DRAFT

Stage 3 Update

Paul Tang, ChairGeorge Hripcsak, Co-Chair

Meaningful Use Workgroup

August 16, 2013

DRAFT

August 7 HITPC Meeting

High-level summary of feedback received from HITPC:

Core Comment Areas Feedback

Focus on Outcomes Connect MU3 objectives with outcomes

Deeming Positive; review eCQM pipeline and recommendations of QM/ACO TT

DRAFT

Functional Objective Feedback

• Stage 3 should clearly signal outcomes– Tie MU3 objectives to outcomes measures– Link to HHS quality strategy (e.g., NQS, Million

Hearts)– Link to future payment models (e.g., accountable

care organizations)– Consider shifting structure of recommendations to

focus on outcomes• The use of certification-only criteria should be

strategically limited

DRAFT

Deeming Feedback

• Deeming concept focuses on achieving good outcomes

• Appreciate the flexibility of this alternative pathway

• Need outcomes-oriented eCQMs• Must all the data measures come from the

EHR? What about claims data?

DRAFT

Next Steps

• Address HITPC concerns• Provide framework recommendations– Present high level outcomes-driven framework to

HITPC at September Meeting– Follow up in Oct or Nov with more detailed

recommendations (QM/ACO TT in Oct)

DRAFT

Recommendations for Presentation to HITPC in September 2013

DRAFT

Core Recommendations

1. Focus on health and care outcomes2. Use eCQMs to measure identified

care outcomes3. Incorporate functional deeming as an option

for MU3 compliance

DRAFT

Recommendation 1: Focus on initiatives that help improve care outcomes

DRAFT

Moving towards outcomes for MU3

MU3

Improved Quality of Care

Healthier Living / Disease

Prevention

Improved Safety

Increased Patient Engagement

Improved Care Coordination

Accessible and Affordable

Care

DRAFT

MU Categories Derived from National Priorities Partnership Goals

Work with communities to promote wide use of best practices to enable health living and well-being

Improved Quality of Care / Healthier Living

Promote the most effective prevention, treatment, and intervention practices for the leading causes of

mortality, starting with cardiovascular disease

Healthier Living & Disease Prevention

Ensure person- and family-centered care Increased Patient Engagement

Make care safer Improved Safety

Promote effective communication and care coordination

Improved Care Coordination

Make quality care affordable for people, families, employers, and governments

Accessible and Affordable Care

National Priorities Partnership Goals

MU3 Care Outcomes Align with NPP

DRAFT

Care Outcome: Improved Quality of Care

Stage One

• CPOE• Initial CDS• Patient lists• Problem lists• Meds lists• Medication

allergies • Drug-allergy

checks• Vitals• Lab results• Smoking• eRx• Patient reminders

Stage Two

• CPOE+• CDS+• Patient lists+• Imaging• Hospital labs• Progress notes

Stage Three Recommendation

• CDS++• Real-time dynamic

dashboards (for clinical and population health management)

• Advanced CDS interventions (e.g., chronic disease management, test ordering, prevention, accuracy of lists)

• Medication adherence• Order tracking (e.g., closing

the loop)

DRAFT

Care Outcome: Healthier Living & Disease Prevention

Stage One

• Immunization• PH reporting• Patient

education

Stage Two

• CDS+• Cancer registry• Family history• Electronic lab

reporting

Stage Three Recommendation

• CDS interventions that use family history

• CDS interventions to manage chronic conditions

DRAFT

Care Outcome: Increased Patient Engagement

Stage One

• Clinical summary

• Online access• Patient

education

Stage Two

• View, download, transmit

• Secure messaging

Stage Three Recommendation

• Patient generated health data

• Communication preferences• Amendments

DRAFT

Care Outcome: Improved Safety

Stage One

• CPOE• CDS• eRx• Medication

allergies• Medication

reconciliation

Stage Two

• CPOE+• CDS+• eMAR

Stage Three Recommendation

• CDS++• Use of Common Formats

(e.g., adverse event reports, healthcare associated infections)

DRAFT

Care Outcome: Improved Care Coordination

Stage One

• Summary of care

Stage Two Stage Three Recommendation

• Health event notification (e.g., ED visit, admission to hospital)

• Close the referral loop

DRAFT

Care Outcome: Accessible and Affordable Care for All

Stage One

• Race• Ethnicity• Language• Formulary

checks

Stage Two Stage Three Recommendation

• Capture of additional information– Occupation– Sexual orientation and gender

identity– Veteran status

• Capture FDA Unique Device Identifier (UDI)

DRAFT

Recommendation 2: Use eCQMs to Measure Identified Care Outcomes

DRAFT

Core Recommendation 2Use CQMs to Measure Outcomes

Improved Quality of Care

• CV Risks• Blood Pressure

Control• LDL Control

Healthier Living/Disease Prevention

• Immunization (i.e., flu, pneumonia, childhood vaccinations)

• Cancer Screening (i.e., colon, prostate, cervical)

Improved Safety

• Falls• Pressure Ulcer• HAI• Morphine

Equivalent• “Never Give

Together”• Time in

Therapeutic Range for Warfrin

Outcomes

Proposed eCQMs

DRAFT

Core Recommendation 2Use CQMs to Measure Outcomes

Increased Patient Engagement

• Knee• Hip• Heart Failure

(functional status)

Improved Care Coordination

• Close the referral loop

• Reciprocal referrals

• Care transitions for hospitals

• Readmissions

Accessible and Affordable Care

• Choosing Wisely• Do not overtreat

A1C• Reduce CT scans

for headache• ED throughput• MRI back pain• Radiation dosing• Adherence

(reference CBO)

Health Improvement Outcomes

Proposed eCQMs

DRAFT

Recommendation 3: Implement Deeming Pathway

21DRAFT

Recommendations on Functional Deeming

• Providers who have already met all functional objectives in stages 1 and 2 should be allowed to “deem”

• Deeming allows high MU performers (or significant improvers) to attest for MU by satisfying a subset of MU objectives; this would be an optional pathway to achieve MU

• “Deeming” promotes innovation, reduces burden, and rewards good performance

• CMS should survey the landscape for available eCQMs that are outcomes-oriented and consider their use as deeming measures; in addition, new development of eCQMs may be necessary

22DRAFT

Next Steps

• Approve outcomes framework for MU stage 3• MU WG to review objectives for alignment

with outcomes framework• Receive input on eCQMs from QM/ACO TT

(Oct)• Present additional recommendations to HITPC

in Nov