Healthcare executives are all too familiar with healthcare conferences—usually two- or three-day events with the same types of people discussing the same types of problems. The Centers for Disease Control and Prevention (CDC) proposed a different approach to the Adapting Clinical Guidelines for the Digital Age meeting held in Atlanta in February 2018.
The meeting brought together a diverse base of over 200 stakeholders representing over 40 institutions across the country that included science experts, informaticians, health IT standards experts, clinicians, software engineers, communicators, and program evaluators from both inside and outside CDC to explore ways to help clinicians and patients adhere to clinical guidelines.
Apervita’s Chief Informatics and Innovation Officer Blackford Middleton, M.D., MPH, MSc, attended and presented at the meeting, which focused on technologies to improve care and outcomes by ensuring clinical guidelines aren’t just evidence-based, but are actually put into practice.
“Guidelines need to be crafted in a way that makes them ready for computer implementation,” Dr. Middleton said. “That means disambiguating logic, understanding data requirements explicitly, and thinking about insertion points and methods to return guideline-based insights into the clinical workflow.”
Maria Michaels, a public health advisor at CDC who spearheaded the forum, engaged colleagues at CDC and outside the agency to try the “Kaizen” method for the meeting, which aimed to get a better understanding of how potential changes to clinical guideline translation might impact clinicians, electronic health record vendors, clinical decision support developers, public health partners, CDC programs and more, according to the CDC.
“Kaizen” is a Japanese word that means “continuous improvement” or “change for the better,” according to the CDC.
Kaizen focuses on continuous improvement by bringing together stakeholders to gather individual perspectives and experiences so that improvements can be made to a specific area of focus in a process.
Kaizen is a long-term approach that works to systematically achieve incremental changes to improve efficiency and quality by removing process waste and maximizing patient value.
“Kaizen is a good tool for complex problems involving a lot of stakeholders that are hard to solve in piecemeal way,” Michaels said. “Electronic clinical quality measures (eCQMs), which also used Kaizen via the Centers for Medicare and Medicaid Services (CMS), are similarly complex and take a lot of different perspectives to get right.” Michaels previously served as policy and operations lead for eCQMs at CMS.
The objective of a Kaizen event is to seek individual perspectives and experiences with current approaches, not to come to group consensus. The meeting, which was open to the public, included stakeholders such as guideline authors, health IT developers, clinicians, patients/patient advocates, medical societies, public health organizations, clinical decision support developers and clinical quality measure developers.
“Previous efforts around clinical decision support have been focused downstream in the process around standards and data models related to CDS and guidelines,” Michaels said. “We haven’t taken it upstream where the source of the challenges start—the guidelines. If we can develop guidelines in a more computable fashion form the start, then all the standards we’ve been working so hard on all these years become more useful.”
The group developed key recommendations around how to improve the uptake of guidelines:
- There’s an urgent need to remove siloes and variability as much as possible across CDC’s programs, and eventually across all guideline developing organizations
- Standardized, centralized modalities are needed to disseminate guidelines
- Guidelines should be disseminated in more structured and actionable formats
- Implementation must be standardized at the local level so it can be the same across organizations
- Evaluation should be planned at the outset of creating new or updated guidelines and evaluation should be embedded throughout the entire process, monitoring the effectiveness of guidelines and creating feedback loops back to the guideline authors to help evolve the science as the evidence changes
- A core team with all related expertise (scientific, informatics, communications, implementation, and evaluation) is needed up front and throughout the process
“The Kaizen process helps to consider all of the steps in knowledge translation and specification to make guidelines ready for computer implementation,” Dr. Middleton said.