HIT Policy CommitteeHIT Policy Committee

Review of Meaningful Use Core Objectives and Existing Measures – Relevance to Specialty and Small Practices and Small Hospitals

Paul TangPalo Alto Medical Foundation

George HripcsakColumbia University

October 27, 2009

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Workgroup Members

Co-Chairs:• Paul Tang, Palo Alto Medical Foundation• George Hripcsak, Columbia University

Members:• David Bates, Brigham & Women’s Hospital• Christine Bechtel, National Partnership for Women & Families• Neil Calman, The Institute for Family Health• Art Davidson, Denver Public Health Department• David Lansky, Pacific Business Group on Health• Deven McGraw, Center for Democracy & Technology• Latanya Sweeney, Carnegie Mellon University• Charlene Underwood, Siemens

ONC Lead:• John Glaser

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Approximate Timeline

• 4Q09/1Q10: Conduct informational hearings to inform 2013 and 2015 criteria development

• 2Q10: Work with HIT Standards Committee to ascertain availability of relevant standards

• Mid-2010: Refine 2013 meaningful use criteria

• 4Q10: Assess industry preparedness for meeting 2011 and initial 2013 meaningful use criteria

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Rationale

• Not all objectives and measures appropriate for all eligible professionals

• How to decide, specify, and maintain mapping

Groups of professionals

Eligible professionals

Objectives & measures

Groups of measures

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Organizing Principles

• Eligible Professionals– Profession: MD, DO, DDS, DMD, nurse mid-wife, NP, PA, etc.

(Medicare vs Medicaid)– Role: Primary Care, Specialty

• Objectives and Measures– Process, Quality, Efficiency– Prevention, etc.

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Process

• Early MU Emphasis on Primary Care– Key role of primary care– Fewer specialty measures available– Number and complexity of specialties

• Begin with a Simple Framework

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Framework

• Core measures – all providers– use CPOE for all orders (process)– avoid use of high-risk medications in the elderly (quality)– percent of patient encounters with insurance eligibility confirmed

(efficiency)

• Adult primary care measures– report percent of diabetics with A1c under control

• Pediatric primary care measures– report up-to-date status for childhood immunizations

• Specialty measures– cross all specialties: closing the loop on referrals– specialty-specific measures

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Who is Primary Care?

• Family medicine

• All or some of internal medicine

• Other professions

• Specialties like obstetrics and gynecology?– Serve as many patients’ sole provider– Preventive care versus treatment

• Role: specific to profession, professional, or patient?

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Issues in Grouping Measures

• Adult & pediatric, Male & female, Cancer survivor, …– Stay simple, use denominator to differentiate

• Self-Selected Quality Measures– Select and track a quality measure for your specialty

• Use of Registries

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Hospitals

• At present, all hospitals responsible for all objectives and measures

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Plan

• Edit the framework based on upcoming testimony

• Create a matrix that maps objectives and measures to professionals

• Circulate back for feedback

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QUESTIONS AND DISCUSSION