AHA), federal contractors (e.g., MITRE), consensus-based organizations (e.g., NQF), quality improvement organizations, health information exchange representatives, and many other stakeholders.
What were some of the topics tackled at recent Kaizens?
- Annual Updates
- Communication Education & Outreach
- Data Processing/Re-Use
- Electronic Health Record Certification
- Future Standards & Timelines
- Harmonized Implementation of Standards
- Implementation Workflows
- Logic Harmonization
- Measure Authoring Tool/Unit Testing
- Measure Updates
- National Test Collaborative
- Value Set Authority Center (VSAC) Harmonization
- Value Set Versioning
What were some of the common themes identified?
- Important to have more upfront and ongoing stakeholder engagement and transparency
- Benefits of streamlined communications and governance
- Need “One Stop Shop” for documentations (i.e., single authoritative source)
- Essential to harmonize and align programs
- Support for earlier and non-traditional testing methodologies
- Variation and lack of standardization across processes
What are some of the outcomes from recent CMS/ONC Kaizens?
- Adjusted electronic reporting of eCQMs to CY (Calendar Year) for EH/CAHs
- Aligned communications across support contracts
- Coordinated publishing of EH and EP eCQM Annual Measure Updates
- Consolidated to one implementation guide (IG) for all CMS eCQM programs
- Established change control board with ONC/CMS
- Developed input process for Cypress update and versioning
- Integrated Measure Authoring Tool (MAT) and Bonnie testing tool
- Increased transparency of Measures Under Consideration and added ability to provide comments
Where can I read about the proposed process changes and next steps from Kaizens?
Files with more information about process changes:
- eCQM Kaizen Results - September 8, 2014
- eCQM Kaizen Summary - September 9, 2013
- Summary of eCQM & CDS Kaizen - February 10, 2014
- Summary of eCQM3 Kaizen - December 8, 2014
- Certification Workgroup History and Background - September 19, 2016
- Implementation Workflow Workgroup History and Background - September 19, 2016
- National Testing Collaborative Workgroup History and Background - September 19, 2016
- Standards and Tools Lean Workgroup History and Background - September 19, 2016
- Value Set Impact Workgroup History and Background - September 19, 2016
- Kaizen Annual Updates Workgroup History and Background - October 4, 2016
- Communication Education and Outreach Workgroup History and Background - December 9, 2016