Project Summary

The Office of the National Coordinator for Health Information Technology in partnership with the Centers for Medicare & Medicaid Services are testing & accelerating the development of clinical quality measures, with the adoption of Lean methodologies, to monitor the impact of the implementation of the HITECH Act & the Affordable Care Act.

Project Team

Internal Entrepreneurs
Farzad Mostashair, ONC
Jacob Reider, ONC
Kevin Larsen, ONC

External Entrepreneur
Mindy Hangsleben
Amy Sherwood


Project Details

The delivery and payment reform provisions of the Affordable Care Act are transitioning the Centers for Medicare and Medicaid Services to value based reimbursement in an effort to achieve the three-part aim of better care and health while reducing costs through improvement.  Clinical quality measures help the Department of Health and Human Services (HHS) understand the impact of its programs and policies and to plan target areas of future focus. HHS is investing electronic health record (EHR) deployment and use in the U.S. With this transition, there is considerable interest and promise in transitioning the clinical quality measures from predominantly pre-EHR measures to leverage the enhanced information found in EHRs.  Clinical quality measures are created in a production system- a series of experts following predictable steps with hand offs and dependencies. Currently the creation of a clinical quality measure from identification of a high priority health topic to deployment is a 3 to 5 year process.

One of the most successful tools from manufacturing industries to achieve improved efficiencies is the Lean Production System. Lean has also become a key tool for quality improvement in health care delivery. Lean is way of analyzing and organizing complex processes with many steps and people involved in a process- especially a production process.  Mindy Hangsleben and Amy Sherwood, External Entrepreneurs are leading a value stream analysis of the clinical quality e-measure production and is guiding the Office of the National Coordinator for Health IT (ONC) and CMS through the work of improving efficiency of the production of quality measures.  They have also held a number of Lean focused workshops to train internal staff on lean methodologies, making experts out of a handful of ONC and CMS employees, including Internal Entrepreneur Kevin Larsen.


HHS Entrepreneurs is one of our in-residence pathways that is bringing new talent into government. HHS Entrepreneurs pairs HHS employees with external expertise to work on an identified problem for a 12 month period. This project is one of five projects from the first cohort of HHS Entrepreneurs. Learn more about HHS Entrepreneurs.